Phys and Pathophys - part 1 - Exam 1 Flashcards
What are the 4 main functions of the HPO axis?
- development of sex characteristics (puberty)
- coordinating regular periodic body changes (ovarial and uterine cycle)
- cervix, vagina and breast function
- maintains pregnancy
Describe the general flow of the HPO axis
hypothalamus makes GnRH ->
then travels to anterior pituitary through the blood stream ->
once at the AP, GnRH binds to receptors then LH and FSH are release ->
FSH and LH travel through bloodstream to the ovary, bind to receptors and Estrogen and Progesterone are released (Activin, Follistatin, Inhibin and Relaxin are also released)
What two things do gondotrope cells synthesize and release? What happens next?
Gonadotrope cells - synthesize and release
Follicle Stimulating Hormone (FSH)
Luteinizing Hormone (LH)
FSH and LH then travel to the ovary
Where is GnRH made? How is it released? Where does it head next?
GnRH in hypothalamus
GnRH is released in PULSES that correlate with their intended action
GnRH then goes to the Anterior pituitary
Once FSH and LH arrive at the ______. What happens next?
ovary
binds to theca and granulosa cells
What are theca cells? Granulosa cells?
theca cells are the outer shell around the oocyte
ganulosa cells are the inner circle of the oocyte
______ is more responsible for the growth and maturity of the theca and granulosa cells in the oocyte
FSH more than LH
What is folliculogenesis?
the growth and maturity process that a primordial follicle takes on the way to becoming a mature/Graafian follicle
Besides stimulating the growth and development of a follicle, name 3 additional roles of FSH and LH?
FSH and LH also stimulate ovarian production of:
steroid hormones: estrogens, progesterone, androgens
gonadal peptides: activins, inhibins, follistatins
growth factors
What are the 6 roles of estrogens?
- Assist with libido
- Promotes vaginal wall thickness and lubrication
- Maintains health of GU mucosa
other:
reduces acne formation
reduces cholesterol and atherosclerosis
What are the 3 secondary sex characteristics that happen has a result of estrogen?
breast enlargement and areolar pigmentation
mature female body shape: wider hips and narrow waist
increased scalp hair, less body hair
What are the 3 roles of progesterone? What is the most important one to remember?
Major player in maintenance of pregnancy
Decreases uterine contractility: allows it to stretch for a baby
Promotes breast maturation and differentiation
(increase/decrease) progesterone levels trigger ______. (increase/decrease) progesterone levels after pregnancy signal _____
decrease progesterone levels trigger menses
decrease progesterone levels after pregnancy signal lactation
_________ stimulate FSH secretion and are
involved in WBC production, embryo development
activins
______ inhibit FSH secretion. ____ and _____ are considered counterpoints to each other
Inhibins
Activins and Inhibins
______ help regulate gonadotropin secretion and binds to and inhibits activins → less FSH
Follistatins
______ inhibits uterine contractions and relaxes pubic symphysis
relaxin
sudden high level spikes of estrogen result in what? in terms of LH and FSH
increased GnRH and LH and then ovulation happens
decreases FSH
sudden slow gradual increase in estrogen, what happens next? in terms of LH and FSH
decrease in LH
decrease in FSH
What are the 2 hormones that use a positive feedback mechanism?
Estrogen and Activin (estrogen is an outlier and can also use a negative feedback mechanisms)
everything else uses a negative feedback mechanisms (Progesterone, inhibin, follistatin, lactation and estrogen)
______ inhibits GnRH and LH
progesterone
______ and ______ inhibit FSH secretion
Inhibin and follistatin
during lactation, ______ causes increased ______ and altered release of ______
hyperprolactinemia causes increased dopamine and altered release of GnRH
What are the 5 pathologic reasons that can affect the HPO axis feedback?
What is the general age of puberty for female? male? What are the 3 factors that can influence the onset of puberty?
females: 8-13
males: 9-14
Weight and nutritional status
Genetic factors
Abnormal hormone levels
What is adrenarche? Is there any evidence to the naked eye? When does it typically start?
increase in secretion of adrenal androgens, DHEA
NO! can only tell with labs
starts PRIOR to or at ONSET of puberty
in females, what is the first event of puberty? what effect does estrogen have on breasts? progesterone?
thelarche (breast developlement)
estrogen is responsible for enlargement of the breasts (think size)
progesterone: responsible for MATURATION of the lobule and alveoli growth
What is the second event in puberty for females? What is the 3rd event?
2nd: pubarche: developement of pubic and axillary hair
3rd: menarche
typically, how long does a pt NOT OVULATE once they start menarche?
Typically anovulatory for first 12-18 months
How long does the average menstrual cycle last? +/- ____ days
roughly every 28 days
+/- 7 days
**Draw the chart that has the hormone levels depending on the day of the menstrual cycle. Be sure to include what phase is included for the coorelating day
a pt has a menstrual cycle that is typically 35 days, what phase is typically longer than average to account for this change
follicular phase is the one that can changes in length
ovulation and luteal phase duration are normally fixed
How long is the typically follicular phase? What is it called?
varying length (roughly 14 days)
Preovulatory phase
early in the follicular phase, what are FSH and LH doing? _____ begins to enlarge
rise in FSH > rise in LH
SEVERAL follicles begin to enlarge
early in the follicular phase, ____ causes production of inhibin B. What is the result?
FSH causes production of inhibin B
inhibin B decreases release of FSH later in follicular phase
What day is considered midfollicular phase? Why is this significant?
about day 6
1 follicle grows very rapidly, becoming DOMINANT follicle and all other follicles regress to become atretic follicles
When is the FSH level higher than the LH level?
at the VERY beginning of the follicular phase, think day 1
What happens to the follicle as it starts to mature during the follicular phase?
develops LH receptors and releases estrogens
What happens as a result of the rising estrogen levels as the follicle matures?
Rising estrogen levels → increased GnRH pulses →
LH surge → ovulation
**______ hormone is responsible for ovulation
huge spike in LH
What day in the menstrual cycle does ovulation typically occur?
approx day 14
What is a Corpus hemorrhagicum?
a ruptured follicle that fills with blood
What is Mittelschmerz? How would a pt describe it?
blood that is leaking from the rupture follicle irritates the peritoneal lining
a “stinging” pain
Describe the terminology flow of a follicle through a menstruation cycle
Dominate follicle, ovulation, corpus hemorrhagicum, corpus luteum, corpus albicans
the corpus luteum reacts to _____ by making _____ and ______
corpus luteum reacts to LH by making progesterone and estrogen
in the luteal phase, rising levels of estrogen and progesterone result in ????
Rising levels of estrogen and progesterone → negative feedback → decline in FSH and LH -> which leads to atrophy of corpus luteum 3-4 days before menses
What is corpus albicans?
the atrophic corpus luteum
What does a declining level of progesterone lead to?
shedding of endometrial lining (menses)
What are the 3 phases of the uterine cycle? What phase can differ in length?
menstrual phase
proliferative phase** can change in duration
secretory phase
during menses, _____ layer of the endometrium does NOT slough off. What is the technical term for it? What is the outer 2/3rd of the uterine lining called?
deep
stratum basale
stratum functionale
What day does the proliferative phase typically begin? **_____ is a growth factor for uterine endometrium
usually around day 5-16
**estrogen
how does progesterone effect the uterine endometrium? How does it effect your period?
tells the endometrium to mature, NOT GROW
progesterone only birth control usually results in lighter periods because endometrium is THINNER
When does progesterone typically peak?
day 21
What is happening in the secretory phase of the uterine cycle as a result of the estrogen and progesterone from corpus luteum?
endometrium becomes more vascularized, edematous
Glands become coiled, tortuous and secrete clear fluid
during the secretory phase, once the corpus luteum regresses, estrogen and progesterone ______. Then what happens?
decline
vascular spasms → endometrial ischemia
Breakdown of extracellular matrix of strata functionalis and necrosis of endometrium and supplying arterial walls which causes hemorrhage which coalesces into menstrual flow
Draw all chart that shows both the ovarian and uterine cycle on the same page. Consider looking at this again, if needed
How does estrogen affect the cervical mucous? progesterone?
Estrogen: mucus is thinner and more alkaline which enhances survival and transport of sperm
progesterone: mucus is more thick, tenacious and cellular
______ influenced cervical mucus: Dries in a fern-like pattern when spread on a slide
estrogen
______ influenced cervical mucus: NO fern pattern, goop, no discernible pattern
progesterone
As estrogen levels rise in puberty, cervical os opens exposing endocervical _____ epithelium. ______ gradually replaces in 20s-30s due to ______ of vagina
columnar (when it first gets exposed, gradually shifts to squamous)
Squamous metaplasia (normal healthy adult)
acidic environment
How does progesterone and estrogen affect the fallopian tubes?
Progesterone - reduces ciliary beat frequency (CBF)
Estrogen - increases ciliary beat frequency (CBF)
How does progesterone and estrogen affect muscle?
Progesterone - reduces spasms, relaxes smooth muscle, and antagonizes effects of insulin on glucose metabolism
Estrogen - improves skeletal muscle contractility
Both estrogen and progesterone may regulate protein metabolism
Which ovarian hormone is the mediator of fat gain in pregnancy?
progesterone
in sodium/water balance, ______ is responsible for sodium and water retention. _____ is responsible for sodium and water excretion.
estrogen: retention
progesterone: excretion
__________ mediates the first half of the menstrual cycle and ____ mediates the second half
estrogen: first
progesterone: second
If the Y chromosome is not functional,
what gender will a human embryo
develop by “default” (male, female,
or intersex)?
female
longitudinal septum
Tetany of the uterine wall
during pregnancy can
result in what pathologic
outcome?
fetal hypoxia
What hormone causes diminished release of
FSH in the latter portion of the follicular phase?
Inhibin B
What hormone causes
endometrial glands to
become more convoluted
and secrete fluid?
progesterone
