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Final-New Material-Rachael Flashcards

1
Q

Androgens

A
  • androstenedione, DHEA, testrosterone, DHT
    • Listed in order of potency
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2
Q

Estrogens and Progestogens

A
  • estrone, estriole, beta-estradiol (“estrogen”)
  • Progesterone
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3
Q

Hormone Signaling

A
  • Non-polar hormones: secretion stimulated by stimulating enzymatic reactions
    • Hormone bound to proteins in circulation
    • Modification by enzymes in target cells
      • Testosterone→dihydrotestosterone (DHT), more potent
        • Enzyme: 5-alpha-reductase
      • Androgens→estrogens
        • Enzyme: aromatase
    • Enzymes can be drug targets
    • Free hormones diffuses across plasma membrane of target cell
    • Signaling via intracellular receptors that act as transcription factors
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4
Q

Hormone Feedback Cycle

A
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5
Q

Gametes Form by Meiosis

A
  • Germ-cell: gametes and the gamete precursors
  • 23 pairs of homologous chromosomes; 22 autosomes; 2 sex chromosomes
  • Haploid cell has 23 single chromosomes
  • In 1st division, the homologous chromosome pair up.
    • Then they divide
    • Crossing-over; recombination; variability
    • Independent assortment; some of maternal and paternal end up dividing together
  • In 2nd division, the chromatids divide up
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6
Q

Nondisjunction lead to aneuploidy

A
  • At first division: 2 of four have n-1, 2 of four have n+1
  • At second division: 2 of four are normal, 1 n+1, 1 n-1
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7
Q

Karyotype via amniocentesis or chorionic villus sampling and Cell Free DNA sampling

A
  • Fetal cells: invasive: miscarriage or infection
  • Placenta has fetal and maternal cells
    • Branching is chorionic plate
    • Protrudes into space created in endometrial spaceàmaternal blood flow
  • Cell-free fetal DNA analysis:
    • Small fragments of DNA enter the maternal circulation
    • Early, non-invasive, blood draw
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8
Q

Hormone regulation: pulsatile secretion of GnRH

A
  • GnRH in the hypothalamus
  • Anterior pituitary: gonadotropins
    • Follicle stimulating hormone (FSH)
    • Luteinizing hormone (LH)
    • Negative feedback regulation by gonadal steroids
    • *Some positive feedback occurs in female
  • Gonadotropin (FSH, LH) secretion is stimulated by pulsatile GnRH, inhibited by continuous GnRH
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9
Q

Review of Pituitary Hormones

A
  • 3 hormone chain of command
  • Magnocellular vs. parvocellular cell
  • Magnocellular release to posterior pituitary
  • Parvocellular release to median eminence, delivered directly to anterior pituitary (adenhypophesis)
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10
Q

Continuous Treatment with GnRH

A
  • Continuous treatment with GnRH agonist (eg. Leuprolide) used to turn off reproductive function
  • Precocious puberty
  • Androgen deprivation therapy for prostate cancer
    • Decreased secretion of testosterone
  • Used in treatment of prostate cancer, endometriosis, precocious puberty
  • Cycle control for IVF
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11
Q

Chronology of reproductive function

A
  • GnRH secretion is high during sexual differentiation, low during childhood, and high after puberty
  • Sexual differentiation is before birth
  • Gonadal steroid secretion during lifetime in females and males
    • Females spike up and down; drops in menopause (estrogen, progesterone)
      • Early menopause: look for increase FSH, would occur because of removal of negative feedback inhibition
    • Males spike and then slowly decrease with age
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12
Q

Leptin and GnRH

A
  • Leptin is part of a negative feedback loop to control adiposity
  • Need leptin to allow GnRH level to increase
  • The obese mutant mouse fails to make leptin and suffers from hypogonadotropic hypogonadism
  • Leptin is permissive for GnRH secretion
    • In abscence, no GnRH, low FSH and LH, decreased gonadal function, infertility
    • Doesn’t cause start of period: other factors turning on
    • At certain level of leptin, factors more likely to turn on
      • Leptin, environmental estrogens
  • Hypoleptinemia in women
    • Low body fat, low leptin secretion, amenorrhea
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13
Q

Male Reproductive Anatomy

A
  • Sperm develop in seminiferous tubules→epididymis→ductus deferens (vas deferens)→ejaculatory duct→urethra
  • Semen: spermatozoa plus seminal fluid
  • Seminal fluid made by accessory glands:
    • Bulbourethral glands: make least amount of stuff neutralizes traces of urine
    • Prostate gland (1)
    • Seminal vesicle (2)
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14
Q

Benign Prostatic Hypertrophy (BPH)

A
  • Causes urinary symptoms
  • Symptoms in 1/3 men over 50
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15
Q

BPH Drugs

A
  • Alpha adrenergic antagonists: Tamsulosin (Flomax)
    • Relax smooth muscle in urethra
    • Really specific for alpha receptors in the urethra and less likely to bind other subtypes-Not have to worry about blood pressure effects as much
  • 5-alpha reductase inhibitors
    • Dutasteride, finasteride
    • Prostate heavily influenced by DHT
    • Prevent testosterone to DHT
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16
Q

Prostate Cancer

A
  • Tends to be very slow growing
  • Incidence and mortality of prostate cancer: effect of increased screening with PSA test
    • Not specific to cancer because BPH also tests positive
    • Lots of cancer diagnosis, over diagnosis
      • Mortality didn’t actually go down
    • Early screening has no benefit on cancer mortality rate
  • Best option in most cases is to leave it alone
    • Treatment increases morbidity and side effects
    • Urinary, defecation, etc. can be messed up
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17
Q

Spermatogenesis

A
  • Differentiation from spermatid to spermatozoon
  • Head of sperm:
    • Nucleus
    • Vesicle called the acrosome
      • Contains digestive enzymes
      • Important in fertilization
  • Sperm made: 100 Million per day, 1000 per second
    • Need 15 million sperm per mL for fertility
  • Leydig cells: make testosterone
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18
Q

Migration of Developing Sperm in Seminiferous Tubule (Figure)

A
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19
Q

Sertoli Cells

A
  • Like epithelium that wrap around and hang onto developing germ cells
  • Create blood testis barrier
    • Between inside of seminiferous tubule and blood
    • Tight junx between sertoli cells
    • Basal: spermatagonia
    • Central: meiosis and mature gametes
    • Isolates from immune system (central compartment)
  • Nourishing/paracrine signaling required for spermtagonenisis
  • Receptors for FSH and testosterone
  • Produce androgen binding protein
  • Endocrine cells that produce:
    • Inhibin: negative feedback
    • Mulllerian inhibiting substance (MIS): involved in sexual differentiation
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20
Q

Sertoli Cell Functions: Summary

A
  • Blood testis barrier
  • Support gamete development
  • Responds to FSH, testosterone
  • Synthesize androgen binding protein
  • Secrete hormones:
    • Inhibin
    • Mullerian Inhibiting Substance
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21
Q

Male Hormonal Regulation

A
  • Leydig cells bind to LH
  • Sertoli cells bind to FSH
  • Negative feedback of tropin
  • Not on and off: rather fine tuning
  • Muscle mass, bone growth, protein synthesis, secondary sexual structure, sex drive
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22
Q

Physiology of erection

A
  • 1 corpus sponginosum and 2 corpus cavernosa
  • Erectile tissues that are vascular spaces that can fill up with blood and become engorged
    • Relaxation of arterials and smooth muscles allows blood to flow in
    • Maintenance helped because filling up compresses the veins
  • neural inputs to arterial smooth muscle of the penis:
    • NANC (nonadrenergic, noncholinergic) neurons:
    • Releases nitric oxide as neurotransmitter
    • Nitrergic neurons
  • Sympathetic neurons:
    • Release norepinephrine
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23
Q

Erectile Dysfunction Drugs

A
  • Phosphodiesterase inhibitors
  • Oral drugs to treat ED
  • NO stimulates guanylate cyclase
    • Make cGMP
    • Lead to decrease in Ca and relaxation
  • PDE inactivates pathway by cleaving cGMP
  • Sildenafil, vardenafil, tadalafil, avanafil
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24
Q

Ejaculation

A
  • Semen from urethra
  • Smooth muscle contraction around the ducts
  • Depends on the sympathetic input to smooth muscle
  • Vas deferens + Ejaculatory Duct
  • Glands
  • Internal urethral sphincter
  • Release of semen from penis
    • Contraction of smooth muscle in urethra
    • Contraction of skeletal muscles in pelvic floor
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25
Q

Sexually Indifferent Stage

A
  • During embryonic development
  • Adjacent to each primitive gonad
  • Wolffian (mesonephric) ducts are more medial
  • Müllerian (paramesonephric) ducts are more lateral, but then fuse in the midline more caudally
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26
Q

Sexual Determination: Male

A
  • Sexual determination: depends upon the sex chromosomes, X and Y
  • SRY gene on Y chromosome
    • activates a gene network that directs the gonads to develop as testes
    • No SRY, goes to ovaries
  • Testes generate regulatory molecules
  • MIS=Mullerian Inhibiting Substance
    • peptide hormone
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27
Q

Sexual Determination: Female

A
  • Female in absence of SRY gene
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28
Q

MIS Information

A
  • produced in the ovary (after it differentiates) by granulosa cells
  • expressed mainly by small growing follicles
  • level of MIS is thus a good indicator of the size of the ovarian reserve
  • Used in IVF to predict how the woman will respond to controlled ovarian stimulation
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29
Q

Androgen Insensitivity Syndrome

A
  • Mutation in androgen receptor
    • “complete androgen insensitivity”
  • Testes develop
  • Externally as a female
    • development of the male external genitalia depends upon androgen
  • Breasts develop because testosterone converted to estrogen
  • Recognized via amenorrhea
    • Uterus never developed because MIS caused regression
  • No armpit or pubic hair because these depend on androgen signaling
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30
Q

Treatment for Androgen Insensitivity Syndrome

A
  • Removal of abdominal testes
    • gonadectomy
  • Increased risk for testicular cancer
    • Cryptorchidism (failure of testes to descend)
    • Low androgen levels
  • Wait until early adulthood and then gonadectomy so that naturally goes through puberty
  • After gonadectomy, kept on hormone therapy
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31
Q

Mutation in 5-alpha-reductase

A
  • Penis and prostate development depends upon dihydrotestosterone (DHT)
  • Mutation in 5-alpha-reductase type 2
  • Born externally female
  • Hypospadias
    • Urethra not in phallus but in the perineum
  • At pubery the large levles of testosterone stimulate the development of male structures
  • Male secondary structures develop
  • Initially raised as girls and then develop male gender identity
    *
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32
Q

Other Ovarin Development Signals

A
  • Occurs in absence of SRY gene
    • But doesn’t occur by default
  • Several genes (RSPO1, WNT4, FOXL2) have been shown to be necessary to initiate ovarian development
    • actively repress gene network for testes development
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33
Q

Comparing Male vs. Female:

  • Spermatagonia
  • Spermatocyte divisions
  • # of germ cells
A
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34
Q

Female Oogensis Flowchart

A
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35
Q

Oocytes develop into follicles

A
  • Prior to birth, oogonia stop proliferating
    • At birth, germ cells in ovaries are primary oocytes
  • Initiated meiosis but are then in meiotic arrest
  • Oocyte+support cells=follicle
  • Not developing=primordial follicles
  • oocyte in meiotic arrest surrounded by a single layer of follicle cells
  • Once starts to develop:
    • Oocyte enlarges
    • Follicle cells differentiate to granulosa cells, proliferate
    • Zona pellucida: glycoproteins
    • Spindle shaped theca cells
    • Fluid-filled antrum
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36
Q

Follicle Development: Independent Development

A
  • Local signals in ovary cause follicles to develop into early antral stage
  • Independent of gonadotropins
  • Before puberty and any time in monthly cycle
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37
Q

Follicle Development: Growth Phase

A
  • Follicles that have undergone initial development
  • Further stimulated by rising gonadotropins (FSH) and (LH)
  • If intial development not later hormonally supported, undergoes atresia
    • 99.9%
    • Happens all throughout childhood
    • Fewer ovulations, less ovarian cancer risk
  • Growing, antral follicles
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38
Q

Follicle Development: Dominant Follicle

A
  • Dominant follicle selected by day 7
  • Day 7-14 matures
  • Egg and small cluster of granulosa cells detaches from wall and follicle floats free within antrum
  • Ovulation on day 14
  • Follicular phase
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39
Q

Follicle Development: Post Ovulation

A
  • Remaining follicle cells into corpus luteum
  • Granulosa cells increase, BM broken down, invaded by blood vessels
  • Corpus luteum secretes progesterone and estrogen
  • Degenerates day 25 and 28 when LH levels decline
  • Fertilized embryo will make chorionic gonadotropin, LH analog that allows corpus luteum to persist during first trimester
  • Luteal Phase
40
Q

Hormonal Regulation: Early Follicular Phase

A
  • Growth stimulated by Gn
  • Decreasing estrogen and progesterone from end of cycle release the negative feedback on the anterior pituitary
  • FSH=granulosa cells
  • LH=theca cells
  • Start secreting estrogen
    • Granulosa: enzyme aromatase (makes beta estradiol)
    • Theca: androgen precurosor
41
Q

Hormonal Regulation: Selection of Dominant Follicle and Late Follicular Phase

A
  • Follicle enlarges and increases estrogen secretion
    • Causes negative feedback inhibition
  • Gn levels decline (esp. FSH)
  • Granulosa secrete inhibin to prevent FSH
  • Selection because negative feedback limits FSH
  • Granulosa cells develop LH receptors in late follicular phase and start reponding to LH
42
Q

Hormonal Regulation: LH surge and Ovulation

A
  • Estrogen from follicle cross threshold and estrogen causes postive feedback
  • Causes rapid rise in LH (“surge”)
  • Causes ovulation
  • Just prior to ovulation, LH causes a blip of progesterone secretion (needed for ovulation)
  • First division of meisosis occurs just prior to ovulation
43
Q

Hormonal Regulation: Luteal Phase

A
  • LH stimulates formation of corpus luteum
    • Secretes estrogen and progesterone
  • Negative feedback on Gn
    • Prevents further follicle development and ovulation
  • LH levels fall below a threshold and corpus luteum regresses
  • Release hypothalamus and pituitary from negative feedback inhibition
    • FSH and LH steadliy increase to start new cycle
44
Q

Complete Diagram of Female Cycle

45
Q

Coordination of Uterine Events

A
  • Endometrium into functional layer under estrogen and progesterone control
  • Basal layer that regenerates functional layer after menustration
  • Middle and Late Follicular Phase:
    • High estrogen cause proliferation (proliferative phase); cervix secrete thin watery mucus
    • Inductiov of progesterone receptors
  • Luteal Phase
    • Progestrone prevent further proliferation
    • Blood vessel growth
    • Secretory Phase
    • Cervix secrete thick mucus
    • Inhibit contractions
  • Menustration
    • Drop in progestrone and estrogen
    • Vasocontriction causes ischemia
    • Later vasodialation to causes bleeding and contraction of myometrium
46
Q

Menorrhagiae

Dysmenorrhea

A
  • Menorrhagiae: excessive uterine bleeding
  • Dysmenorrhea: painful menustration
47
Q

Leiomyoma

A
  • “Fibroids”
  • Benign growths in myometrium
  • Abnormal entometrial growth over fibroids leads to excessive bleeding
  • More common in older women, have hystorectomy
48
Q

Unopposed Estrogen

A
  • Occurs in PCOS
  • PCOS: annovulation: no switch to luetal or secretory phase
    • Lots of estrogen and not a lot of progesterone
    • Endometrium keeps proliferating
  • Miss a bunch of periods and then have a really bad period
  • Increased risk for endometrial cancer
  • Treated with hormonal contraceptives
49
Q

Hyperprolactinemia: Prolactin regulation

A
  • Stimulates milk production in the breast/growth
  • Estrogen and progesterone prevent lactation
  • Suckling stimulates mechanoreceptors
  • Magnocellular Cell:
    • Release oxytocin from posterior pituitary
    • Milk ejections from myoepithelial cells
  • Parvocellular cell that release dopamine at the median eminence
    • Dopamine travel to the anterior pituitary via hypophyseal portal vessels and inhibit prolactin secretion
    • Suckling inhibits dopamine release​
50
Q

Hyperprolactinemia: Causes and Treatments

A
  • Pituitary tumor (prolactinoma) that secretes prolactin
  • Cause infertility because prolactin inhibits GnRH secretion
  • Low GnRH, low FSH and LH
    • Hypogonadotropic hypogonadism
    • anovulation
    • amenorrhea and galactorrhea
    • osteoprosis
  • Dopamine antagonists can cause hyperprolactima
  • Gonadal hormone treatment
  • First line treatment is dopamine agonist
    • bromocriptine and cabergoline
51
Q

PCOS: Description

A
  • Most common cause of anovulatory infertility
  • Chronic ovulation problems with hyperandrogenism
    • Amenorrhea or oligomenorrhea
    • Hirsutism, acne, hair loss on scalp
  • Ovaries enlarged with multiple immature follicels
    • Hyperplasia of theca cells
    • Fewer granulosa cells
    • No domininant follicle chosen and on LH surge
  • Often insulin resistant: hyperinsulinemia , greater T2DM risk
  • Ultrasound show “necklace of black pearls”
52
Q

Endocrine disturbances in PCOS

A
  • Normal follicle development when estrogen and progesterone levels drop due to degeneration of corpus luteum
    • Granulosa respond to FSH and Theca to LH
  • In PCOS, LH secretion is elevated (FSH the same or decreased)
    • Theca cells and androgens produced but there is not enough FSH to stimulate granulosa cells
  • Failure of follicle development to progress
  • Androgen converted to estrogens in adipose tissue
    • Abnormal feedback regulation
    • LH continues to be high compared to FSH
    • Hyperinsulinemia contributes because insulin stimulates androgen production
53
Q

Treatment for PCOS: Hormonal Contraceptives

A
  • Decrease hyperandrogenism and negative effects on uterus
  • Estrogen and progestrone restore normal LH levels
  • PCOS causes there to be unopposed estrogen because never progress to luteal phase that has progesterone
    • Continued proliferation leading to menorrhagia
    • Increases risk for endometrial cancer
54
Q

Treatment for PCOS: Clomiphene

A
  • SERM
  • In hypothalmus and anterior pituirtary, acts as estrogen antagonist
    • prevents negative feedback effect of estrogen, allows FSH secretion to increase so that follicle development can be stimulated
  • Taken at a certain time in cycle to snap out of bad habits
  • Potential for mulitple ovulations
  • Alters uterine environment making it harder to concieve
  • Usually 1st line in those wanting to concieve
55
Q

Treatment for PCOS: Aromatase inhibitors

A
  • Letrozole and anastrozole efficicay in ovulation induction
  • Prevent androgens from converting to estrogens
  • Limit estrogen negative feedback on GnRH
  • Shorter half-life allowing normal estrogen secretion later in cycle
  • Less risk for multiple ovulations
  • More estrogen stimulation of endometrial development during proliferative phase
56
Q

Tratement for PCOS: insulin sensatizers

A
  • Metformin
  • Safe and effective in lowering androgen levels
57
Q

Treatment for PCOS: Gonadotropins

A
  • Exogenous FSH
  • Menotropin
    • mixture of gonadotropins from menopausal urine
  • Urofollitropin
    • purified FSH from urine
  • Follitropin
    • Recombinant FSH
  • FSH may lead to multiple ovulations
  • Ovarian hyperstimulation syndrome, increased vascular permeability (edema, nausea, abdominal pain)
    • Severe: clotting abnormalities, renal failure, respiratory distress
58
Q

Treatment for PCOS: Ovarian Surgery

A
  • Induce damage to ovarian tissue
  • Breaks the cycle of androgen production and abnormal negative feedback
  • No risks of hyperstimulation or multiple pregnancy
59
Q

PCOS Treatments for women who do not want to concieve

A
  • Hormonal Contraceptives
  • Weight Loss
  • Metformin
60
Q

PCOS treatments for women who do want to concieve

A
  • Clomiphene
  • Weight Loss
  • Aromatase Inhibitors
  • Metformin
  • FSH
  • Surgery
61
Q

Definition of Conception

A
  • Implantation of fertilized embryo
  • Measure by increase in chorionic gonadotropin
  • Measure ovulation by LH surge
62
Q

Hormonal Contraceptive: MOA

A
  • Suppress the secretion of gonadotropins (FSH and LH) thorugh negative feedback inhibition
  • Inhibit during luteal phase
  • Suppress ovulation
  • Prevent rise in FSH needed for initiation of follicle development and selection of dominant follicle
  • Prevents LH surge needed to trigger ovulation
  • In follicular phase, estrogen makes thin water mucus that sperm can traverse
  • In luteal phase, progesterone makes thick mucus. Progesterone in HC does this
  • Reduce endometrial growth and interfere with implantation
    • Side effect: mid-cycle bleeding from abnormal endometrial proliferation
63
Q

Combination Contraceptives

A
  • Estrogen and progestin
  • Placebo causes withdrawl bleed
    • Sign not prego, but not essential
  • Continuous for women who suffer menorrhagiae or dysmenorrhea
64
Q

Progesterone Only Contraceptives

A
  • Low Dose Pills
    • Not as reliable at preventing ovulation but work by thickening cervical mucus
    • Must be taken at the same time everyday
    • Good for lactating mothers
  • Long-Acting Methods
    • Depo-Provera
    • Injected every 3 months
    • Inhibition of estrogen may cause loss in bone density
65
Q

Emergency Contraception

A
  • Block or delay ovulation since sperm can be in reproductive tract for days
  • Plan B (levonorgesterol in higher dose)
    • Negative feedback inhibitior of GnRH
    • Only works if taken before LH surge
    • Use within 12 hrs, but can be effective for 5 days
  • Ella (ulipristal acetate)
    • selective progesterone receptor modulator
    • Blocks progesterone action in follicle
    • Small increase in progesterone caused by LH surge
    • Delay ovulation even if begining of LH surge has already occured
    • Not effective if taken after the peak of LH surge
    • May affect endometrium, but very low doses so maybe not
66
Q

Hormonal Contraceptives: Risks

A
  • Cardiovascular Risk
    • Rare in young women and pregnancy increases these risks even greater
    • Promote thrombosis (VTE); pulmonary embolism, MI or stroke
    • Clotting due to estrogen
    • Newer progestin (drospirenone, desogestrel) have higher risk than older (levonorgestrel)
  • Breast Cancer
    • Tumors stimulated by estrogen
    • Estrogen and Progesteronen promote breast growth
    • No increase in breast cancer (but study done in older women)
      *
67
Q

Hormonal Contraceptives: Benefits

A
  • Menstural Symptoms:
    • Menorrhagia, dysmenorrhea, PCOS
  • Endometrial Cancer:
    • Decreased endometrial proliferation
    • Lowest risk in those of HC for longest
  • Ovarian Cancer:
    • Lowest risk in those on HC for longest
  • Androgen Secretion
    • Treat hyperandrogenism because decrease gonadotropin androgen secretion
    • Reduce severity of acne
68
Q

Mifepristone

A
  • Progesterone antagonist
  • Terminate pregnancy in first 7 weeks
  • Need progesterone to keep gestation
  • Progesterone maintains endometrium and quiet myometrium
  • Mifepristone and then prostaglandins
    • prostaglandins induce myometrial contractions
    • Mifepristone induces shedding of endometrium
  • Ella progesterone antagonist is used at a much lower dose
69
Q

Acrosome Reaction

A
  • Sperm matures as goes through female reproductive tract
  • Acrosome: large vesicle in head of sperm; contains digestive enzymes
  • Sperm bind to zona pellucida; acrosome reaction is undergone
  • Release of digest enzyme; allows sperm to burrow through zona pellucida
  • Many sperm undergo acrosome reaction, but only one “wins”
  • Once sperm membrane fuses with egg membrane; triggers a reaction in the ovum (cortical reaction)
70
Q

Cortical Reaction

A
  • Exocytosis of vesicles
  • Change the zona pellucida; zona hardening
    • Other sperms that are bound fall off and prevents other sperms from fertilizing the egg
  • Zona pellucida stay with the fertilized egg (conceptus)
    • Give rise to embryo and extra embryonic tissue
  • Sperm-egg fusion stimulated the second division of meiosis
    • Male and Female pronucleus fuse and then divide to make zygote (other female nucleus is the polar body)
71
Q

First Cell Divisions in Pregnancy

A
  • First cell divisions through fallopian tube occur without any growth; cleavage
  • 70-100 cells
  • Zona pellucida prevents it from implanting where it shouldn’t
  • Blastocyst
72
Q

Implantation-stage conceptus: blastocyst

A
  • Once reaches the uterus, there is zona hatching
  • Two kinds of cell in blastocyst
    • Trophoblast: Outer layer that forms extra embryonic tissue (chorion)
    • Inner Cell Mass: Cell concentrated on one side; forms embryo
73
Q

Trophoblast

A
  • Trophoblast is sticky and adheres to endometrium
    • Promotes proliferation
    • Divides into two groups
  • Syncytial trophoblast: cell membrane break down, so many nuclei in one membrane
    • Invasive into endometrium
    • Proteolytic enzymes
    • Makes chorionic gonadotropin
    • Makes lacuna
  • Cellular trophoblast: normal cells
    • Forms chorionic villi
74
Q

Implantation

A
  • Occurs 6 to 7 days after fertilization
  • syncytial trophoblast
    • invasisive and proteolytic enzymes
      • embyro nourished by digestion of endometrium
    • Digestion of endometrial tissue creates lacunae
    • produce chorionic gonadotropin
      • Pregnancy test
      • LH analog, maintains corpus luteum
  • Cellular trophobasts create branched structures, known as chorionic villi
  • developing embryo forms a disc that pulls away from the proliferating trophoblast to create a new space
    • amniotic cavity
75
Q

The Placenta

A
  • from the trophoblast and the endometrium
    • during pregnancy the endometrium is known as the decidua
  • Placenta 5 wks after implantation
  • fetal part of the placenta, or chorion, is made up of the chorionic villi
    • branched
    • blood vessels just under trophoblast layer
  • villi protrude into large spaces (lacunae) in the decidua
    • maternal blood into lacunae to wash over villi
      • exchange of nutrients, wastes, and blood gases
  • Source of estrogen and progesterone after 8 weeks of pregnancy
76
Q

Development of the Amnion

A
  • Development of the amnion
    • Fluid filled
  • Chorion develops on one side and then fuses with the amnion
    • Chorion will be on one side of the uterus
77
Q

Estrogen and Progesterone in Pregnancy: Immplantation

A
  • Gonadosteroid make the uterus prime for immplantation
  • Estrogen in follicular phase proliferates endometrium
  • Progesterone in luteal phase stimulates secretion and promotes blood vessel growth
  • Estrogen and Progesterone by corpus luteum
    • Early in pregnangy CL stimualted by HCG
  • By 4 weeks there are detectable levels of HCG
78
Q

Estrogen and Progesterone in Pregnancy: Gestation

A
  • Progesterone: smooth muscle relaxation in the myometrium, developmental changes in endometrium for decidua formation
  • Progesterone supplementation in women who have a history of preterm labor
79
Q

Graph of Hormonal Changes in Pregnancy

80
Q

Estrogen and Progesterone in Pregnancy: Preparation for Lactation

A
  • Progesterone stimulates growth of milk-producing cells in the glands
  • Estrogen stimulates growth of duct cells
  • Estrogen stimulated prolactin
81
Q

Partruition

A
  • Delivery of infant and placenta
  • Estrogen stimulates proliferation in the myometrium
    • synthesis of gap junctions between myometrial smooth muscle cells
    • Coordinated contraction
    • synthesis of enzymes involved in prostaglandin synthesis
  • Prostaglandin cervical ripening
    • Soft, flexible and dialated
    • Prostaglandins stimualte myometrial contractions
  • oxytocin is the strongest stimulator of uterine contractions
    • estrogen increases responsiveness to oxytocin by increasing expression of oxytocin receptors
82
Q

Partruition: Hormonal Loop

A
  • Head pushes head against the cervix
    • Stretch receptors in the cervix
    • Feed onto the hypothalamus
    • Activate neurosecretory cells to release more oxytocin
  • Positive feeback stimulation to make sure that the baby is born “all the way”
83
Q

Strucutre of the Breast

A
  • Milk is produced by secretory structures known as alveoli
  • Alveoli are arranged in clusters called lobules
  • The lobules are connected to outlets at the nipple by ducts
  • The alveoli are surrounded by special contractile cells known as myoepithelial cells.
84
Q

congenital adrenal hyperplasia

A
  • Problems with sexual differentiation of XX infants
  • when excess androgens are produced during development
  • can be due to an adrenal tumor in the mother
  • most often in the disorder known as congenital adrenal hyperplasia
    • defects in the enzymatic pathways that produce cortisol
    • Low cortisol cannot exert negative feedback regulation on the secretion of the pituitary hormone ACTH, which stimulates hormone production by the adrenal gland
  • adrenal glands produce large amounts of androgens, which have the effect of masculinizing XX females
  • precocious sexual development in males
85
Q

Cryptorchidism

A
  • Failure of both testes to descend into the scrotum by birth
  • Surgical correction of cryptorchidism is done ideally before 2 years of age and is known as orchiopexy
  • Cryptorchidism increases risk for testicular cancer and orchiopexy reduces this risk
86
Q

Testicular cancer

A
  • most common malignancy in young men
  • vast majority of testicular cancers (95%) are germ cell tumors
  • these tumors arise when there is disrupted growth and development of germ cell precursors
  • the cure rate approaches 80%
  • removal of the tumor, followed by radiation, or chemotherapy
  • chemotherapy drug cisplatin has proved to be very effective in the treatment of testicular cancer
87
Q

Benign Prostatic Hyperplasia

A
  • non-cancerous growth of the prostate gland
  • pelvic pain and difficulty in urination
  • prostate is more responsive to DHT, one therapeutic approach uses 5-a-reductase inhibitors, such as dutasteride and finasteride
  • Another medical approach is to use a–blockers (an example is tamsulosin), which relax smooth muscle in the prostate and urethra to ease urinary symptoms
  • Surgical resection of the enlarged prostate can also be done using an instrument inserted in the urethra.
88
Q

Prostate Cancer

A
  • most frequently diagnosed cancer among men in the United States
  • Detection of prostate tumors was traditionally done by digital rectal examination
  • Prostate-specific antigen (PSA) is a protein produced by the prostate, and its levels rise in the blood when the prostate enlarges, as it would if a tumor was present
    • high rates of false positives and false negatives
  • Treat with hormonal therapy
  • Radiation
  • prostatectomy
89
Q

Breast Cancer

A
  • mammography also causes overdiagnosis, that is, the identification of tumors that may not be otherwise clinically significant in a woman’s lifetime
  • non-invasive (confined to breast ducts or lobules) or invasive (spread to surrounding connective tissue)
    • Another term for non-invasive breast cancer is carcinoma in situ
  • To determine whether breast cancer has metastasized, the axillary lymph nodes (lymph nodes of the armpit) are dissected and examined.
  • over-expresses hormone receptors (either for estrogen or progesterone) or the growth factor receptor HER2
  • treat it with drugs that interfere with estrogen, such as tamoxifen (which is a selective estrogen receptor modulator; SERM) or letrozole (an aromatase inhibitor that prevents estrogen synthesis). Tumors that are positive for HER2 are treated with trastuzumab (tradename: Herceptin), an antibody-based drug that binds to the receptor and prevents cell growth.
90
Q

Breast Cancer Surgery

A
  • mastectomy (removal of the breast) or lumpectomy, in which the tumor and surrounding tissue are removed
    • lumpectomy after radiation
  • Adjuvant therapy refers to any of the various systemic therapies: chemotherapy, hormone therapy, or trastuzumab.
91
Q

Breast Cancer and HRT

A
  • hormone replacement therapy increased the risk of heart disease and breast cancer
92
Q

PID

A
  • acute infection of the upper reproductive tract in women, namely endometritis
  • salpingitis (infection of the fallopian tubes)
  • oophoritis (infection of the ovaries)
  • Usually by the clap
  • pelvic pain, tenderness upon palpation, and (sometimes, but not always) vaginal discharge
  • Can lead to infertility and tubal dysfunction
  • Treat with antibiotics
93
Q

Endometriosis

A
  • endometrial tissue is found in ectopic locations, usually in the pelvic cavity
  • pelvic pain, tissue damage, and lowered fertility
  • retrograde menstruation (i.e. menstruation through the fallopian tube instead of the cervix) allows ectopic endometrial tissue to implant in the pelvic cavity
  • persist there due to an insufficient immune response
  • treated surgically, or with drugs that decrease estrogen levels such as oral contraceptives or the GnRH agonist leuprolide
94
Q

Dysmenorrhea

A
  • painful menstruation
  • High prostaglandin levels
  • sensitize pain fibers in the uterus
  • treated effectively with NSAIDs (non-steroidal anti-inflammatory drugs)
  • oral contraceptives
    • Progesterone opposes prostaglandin function
    • less endometrium overal lowers prostaglandin secretion as well
95
Q

Menopause

A
  • end of ovarian follicle production, there is also a marked drop in production of estrogen
  • decrease in the size of the breasts and uterus
  • bone density and cardiovascular system
  • lack of estrogen leading to hot flash
  • HRT for vaginal dryness and hot flash and osteoporosis
  • Treatment of estrogen loss:
    • selective estrogen receptor modulators (SERMs), such as raloxifen
    • act as estrogen antagonists in some tissues, while acting as estrogen agonists in other tissues
    • Raloxifene may now also be prescribed to prevent breast cancer in post-menopausal women at high risk for invasive breast cancer.

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