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FHB - Endocrine & Reproductive > Lecture 16: 82 - Reproduction 4 > Flashcards

Lecture 16: 82 - Reproduction 4 Flashcards

1
Q

Which one of these players has unusually high FSH, LH,
and testosterone?

a) androstendione
b) testosterone
c) clomiphene
d) hCG
e) growth hormone

A

c) clomiphene

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2
Q

What is primary amenorrhea?

What are the 3 common causes?

A

Primary Amenorrhea – the absence of menses in a phenotypic female by age 17

Disorders of sexual differentiation:

  1. Turner’s syndrome
  2. Complete ANDROGEN RESISTANCE (testicular feminization)
  3. Hormonal disorders in ovaries, adrenals, thyroid, pituitary/adrenal/hypothalamic axis
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3
Q

What is secondary amenorrhea?

What are 3 most common causes?

How does prolactin get involved?

A

SECONDARY:
cessation of menstruation for longer than 6 months

  1. Pregnancy
  2. Lactation
  3. Menopause

***Hyper-prolactinemia – from pituitary prolactinomas or hypothalamic disorders. (increase in prolactin disorders)

  • -> high prolactin inhibits GnRH pulses
  • decreases pituitary LH and FSH
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4
Q

What is oligomenorrhea?

What are most common causes? (3)

A

Oligomenorrhea:
- infrequent periods (cycle length> 35 days)

Causes:
1. changes ude to abnormalities in CNS mechanisms that regulate GnRH release including stress/illness

  1. Changes in body fat (low levels)
  2. Intense exercise, extreme weight loss, anorexia nervosa
    - no consistent chnages in plasma gonadotropins or ovarian steroids
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5
Q

What is dysmenorrhea?

How do prostaglandins play a role?
What promotes their synthesis?

What is the TX?

A

Painful menses related to uterine contractions may involve pelvic pain radiating to back and thighs, nausea, vomiting, diarrhea.

Prostaglandin synthesis is promoted by E2.

Prostaglandins may cause uterine contraction, may be severe enough to cause ischemia and pain

TX:
1. prostaglandin synthesis inhibitors

  1. Oral contraceptives
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6
Q

What is Hirsutism?

What are 3 common causes?

What is virilization?

What is the main cause?

A

Inappropriate hair growth in androgen sensitive areas

  1. Intake of exogenous androgens
  2. excessive androgen production by adrenals
    (adrenal hyperplasia, Cushing’s syndrome)
  3. Idiopathic increases in sensitivity to androgens

Virilization: includes hirsutism and pronounced androgen stimulation

  • clitoral hypertrophy
  • deepening voice
  • temporal balding
  • male pattern skeletal muscle development

CAUSE: excessive androgen production!

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7
Q

What is the premenstrual syndrome?

What phase does it occur in?

What are some symptoms?

TX?

A

Both physical and behavioral symptoms that interfere with normal life.
–> occur in LATE LUTEAL phase

Symptoms: Abdominal bloating, extreme sense of fatigue,
breast tenderness, labile mood – irritability, tension, depression

Cause not clear but related to cycle.***

Treatment: antidepressants and agents that suppress ovulation (birth control)

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8
Q

What is polycystic Ovarian syndrome?

It is the leading cause of ______

The cause and effect of PCOS is both______

High levels of _____ disrupt the menstrual cycle

A

Follicle development impaired, ovulation isn’t completed, follicles degenerate into cysts

INFERTILITY

  1. INSULIN RESISTANCE caused by obesity
  2. High levels of androgens
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9
Q

What are some symptoms of PCOS?

TX?

A
  1. sleep apnea
  2. menstrual irregularity
  3. obesity
  4. acne
  5. decreased HDL and increased TAG
  6. HIRSUTISM due to high androgen levels

TX:

  • weight loss*
  • smoking cessation
  • Metformin (for insulin resistance)
  • Clomiphene

** weight loss is more difficult when PCOS is involved since it causes WEIGHT GAIN

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10
Q

What years are peak fertility?

Female infertility _____ between age 20 and 40.

A
  1. 18 -25
  2. Quadruples between age 20 - 40
    - pregnancy complications also increase with maternal age
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11
Q

Fertilization:

Normally occurs in the ________within 24 hours (ovum is viable for 12-24 hours) after ovulation i.e.

How many days after menses?

Requires rapid transport of what?

Gestational age calculated from first day of ______

“Fetal age” is about ______ less than gestational age.
(since fertilization occurred a few weeks after)

A
  1. uterine tube (fallopian)
  2. 12-16 days after onset of previous menses
    - variable since follicular phase is variable
  3. Requires rapid transport of germ cells to oviduct
  4. last menstrual period.
  5. 2 weeks less than gestational age
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12
Q

When is the bast chance or fertilization?
(ovum/sperm)

Fertilized embryo implants into the endometrium, and the ______ is formed from both fetal and maternal cells

A
  1. 24 hours post-ovulation for ovum & 48-72 hours post-coitus for sperm
  2. placenta
    - [placenta acts as a new endocrine gland that takes over steroid and protein hormone production]
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13
Q

What are symptoms of pregnancy following placenta formation?

A
  1. Breast tenderness
  2. fatigue
  3. nausea
  4. absence of menstruation
  5. softening of the uterus
  6. sustained elevation of body temperature
  • if no pregnancy, temp decreases, but if pregnant = body temp stays high

Parturition is the final stage of gestation and is influenced by both fetal and maternal factors.

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14
Q

Sperm capacitation:

sperm need to be _____ hours post coitus for max fertilization)

What happens to the sperm in the female tract? What does this allow?

A
  1. 48-82 post coitus
  2. changes in functional properties that allow for penetration of ZONA PELLUCID of the egg
    - Thought to involve removal or modification of the protein coat covering sperm
    - May involve vagina, uterus, cervix or can occur with direct implantation into fallopian tube
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15
Q

What is the acrosomal reaction?

What is released?

What is the result?

What happens to sperm once it hits the zone pellucida?

a) what receptors are involved
b) binding causes release of what?
c) what is the result?

A

1- Exocytosis of spermatozoan internal membrane contents

Release of proteolytic enzymes (acrosin, neuraminidase, hyaluronidase) contained within the acrosomal membrane
- disperse granulosa cells and permit sperm attachment to ZONA PELLUCIDA and penetration.

  1. Spermatozoan has receptors for a) glycoprotein called ZP3
    b) Binding causes increased IP3 leading to increased [Ca++],
    c) triggering fusion of the outer and inner membranes, forcing enzyme-rich contents out.

RESULT:

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16
Q

What are the 2 exocytosis events in fertilization?

A

2- Exocytosis of oocyte’s internal vesicles

#1 sperm hits egg = dumps acrosomal contents
(Exocytosis of spermatozoan internal membrane contents)
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17
Q

What are the 6 steps of sperm penetrating the egg?

A
  1. binding of sperm to zone pellucida
  2. acrosomal reaction
    - exocytosis of sperm contents
  3. Penetration through zone pellucida
  4. Fusion of plasma membranes
  5. Sperm nucleus enters egg cytoplasm
18
Q

What is the cortical or ZONA reaction?

What does spermatozoan penetration trigger?

What is the 2nd exocytosis event?

A

2 = exocytosis of oocyte’s internal vesicles

Spermatozoan penetration triggers increased CALCIUM

  1. Fusion of cortical granules with plasma membrane releases enzymes that HARDEN GLYCOPROTEINS of zone pellucida
19
Q

The increase in serum calcium that triggers the cortical reaction also trigger completion of _______.

What is released?

What is the oocyte?(haploid/diploid)

Fusion with male pronucleus leads to _____ formation

A
  1. SECOND MEIOTIC DIVISION
  2. Second polar body is released
  3. Leaving oocyte with haploid unduplicated chromosomes
  4. zygote
20
Q

What does the Cortical or ZOna reaction prevent?

What occurs?

A
  1. prevent polyspermy
  2. Calcium influx triggers fusion of cortical granules with plasma membrane

= exocytosis of oocytes internal vesicles

21
Q

Sperm can begin appearing in the ampulla_______after coitus and continue migrating from the cervix for 1-3 days.

Sperm retain fertilizing capacity for 24-48 hrs, and the optimum time for fertilization is within _____hrs of ovulation. These windows need to match up.

Of ~ 250 million deposited in vagina, 0.1% make it to the oviduct and only a few hundred make it to the ampulla.

A
  1. 5-6 minutes

2. 24 hours of ovulation

22
Q

What primes the female tract to aid sperm transport to oviduct?

What increases velocity and direction of sperm ?

Decreased _____of vagina facilitates sperm motility

Decreased ______ of cervical mucus increases sperm access to uterine cavity

What 3 things all enhance sperm transport toward the ampulla, related to movement?

A
  1. ESTROGEN from late follicular phase
  2. cGMP (ANP, nitric oxide)
  3. [H+] decreases = increase sperm motility
  4. viscosity
  5. a) increase ciliary movement
    b) peristaltic movement
    c) fluid flow in oviduct

** increase sperm transport toward ampulla***

23
Q

OOCYTE TRANSPORT:

What happens to the oocyte at ovulation?

What produces a churning motion that promotes random interaction of sperm & ovum?

A
  1. At ovulation, the oocyte with its surrounding cumulus oophorus is released into the peritoneal cavity and is SWEPT INTO THE OVIDUCT BY FIMBRAE
  2. Contraction of AMPULLA
24
Q

Blastocyst traverses the oviduct in how many days?

What does the timing and arrival of blastocyst in uterine cavity depend on?

A
  1. 3 days

2. Estrogen & progesterone

25
Q

What is the action of estrogen in transport of blastocyst to uterus?

Progesterone?

A

ESTROGEN:
- stimulate CONSTRICTION of the isthmus, barring passage of embryo to uterus

PROGESTERONE:

  • increase once corpus luteum forms
  • promotes Myometrium RELAXATION and transport of blastocyst to uterus
26
Q

How many sperm arrive at the distal end of the fallopian tube?

A

50 or less sperm

27
Q

What are the 3 steps during Implantation?

What happens during adhesion:

  1. _______dissolves
  2. Requires adequate ______ during luteal phase
  3. What binds endometrial cells together and blastocyst cells?
  4. What cytokine increases #3?
  5. What does osteopontin do?
  6. _______ develop from blastocyst and connect with endometrial cells… With what? (2)
A
  1. Adhesion
  2. Penetration
  3. Invasion
  4. Zona pellucida
  5. progesterone
  6. INTEGRINS bind both endometrial cells & blastocyst cells together
  7. IL- 1 increases interns in endometrial cells (from blastocyst)
  8. Osteopontin binds intergins of both endometrium & blastocyst
  9. Trophoblasts
  10. Trophoblasts develop from blastocyst and connect with endometrial cells via laminin and fibronectin.
28
Q

What is the “bridging” molecule that connects both the endometrium and embryo cells together?

What is the function of streams cells?

What does this become later?

A

OSTEOPONTIN

Streams cells from DECIDUA
(forms the maternal part of the placenta)

–later this structure becomes a barrier AND endocrine organ
= PLACENTA

29
Q

______ of the trophoblasts interdigitate with endometrial cells, then trophoblasts burrow in and under the epithelial cells (penetration).

What else do they do?

A
  1. Microvilli

2. They also phagocytize and digest dead endometrial cells.

30
Q

What stimulates penetration?

What enlarge and form the decade, prompted by progesterone?

Their function is the following:

  1. decidua formation
  2. Source of nutrients for embryo until vascular connections established
  3. Mechanical/immune barrier
  4. Endocrine function (prolactin, relaxin, and prostaglandins)
A
  1. PROGESTERONE stimulates penetration

2. STROMAL cells perform the listed functions

31
Q

INVASION:

  1. Balance between what 2 cells?

What do these cells do? (2)

A
  1. Decidual cells & trophoblast
  2. MMP from trophoblast and inhibitors of MMP from decidual cells
  3. IGF - 2 from trophoblasts, IGF - Binding Proteins from decade
  4. Balance prevents invasive trophoblasts from penetrating too deeply
32
Q

Which of the following describes Cytotrophoblasts ? SYncytiotrophoblasts?

  1. secrete hypothalamic-like stimulatory(CRH, TRH) and inhibitory (somatostatin) proteins that act on ______
  2. mass without cell boundaries, extends between uterine epithelial cells, secrete TNF into basement membrane. –

Responsible for most endocrine functions
They are surrounded by decidual cells that provide nutrients.

A
  1. Cytotrophoblast = HYPOTHALAMUS
  2. Syncytiotrophoblast
    = endocrine!!
33
Q

What are the 4 functions of the placenta?

A
  1. Gut- supplies nutrients
  2. Lung- gas exchange
  3. Kidney- regulating
    fluid volume and waste disposal
  4. Endocrine gland
34
Q

How are glucose and AA’s and electrolytes transported across the placenta?

How is oxygen transported?

What supports oxygen transport?

A
  1. DIFFUSIOn or facilitated diffusion
  2. Oxygen diffuses down concentration gradient
    - supported by fetal hemoglobin which has higher affinity for OXYGEN compared to the adult
35
Q

What waste products does the placenta remove? (3)

A
  1. Urea
  2. Creatinine
  3. CO2

pCO2 in fetal arterial blood is 2-3 mmHg higher than maternal blood –> allowing diffusion from fetal to maternal circulation

36
Q

What 2 hormones does the placenta make?

What controls the function of the placenta as an endocrine gland?

A
  1. Estradiol & progesterone

2. Cytotrophoblasts and syncytiotrophoblasts

37
Q

HCG:

What 3 hormones are similar to HcG in structure?

How does a radioimmunoassay for pregnancy tests work? (antibodies for what?)

Can be detected in urine about ____ days after conception

Produced by ______under control of GnRH from ______

A
  1. TSH, LH, FSH
  2. Antibodies against  subunit are used in radioimmunoassays for pregnancy tests.
  3. 9
  4. syncytiotrophoblasts, cytotrophoblasts.

(GnRH from cytotrophoblasts –> sync = hypothalamus)

38
Q

What is the signal to the ovary that implantation has occurred?

A

HcG!!!! Signals to ovary that implantation has occurred (maternal recognition of pregnancy)

39
Q

HcG:

Rescues from and stimulates secretion of what 2 hormones?

High hCG affects LH and FSH how?
What is the purpose of this?

What makes progesterone in 1st trimester? 2nd and 3rd?

A
  1. Luteotrophic: rescues corpus luteum and stimulates secretion of progesterone and estradiol
  2. High hCG has negative feedback effects on maternal pituitary to prevent LH/FSH secretion
  3. Prevents LH and FSH release that would otherwise stimulate next cohort of follicles to develop.
    - Corpus luteum is rescued by HcG = keeps FSH and LH LOW!!!
  4. PLACENTA MAKES PROGESTERONE during week 4!!! in the 2nd and 3rd trimester  corpus luteum in the 1st trimester

makes moderate INSULIN RESISTANCE by keeping glucose levels high for the fetus!!!
breasts do not start making milk until baby is born

40
Q

HPL (human placental lactogen) or Human Chrionic Somatomammotrophin (HCS)
1. Similar to what hormone?
2. Produced by?
3. HPL stimulates lipolysis/lipogenesis?
anti or proinsulin?
Increase/decrease in plasma glucose & FFA?

A
  1. similar to GH
  2. produced by SYNCYTIOTROPHOBLASTS
  3. in response to hypoglycemia:
    - increase lipolysis
    - anti-insulin actions on maternal carbs
    - nutrients for embryo
41
Q

What happens if too much HCS/HPL is produced?

A

GESTATIONAL diabetes can develop

FHB - Endocrine & Reproductive (17 decks)

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