REB Endocrine 2 Flashcards
What main gonadal hormones are produced by males
DHT and testosterone
What main gonadal hormones are produced by females
Estrogen and progesterone
There are several types of Estrogens produced by woman. What is the primary oestrogen in woman
estradiol
GNRH is released from the hypothalamus through
Pulsatile secretions
GNRH causes the release of what is hormones from the anterior pituitary?
Gonadotropins FSH and LH
Where does FSH go after being released by the anterior pituitary and what does it stimulate? (female)
Ovary
Estrogen production
Follicular development
When is LH released? (female)
After ovulation
What is the function of LH (female)
causes the secretion of progesterone and oestrogen production from the corpus luteum
maintains structure and secretory function of corpus luteum
high frequency pulse of GnRH causes the release of
FSH
low frequency pulse of GnRH causes the release of
LH
what is the function of progesterone?
converts endometrium to it’s secretory stage, prepares uterus for implantation
what cells secrete inhibin? where are these cells located?
granulosa cells
ovary
what does inhibin inhibit?
FSH secretion
what are the stages of the menstrual cycle?
- menses
- follicular phase
- ovulation
- luteal phase
what is menses
shedding of endometrium
important events of follicular phase
ovum maturation
endometrium proliferation (thickening)
increased estrogen levels
during the ovulation phase, there is a surge of
LH
the surge of LH during the ovulatory phase causes
rupture of follicle and small surge in FSH
in the luteal phase, there is an increase in
progesterone secretion
the increase of progesterone secretion in the luteal phase causes inhibition of release of
gonadotropins (by negative feedback)
what happens if there is no implantation in the luteal phase
progestesterone secretion stops
induces menses
what happens if there is implantation in the luteal phase
corpus luteum persists and continues to secrete progesterone
maintains pregnancy
what are the changes of body temperature observed after ovulation? what is the importance of this?
increased by 0.3°C
increases the chance of conceiving
FSH has a positive relationship with ___
LH has a positive relationship with ___
estrogen
progesterone
when do inhibin levels peak
after ovulation
what is the relationship between inhibin and estrogen levels
inversely proportional
what hormone aids in the development and maintenance of sex characteristics in females
estrogen
what are some common sex characteristics of females
breasts body hair sweat glands thigh muscles behind femur low hip-waist ratio more fat around butt, thigh, hips
what hormone controls ovarian and uterine cycles
estrogen
what hormone stimulates linear bone growth (puberty)
estrogen
what are the types of estrogens produced and in what quantity (%). in what stage of a female’s life is each type released
estrone - (E1) - 10% - menopause
estradiol - E2 - 80% - NORMAL
estriol - E3 - 10% - during pregnancy
estradiol regulates what phase of the menstrual cycle
follicular phase
estradiol is regulated by what hormone
FSH
other than ovaries, where is estrogen produced
adipose tissue
adipose tissue estrogen through what type of reaction. what enzyme catalyses this reaction?
aromatization
aromatase - CYP19a1
what type of estrogen is made in adipose tissue
estrone - E1
estrone is made from what hormone
androstenedione
what type of estrogen is made in ovaries
estradiol - E2
estradiol is made from what hormone
testosterone
what is the purpose of aromatase inhibitors
used to prevent estrogen from forming cancers in post-menopausal women
how does estrogen aid in fertility control
ovum maturation and development
the timing of the follicular phase is controlled by E2
how does estrogen aid in the preparation of the uterine wall
proliferation of the endometrial lining and induction of progesterone receptors to allow for progesterone sensitivity in the luteal phase
how does estrogen inhibit FSH release
by negative feedback on the ant pit
what is the metabolic action of estrogen
similar to mineralocorticoids
retention of Na+ and water
what is the action of estrogen on lipids
increases HDL in plasma
decreasing LDL and cholesterol concentration
estrogen increases blood coagulability by
increase in the number of clotting factors
what is the effect of estrogen on bone, skin and blood vessels
maintains bone density and elasticity of skin and blood vessels
progesterone is secreted by the ____ during the cycle and by ____ during pregnancy
corpus luteum
placenta
what is the function of progesterone
supports gestation and embryogenesis
maturation of the endometrium
gonadotropins are produced and secreted by
gonadotropes in the ant pit
or by the chorion and placenta during pregnancy
what are the gonadotropins produced
FSH
LH
HCG
what type of hormones are gonadotropins
glycoprotein
what subunits are in gonadotropins and what is their significance
alpha and beta
alpha is common
beta is different
LH and HCG have similar beta –> same target tissue –> same response (increase progesterone)
why can LH and HCG act on the same target tissue
similar B group
LH and HCG both increase the secretion of what hormone
progesterone
what controls the secretion of FSH and LH
GnRH and GnIH
negative feedback form androgens and estrogens
describe the pulses of GnRH in males and females
females - low f - FSH
high f - LH
male - constant pulses
describe GnRH activity in children
very low and is activated at puberty
what ant pit hormones do both males and females produce
FSH
LH –> ICSH
what is the function of FSH in males
targets sertoli cells to promote spermatogenesis
what is the function of ICSH or LH in males
causes secretion of testosterone and other androgens
testosterone is the precursor of
DHT
testosterone has negative feedback to the
AP and Hypothalamus
what is the result of too much testosterone
infertility
what is testosterone produced by
what hormone stimulates its release
interstitial cells
ICSH
interstitial cells convert testosterone to
what enzyme is used
DHT
5 alpha reductase
DHT is present at ___ the concentration of testosterone in plasma
1/10th
androstenedione is produced by the
adrenal cortex
the adrenal cortex produces androstenedione
what else does it produce
DHEA
what hormones are formed from testosterone and in what amounts (%)
DHEA (10%)
estradiol (0.3%)
Inactive metabolites (90%)
is androstenedione less potent than testosterone?
YUP
what hormone is a major source of androgens in females?
androstenedione
what are the common secondary sexual characteristics in males
muscles in thigh at front of femur shoulder wider than hips heavier skull and bones higher waist-hip ratio enlargement of larynx for deeper voice
what is the result of a 5 alpha reductase deficiency
no synthesis of DHT
- -> boys born with ambiguous external genitalia but will have normal ducts and internal structures
- things still develop normally at puberty
what is the importance of DHT in males
formation of male external genitalia during embryogenesis
CAH is a deficiency in
21OH and 11B-OH
what is the result of CAH
increased androgen production
- electrolyte imbalance
- salty urine
- early puberty in boys, ambiguous genitalia in girls
explain how hormones aid in the maintenance of the endometrial lining in pregnancy (start from the beginning of the cycle)
FSH –> estrogen –> estrogen burst –> increased LH –> ovulation –> corpus luteum –> estrogen and progesterone
after ovulation, the ovum is picked up by the ______ and enters the ______
fimbriae of fallopian tube
oviduct
where does fertilisation of the ovum occur
ampulla in the upper 1/3 of it
how long after ovulation can fertilisation occur?
24 hours
how long does sperm last in a female
48 hrs-5 days
how much sperm (%) gets to the uterus and how much gets to the ampulla
- 1%
0. 001%
the ovum is surrounded by how many layers?
2
what the layers surrounding the ovum? describe them
- corona radiata - yellow layer of follicular cells
2. zona pellucida - matrix of glycoproteins
fertilization occurs when the sperm binds to a ____ in the zona pellucida
sugar group
** ZP3 receptor
describe the steps of fertilization
- fertilizing sperm penetrates the corona radiata using enzymes found on its head and binds to the ZP3 receptor on the zona pellucida
- binding of sperm to the receptor triggers acrosome reaction where enzymes located in acrosome of sperm are released on the zona pellucida and digests it
- once the sperm reaches the ovum, the plasma membranes of the 2 cells fuse allowing the sperm nucleus into to the ovum cytoplasm
- the sperm stimulates release of CA2+ stored in cortical granules in the ovum which in turn inactivates ZP3 receptor, blocking sperm
what is the effect of the binding of sperm to the ZP3 receptor
triggers acrosome reaction where enzymes located in acrosome of sperm are released on the zona pellucida and digests it
in fertilisation, what mechanism prevents the binding of additionals sperm after the binding of the 2 nuclei
sperm stimulates release of CA2+ stored in cortical granules in the ovum which in turn inactivates ZP3 receptor, blocking sperm
to prevent the binding of additional sperm nuclei, the sperm which fertilised the ovum releases Ca2+. where is this Ca2+ stored?
cortical granules
3-4 days after fertilisation, the zygote remains in the ampulla and undergoes _____ to form a ____
mitotic divisions
morula
in the early stages of development, what stimulates the release of glycogen from the endometrium?
what is the function of this glycogen?
rising progesterone levels from the corpus luteum
fxn - energy source for embryo
in the early stages of development, what is the effect of rising progesterone levels from the corpus luteum
stimulates the release of glycogen from the endometrium
at what stage of development (DAYS) does the morula enter the uterus
3-4 days after ovulation
6-7 days after ovulation, what hormone prepares for implantation
progesterone
what is the importance of progesterone 6-7 days after ovulation
to prepare for implantation
when is the endometrium suitable for implantation?
1 week after fertilization
the morula becomes a
blastocyst
what is the inner and outer cell mass of the blastocyst
inner - embryo
outer - trophoblast
what is the importance of trophoblasts?
making fuel (from glycogen) and drawing materials from the embryo they also release enzymes to penetrate the endometrium (deucida) before degenerating its plasma membrane to form the fetal part of the placenta
what forms the fetal part of the placenta
degeneration of the plasma membrane of the trophoblast cells
at day ____, the embryo is embedded within the decidua
12
after implantation, the. trophoblastic layer is now __ layers thick and is called the ____
2
chorion
what does the chorion form
blood supply using maternal blood, forming placental villi
does maternal and fetal blood mix?
NOPE
what forms the placenta
interlocking of chorionic and decidual tissue
importance of placenta
does all the work of the digestive, respiratory, etc systems
although fetus has the necessary structures
secretion of hormones by the placenta is based on
stage of pregnancy
is the secretion of hormones by the placenta subject to extrinsic control?
NOPE
what hormones are secreted by the placenta?
estrogens
progesterone
HCG
HPL
what hormone increases the size of the uterus
estrogen
what hormone increases uterine blood flow
estrogen
what hormone induces the formation of uterine receptors for progesterone and oxytocin
estrogen
what hormone promotes development of ducts within mammary glands
estrogen
what hormone is essential for maintaining uterus and embryo
progesterone
what hormone inhibits myometrial contractions
progesterone
what is the importance of inhibiting myometrial contractions
to prevent miscarriage
what hormone is responsible for the formation of a mucus plug at the cervix?
progesterone
what is the importance of the formation of the mucus plug at the cervix?
prevent vaginal contaminants from entering uterus
what hormone suppresses immunological responses to fetal antigens?
progesterone
what hormone stimulates development of milk glands in preparation for lactation
progesterone
what hormone stimulates and maintains the corpus luteum, preventing it from degenerating?
HCG
what hormone prevents the blastocyst from being flushed out in the menstrual flow?
HCG
what hormone increases progesterone production by trophoblasts?
HCG
what hormone stimulates precursor leydig cells in the male fetus to secrete testosterone for masculinisation of the developing reproductive tract?
HCG
what hormone is eliminated from the body through urine and produces a positive pregnancy test
HCG
HCG levels are maximal at
week 10
HPL is maximal at
week 35
what hormone has lactogenic and GH-like actions?
HPL
what hormone promotes cell specialisation in mammary gland (less potent than prolactin and GH)?
HPL
what is the MAIN function of HPL?
ensure adequate fuel supply for fetus metabolism
the placenta cannot produce estrogen until
fetal adrenal cortex is secreting DHEA in the blood
what molecule, provided by the mother, is used by the fetus to make DHEA
cholesterol
fetal DHEA travels to the placenta where it is converted into
estriol
the level of what hormone is used to assess viability of fetus
estriol
the placenta synthesizes small amounts of progesterone after implantation. what is the relationship between progesterone synthesis and weight of placenta?
progesterone synthesis is proportional to weight of the placenta
there is a notable increase in progesterone synthesis at what month in pregnancy?
3rd
what are the stages of labour? describe them
- longest - cervical dilation to 10cm (up to 24 hours)
- delivery of baby - begins when cervical dilation is complete (30-90 minutes)
- delivery of placenta - second wave of uterine contractions separates placenta from myometrium. - shortest stage - 15-30 minutes after baby
what is the significance of the baby being born head first?
to ensure sufficient pressure at cervix for dilation
during labour, what is the importance of the the second wave of uterine contractions?
separates placenta from myometrium
what is the role of progesterone in labour
inhibits uterine contractions to prevent miscarriage
what alters the effective concentration of progesterone?
rise in placental progesterone-binding protein
decline in the number of myometrial progesterone receptors
what is the role of estrogen in labour (3) comment on the levels
- levels rise dramatically and promote the synthesis of connexons within uterine smooth muscle cells
- dramatic increase of oxytocin receptors for positive feedback on contractions
- promotes the production of prostaglandins which contribute to cervical ripening and increases responsiveness to oxytocin
what is the role of prostaglandins in labour?
contribute to cervical ripening and increases responsiveness to oxytocin
what is the role of oxytocin in labour? comment on the levels
- circulating levels of oxytocin remains constant prior to onset of labour
- leads to more frequent and stronger contractions until fetus has passed
- stimulates prostaglandin release
what is the role of relaxin in labour and where is it produced?
produced by corpus luteum and decidua
assists in permitting passage of fetus through cervix and increases oxytocin receptors
what hormones increase oxytocin receptors?
estrogen
relaxin
cervical stretch stimulates the release of what hormone?
oxytocin
when is labour initiated? (in relation to oxytocin levels)
labour is initiated when myometrial responsiveness to oxytocin reaches critical threshold
the breast is an ____ gland which provides nutrients and immunity
exocrine
what are the layers of the breast tissue? (with functions)
inner - lobular luminal epithelial cells which produce milk
outer - myoepithelial cells which provides structural support to lobules and assists in milk secretion
what layer of breast tissue is responsible for milk production
inner - lobular luminal epithelial cells
what layer of breast tissue provides structural support and assists in milk secretion
outer - myoepithelial cells
what do the layers of the breast tissue form
tubuloalveolar glands organised into lobes
each lobe drains into a _______ that dilates into a _______ onto the areola
lactiferous duct
lactiferous sinus
trace the passage of milk from production to the areola
RER –> golgi –> secretory vesicles –> alveolar lumen –> lactiferous duct –> lactiferous sinus –> areola
what is the breastfeeding recommendation
feeding up to 6 months
mixed until 2 years
what is the principal hormone responsible for lactation
prolactin
PRL secretion is stimulated by
TRH
PRH
progesterone
suckling (positive feedback)
PRL secretion is inhibited by
PIH
dopamine
comment on the levels of prolactin during pregnancy
increases gradually throughout pregnancy with increased nighttime secretion
prolactin inhibits what hormones
what is the overall result of this?
FSH
LH
inhibiting ovulation
hyperprolactinemia can be due to ____
why?
hypothyroidism
low feedback of TH on TRH –> increased TRH secretion, increased PRL secretion
what is the effect of hyperprolactinemia
infertility
galactorrhea (inappropriate lactation)
what are the 3 phases of maternal breast changes
- mammogenesis
- Lactogenesis I, II and III
- galactogenesis
what changes occur during mammogenesis
development of ducts and alveolar systems by pregnancy hormones
what hormones are involved in mammogenesis and what are their functions
prolactin –> milk production (completes cellular differentiation and lactogenic capacity)
estrogen –> duct formation
progesterone –> completes alveolar systems of mammogenesis
insulin –> required for multiplication of epithelial cells and lobular structure
what is the main occurrence in lactogenesis
how many phases are there?
milk secretion - this occurs on 3 phases
describe lactogenesis I
mid pregnancy until 30 hours after birth - capable of lactogenesis but high progesterone levels inhibit release
describe lactogenesis II
30 hours –> 2-3 months
delivery of placenta decreases progesterone, estrogen and HPL levels and increase milk production and secretion
what is the effect of placenta delivery on hormones
delivery of placenta decreases progesterone, estrogen and HPL levels
describe lactogenesis III
what type of regulation is this?
from 2-3 months of age
as long as milk is being secreted (suckiling), milk will be produced
autocrine regulation
describe the synthesis of milk.
what is it catalysed by and where is this enzyme found?
2 glucose molecules needed
1 becomes UDP glucose and then UDP galactose
the other remains unchanged
it is catalysed by Lactose Synthase which is found in the mammary glands
what is lactose synthase composed of and what is the importance of eacg
- galactosyl transferase - catalytic component
2. alpha lactalbumin - regulatory component - increases PRL
what changes occur in galactogenesis
milk let down caused by activation of neurosensory reflex
what stimulates the release of oxytocin from the posterior pit
suckling
cortical inputs eg. baby crying
fxn of oxytocin
contraction of myoepithelial cells
what are the components of human milk
carbs - lactose and oligosaccharides
milk fat - TGs
proteins - casein, whey proteins, secretory IgA, alpha lactalbumin
others - growth factors
what components of human milk is not found in formula?
lactoferrin protein, growth factors, lipase and polyunsaturated fats
instant formula is from cow milk but the _______ balance is altered and ______ is added.
there is also replacement of dairy fat with _____
protein
immune fortification
vegetable fat
what is colostrum and comment on its components
yellow liquid produced which is low in fat and high in carbs and proteins
it has a high concentration of antibodies (especially IgA)
what is the importance of a high concentration of antibodies in colostrum
important in preventing jaundice
after colostrum, __________ is produced for a few days before becoming mature
transitive milk
what is weaning?
reduction of breast milk and/or replacement with solid food
how long before the introduction of cow’s milk should formula be used?
12 months
what is the mechanism of action of synthetic estrogen
steroid hormones –> intracellular receptors ERalpha and ERbeta
how can synthetic estrogen be given
orally
IM
IV
etc etc
stilbestrol is an example of
synthetic estrogens
mestranol is an example of
synthetic estrogens
ethinyl estradiol is an example of
synthetic estrogens
do natural estrogens degrade more rapidly than synthetics
YUP
what are the main clinical uses of synthetic estrogen
contraceptives and replacement therapy due to primary ovarian failure or secondary ovarian failure
as a contraceptive, estrogen is usually given with
progesterone
what is secondary ovarian failure
menopause
what is an example primary ovarian failure
turner syndrome
what are the side effects of taking synthetic estrogens
edema (increased water retention)
increased Bp
increased thromboembolism
increased cancer
tamoxifen is an example of
antiestrogen
what is the use of tamoxifen
combat estrogen-dependant tumours and reduces fractures (affected by cancer)
clomifene is an example of
antiestrogen
what is the use of clomifene
induce ovulation
fertility treatment
if an individual is a heavy smoker, what synthetic hormone should they not take
synthetic estrogen
other than heavy smokers, individuals with what other medical conditions should not use synthetic estrogen?
tumors
liver disease
history of thromboembolism
can natural progesterone be taken orally?
nope
what are progestogens
derivatives such as testosterone derivatives are used
**they give androgen activity
desogestrel is an example of a
progestogen
**testosterone derivative
desogestrel has less side effects but has an increased risk of
thromboembolism
what are some clinical uses of progestogens
contraception
hormone replacement therapy
endometriosis (prepares endometrium for implantation)
mifepristone is an example of
antiprogestogens
what is the function of mifepristone
acts as a competitive antagonist or as a partial agonist (in the absence of progesterone) used to terminate uterine pregnancies
what are the common types of oral contraceptives (4)
- combined pill
- progestogen-only pill
- long-acting progestogen
- emergency post-coital contraception
what is the combined pill? when is it taken?
it has estrogen and a progestogen
taken for 21 consecutive days and 7 days without
how does the combined pill work?
estrogen inhibits FSH release and development of the ovarian cycle
progestogen will inhibit LH release and prevent ovulation and makes mucous inhospitable to sperm
progestogen withdrawal for 21 days will cause menstruation
what are some side effects of the combined pill
weight gain nausea mood changes pigmentation ** LIMITED TO THE FIRST FEW CYCLES
which hormone in the combined pill inhibits FSH release and development of the ovarian cycle
estrogen
which hormone in the combined pill will inhibit LH release and prevent ovulation and makes mucous inhospitable to sperm
progestogen
what is the progestogen only pill and how often is it taken?
norethisterone
taken everyday, no interruption
how does the progestogen only pill work?
makes cervical mucus inhospitable to sperm, hinders implantation, inhibits LH and ovulation
is the progestogen-only pill more or less reliable than the combined pill?
very slightly less reliable
which pill can be taken as an oral contraceptive if the patient has an estrogen contraindicatio?
progestogen only pill
what are the side effects associated with the progestogen only pill?
irregular menstruation
risk of ovarian cyst
how is long-acting progestogen given to a patient?
injectable
subdermal implant
how does the injectable long-acting progestogen work and how often is it taken? are there any side effects?
slowly released into systemic circulation following IM injections
taken every 3 months and is effective
menstrual irregularities are common
Can the injectable long-acting progestogen be taken long term? why?
NOPE
causes reduction on bone mineral density
also affects mucus hospitality and ovulation
how does the subdermal long-acting progestogen implant work and how often is it taken?
implanted subcutaneously and released over 3 years
side effects of the subdermal long-acting progestogen implant
irregular bleeds
headaches
what is the mechanism of action of emergency post-coital contraception
if taken in the:
- first half of cycle - prevents ovulation
- second half of cycle - delays movement of edd and thickens cervical mucus
can emergency post-coital contraception be used in an established pregnancy?
NOPE
what are the types of emergency post-coital contraception?
- progestin-only pill
2. 5-day pill
when should the progestin-only pill be taken?
what are some common side effects
must be taken within 72 hours
**efficacy decreases over time
side effects
nausea
weight gain
what is the 5-day pill
prevents pregnancy up to 5 days after
it is a progesterone receptor modulator
ulipristal acetate (ella one) is an example of
5-day pill
differentiate between
progesterone
progestogen
progestin
progesterone - natural hormone
progestogen - synthetic hormone
progestin - in the “day after”pill
what can cause contraceptive failure?
change in absorption or in clearance
what enzyme metabolises OCP
CYP450
Rifa-x is a
CYP enzyme-inducing antibiotics
what should the patient do of they experience vomiting and diarrhea while taking OCPs
7 day rule