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Endocrinology > Last Day > Flashcards

Last Day Flashcards

1
Q

Follistatin

A

Testicular Peptide hormones

-inhibits activins and inhibing

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2
Q

Activins

A

Testicular Peptide hormones

  • produced in sertoli cells
  • stimulate FSH beta-subunit production
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3
Q

Inhibins

A

Testicular Peptide hormones

  • produced in seminiferous tubules and sertoli cells
  • suppresses FSH secretion
  • injury to seminiferous leads to elevated FSH
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4
Q

Primary Hypogonadism

A

-failure of testes

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5
Q

Secondary Hypogonadism

A

-non-testicular condition including hypothalamic and pituitary diseases

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6
Q

Hypothalamic disorders

A

-low GnRH leads to failed LH and FSH production

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7
Q

Pituitary disorders

A

-low LH and/or FSH production leads to failed testosterone production and/or spermatogenesis

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8
Q

Gonadal Disorders

A

-failure of testosterone production from Leydig cells and/or spermatogenesis, no feedback leads to elevated LH and FSH

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9
Q

Post-Gonadal Disorders

A

-defects in testosterone receptor function

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10
Q

Kallman’s Syndrome

A

Hypothalamic Disease - inappropriately ‘normal’ LH and FSH with low testosterone
-anosmia

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11
Q

Prader-Willi Syndrome

A

Hypothalamic Disease - inappropriately ‘normal’ LH and FSH with low testosterone
-obesity, hyperphagia, hypotonia, micropenis, small hands & feet

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12
Q

Lawrence-Moon Syndrome

A

Hypothalamic Disease - inappropriately ‘normal’ LH and FSH with low testosterone
-retinitis pigmentosa polydactyly

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13
Q

Fertile Eunuch Syndrome

A

Pituitary Disease - nappropriately ‘normal’ LH and FSH with low testosterone
-LH deficiency

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14
Q

Pre-pubertal Gonadal Failure

A
  • small testes, phallus, & prostate
  • delayed puberty
  • scant pubic and axillary hair
  • disproportionately long arms & legs (delayed epiphyseal closure)
  • Reduced male musculature
  • Gyneocomastia
  • Persistently high-pitched voice
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15
Q

Post-pubertal Gonadal Failure

A
  • progressive decrease in muscle mass
  • loss of libido
  • impotence
  • oligospermia or azoospermia
  • occasionally, menopausal-type hot flushes (with acute onset of hypogonadism)
  • poor ability to concentrate
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16
Q

Evaluation of hypogonadal patient

A

History: sexual function, family, fertility status
Physical Exam: arm span to height, axillary/pubic hair, phallus and testes
Lab: Test. FSH, LH, Prolactin, Karyotyping
Provacative Testing: GnRH stimulation, Clomiphene stimulation, hCG stimulation
Pituitary MRI

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17
Q

Isolated FSH Deficiency

A

Pituitary Disease - nappropriately ‘normal’ LH and FSH with low testosterone

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18
Q

Hyperprolactinemia

A

Pituitary Disease - nappropriately ‘normal’ LH and FSH with low testosterone
-inhibited GnRH release and libido

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19
Q

Hemochromatosis

A

Pituitary Disease - nappropriately ‘normal’ LH and FSH with low testosterone
-loss of LH and FSH (also effects testes directly and can cause a primary hypogonadism)

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20
Q

Testicular Diseases

A

High LH and FSH due to absent feedback of testosterone

  • bilateral anorchia (vanishing testes syndrome)
  • chyptorchidism
  • sertoli cell only syndrome
  • myotonic dystrophy
  • gonadotoxins
  • chemo
  • radiation
  • orchitis (mumps)
  • systemic illness
  • hemachromatosis
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21
Q

Testosterone

A
  • levels vary from hour to hour
  • normally highest levels in the early morning hours
  • circulating bound to sex hormone-binding globulin (SHBG) and albumin
  • only ~2% of total hormone is free for biological availability
  • normal total test. can be seen in bypogonadal patients with increased SHBG in whom the available test. is truly low
  • SHBG increase about 1% per year with aging
  • equilibrium dialysis measures of free test. are most accurate
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22
Q

What can cause low SHBG?

A

hypothyroidism, acromegaly and obesity

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23
Q

Gonadotropins

A
  • LH and FSH are both released in pulsatile fashion
  • LH has a shorter plasma half-life than FSH and single low measures may be misleading
  • biologic activity is affected by post-translational glycosylation and 2-site radioimmunometric assays yeild results with correlate well with biologic activity
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24
Q

Prolactin

A
  • unusual in that it is tonically secreted and requires dopaminergic signaling from the hypothalamus to down-regulate its release
  • directly down-regulates release of FSH and LH
  • directly decreases libido independent of testosterone levels
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25
Q

Semen Analysis

A
  • primary test to assess fertility potential of male
  • should be collected after 2-5 days of abstinence and evaluate within 2 hours
  • volume should range from 1.5-6mL
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26
Q

Fertile Sperm Sample

A
  • motility of more than 50%

- sperm count that exceeds 20 million/mL

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27
Q

Klinefelter’s Syndrome

A
  • chromosomal disorders
  • XXY
  • tall, gynecomastia, eunuchoid habitus, MR common
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28
Q

XYY

A
  • chromosomal disorders

- oligo/azospermia

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29
Q

Noonan’s Syndrome

A
  • chromosomal disorders
  • XO
  • phenotypically similar to Turners patients but male
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30
Q

XX Male Syndrome

A
  • chromosomal disorders

- normal height, no MR, azospermia

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31
Q

Male primary sex organ?

A

-testes

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32
Q

Testes

A

1) located in scrotum (temp. regulating system)
2) need temp <37C for optimal spermatogenesis
3) blood supply via pampinoform pelxis (countercurrent heat exchanger)
4) testicular movement: cremaster muscle
5) scrotal movement and sweating

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33
Q

Secondary Sex Organs

A

1) genital tract

2) accessary glands

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34
Q

Genital tract

A

epididymis, vas deferens, ejaculatory duct, urethra (and penis)

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35
Q

Accessary glands

A
  • bulbourethral glands
  • seminal vesicles (60% of seminal volume, contains prostaglandins, fructose, cirtic acid)
  • prostate (20% seminal volume)
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36
Q

Permanence/reversibility of pubertal changes

A
  • (by dec. gonadotropin or androgen secretion)

- spermatogeness, size, secretions, content (fructose, citrate) or sex accessor glands

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37
Q

Changes that are not reversible

A

-voice or height

slow is beard growth, libido, muscle mass

38
Q

What do testes have?

A
  • seminiferous tubules
  • produce gametes (sperm)
  • intersitial (Leydig) cells
  • produce testosterone
39
Q

Spermatogenesis hormones required

A

1) TSH
2) Testosterone: high concentrations
- indirectly require LH for test. and GnRH for FSH and LH

40
Q

Sertoli Cell Functions

A

1) stimulate spermatogenesis (site of action of FSH and test)
2) “Nourish” developing sperm
3) Provide blood-testis barrier to may chemicals
4) Produce hormone inhibin that feeds back negatively to dec. FHS
5) Secrete luminal fluid; includes androgen binding protein (ABP)
6) Phagocytosis of: dead or defective developing sperm excess cytoplasm from developing sperm

41
Q

Testosterone production is stimulated by?

A

LH (pulsatile ~1.5hr)

  • secretion is pulsatile
  • but seems steady in comparison to female sex hormones over month
42
Q

Metabolism of Testosterone

A

-activation in some target tissues it must be metabolized to dihydrotestosterone (DHT) in order to reach nucleus and prodcue androgenic actions

43
Q

Processes that do NOT require transformation of hormone to be active in nucleus?

A
  • pubertal growth of skeletal muscle, penis, scrotum

- libido

44
Q

Metabolism/Excretion of Testistrone

A
  • degraded by liver
  • metabolites excreted in urine (sulfated and glucuronated)
  • excreted as 17-ketosteroids
45
Q

Transport of Testosterone

A

-In blood

46
Q

Actions of Testosterone

A
  • fetal differentiation of male accessory organ
  • change in tissues at puberty, some permanent
  • maintain size & function
47
Q

Regulation of Pituitary-Testicular Axis

A

1) always negative feedback

2) test: both hypothalamus dec. GnRH (inc. interval b/w pulses) and pituitary (mainly dec. LH, weaker dec. of FSH)

48
Q

Primary Female Sex Organ

A

ovary

49
Q

Ovary

A

-located in abdomen (function well at body temp)

50
Q

Female Secondary Sex organs?

A

Genital Tract: oviducts (fallopian tubes), uterus, vagina

Accessary glands: mucus glands, (mammary?)

51
Q

Functions of Estrogen

A

1) stimulates growth and hormonal secretion of both the ovaries and the follicles that produced the estrogen, particularly in the “dominant follicle”
2) - and + feedback effects on hypothalamus and anterior pituitary (on GnRH, FSH, LH)
3) produce female configuration of body
- hip widening, fat amount, distribution
4) Stimulates: growth, motility, and secretions of muscle and endothelial surface of oviducts, uterus, vagina

52
Q

Thecal Cells

A

like leydig cells
-make androgen
with high areomatiase activity, estrogens are made

53
Q

Granulosa Cells

A

like sitori cells, around ovum, on inside

54
Q

Low Estrogen does what?

A

-inhibits on LH and FSH

55
Q

Rising Estrogen does what?

A

-stimulatory LH and FSH leads to mid-cycle LH surge that causes ovulation

56
Q

Very high Estrogen does what?

A

-inhibitory (was used as birth control, not now b/c side effects of E)

57
Q

Very low Estrogen + Progesterone

A

moderate does, inhibitory

-used in birth control

58
Q

Oviducts

A
  • increase

1) growth of muscle and epithelium

59
Q

Estrogen effects on uterine endometrium

A
  • growth, blood supply, endometrial glands

- induces progesterone receptors in the uterine endometrium

60
Q

Estrogen effects on growth?

A
  • long bone growth, causes epiphyseal cartilage plates of long bones to “close”, thus halts height growth
  • BUT initially, estrogens stimulate height growth
  • promotes growth of female external genitalia
61
Q

Effect of estrogen on bone loss?

A

reduce it

62
Q

Actions of Progesterone

A

1) Uterine Muscle: inhibitory
2) Endometrium: Stimulatory
3) Pituitary - inhibits LH & FSH secretion, especially low estrogen present
4) Stimulates mammary gland growth, especially the milk producing glands, inhibits Prl (or hPL) stim. of milk synthesis
5) Raises body temperature: rise in BBT beginning a few days post-ovulation
6) production of thick, sticky cervial mucus

63
Q

Uterine muscle Progesterone

A
  • decreases motility and prevents contractions from being coordinated
  • antagonizes estrogen’s enhanvement of motility
    • partly by dec. # of estrogen receptor (on smooth muscle on female tract)
  • decreases sensitivity to oxytocin
  • hyperpolarizes muscle membrane (makes it less excitable)
64
Q

Endometrium: stimulatory - Progesterone

A
  • after priming of tissue with estrogen, progesterone stimulates secretion by endometrial glands lining the uterus
  • this prepares uterus for implantation
65
Q

Thick Cervial Mucus

A

1) dec. chance of other sperm to get into uterus

2) provide barrier to potentially damaging microorganisms from getting into uterus and into the develping fetus

66
Q

To get pregnant, at least several sperm must…

A
  • survive in vagina
  • penetrate the cervical os (1/2000)
  • become capacitated
  • move up uterus (1/5000)
  • go into the “correct” oviduct (1/10,000)
  • move up the ovidict-fertilization usually occures in upper oviduct
  • peretrate zona pellucida
67
Q

Survival of Ovum

A

6-12 hrs

68
Q

Survival of Sperm

A

1-2 days

69
Q

Sexual interest in men?

A

always

70
Q

Sexual interest in women?

A
  • mid cycle (ovulation)

- pre-menstration

71
Q

Lots of Sperm: ejaculation

A

volume: 1-3ml
conc: 100mill/ml
total # 100-300 million

72
Q

What helps to get sperm to egg?

A
  • thinning of cervical mucus from estrogen

- motility of female tract is increased by: estrodiol, prostaglandins, oxytocin

73
Q

How many germ cells at birth?

A

1 million, most >70% regress before puberity

74
Q

How many eggs are ovulated?

A

400-450 over next 35 years, the rest start to grow and then degenerate

75
Q

When all eggs are gone?

A

-menopause, no more ovulation, decline in estrogen level, increase in LH and FSH secretion

76
Q

What is ovulation triggered by?

A

-mid-cycle surge of LH (probably FSH is not needed for ovulation)

77
Q

Ovulation

A

1) mid-cycle surge of LH
2) follicular membrane ruptures after attack of proteolytic enzymes
3) Some local bleeding may occur, some pain may be felt (“mittleschmerz”)
4) variation in length of a women’s menstrual cycle is caused by the length of the follicular phase, time for follicle to develop and the ovum to be released

78
Q

Luteal Phase

A

1) the Corpus Luteum (CL) develops from follicular cells, starting shortly before ovulation (small inc. in progesterone near end of follicular phase)
2) the CL secretes estrogen, lots of progesterone, 17-hydroxyprogesterone, and inhibin

79
Q

How long does luteal phase last?

A

-2 weeks (but CL is degenerating in last 5 days)

80
Q

Regulation of Menstrual Cycle

A

-correspondance of events in ovary and uterine endometrium

81
Q

Importance of Ovary in regulation of cycle timing?

A
  • only need to have
    1) a functional ovary (or 2)
    2) hypothalmo-hypophyseal portal system intact
    3) pituitary gonadotropes
    4) GnRH pulses
82
Q

Shorter Luteal Phase in women?

A
  • started sudden heavy exercise program
  • infertile women
  • women who have had first trimester miscarriage
83
Q

Bone conditions considered to be metabolic bone disorders?

A
  • osteoporosis
  • paget’s disease of bone
  • osteomalacia in adults and rickets in children
  • osteoitis fibrosa cystica
84
Q

Bone Remodeling

A
  • bone remodeling maintains a healthy skeleton
  • bone remodeling includes removing of old bone and replacing it with new bone
  • imbalance of bone remodeling results in metabolic bone disease
  • bone remodeling can be biochemical markers of bone resorption and formation
85
Q

Risk Factors for Fracture

A

Age: major contributor to fracture risk
Gender: W > M
Bone Mineral Density
Body Mass Index

86
Q

Lifestyle Risk factors of Osteoporosis

A
  • alcohol abuse
  • smoking
  • immobilization or inadequate physical activity
  • excessive thinness
  • high salt intake
87
Q

Nutritional Factors of Osteoporosis

A
  • low Ca intake
  • low vit D intake
  • excess vit A intake
88
Q

GI disorders of Osteoporosis

A
  • Celiac Disease
  • Gastric Bipass
  • GI surgery
  • Inflammatory Bowel Disease
  • Malabsorption
  • Pancreatic Disease
  • Primary biliary cirrhosis
89
Q

Hormone abnormalities of osteoporosis

A
  • hyperparpthyroidism, primary/secondary
  • low T or androgen insensitivity
  • low estrogen during menopause or associated with athletic amenorrhea, premature ovarian failure, premature menopause, hyperprolactinemia or hypopituitarism
  • excess cortisol, secondary or primary
  • thyrotoxicosis
  • diabetes type I or II
  • adrenal insufficiency
90
Q

Genetic Factors of Osteoporosis

A

marfan syndrome

hemachromatosis

Endocrinology (15 decks)

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