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Reproductive Physio Flashcards

1
Q

what happens first in female pubertal development?

A

thelarche- breast budding (coincides with increase in estrogen)
then adrenarche - pubic hair

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2
Q

when does menarche occur?

A

first menses- between 11-14, average 12.5 (later than 2.5 years after beast development is abnormal)

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3
Q

when is puberty considered precocious? what is a concern?

A

6 for girls, 9 for boys

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4
Q

when does no pubertal development warrant investigation?

A

13 years old and no breast development

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5
Q

What difference in tanner stages between tissues is abnormal?

A

> 2

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6
Q

What is the first sign of male pubertal development

A

increase in testicular volume >3 ml (increased FSH); tanner stage 2

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7
Q

Normal menstrual cycles depend on _____ feedback provided by estrogen to the hypothalamus and pituitary

A

positive

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8
Q

important tanner stages for breasts

A

3- adult but smaller

4- nipple froms secondary mound

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9
Q

during what tanner stage does pubic hair become coarse and curly and extend to pubis?

A

tanner 3

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10
Q

lab evaluations for precocious puberty

A
  • bone scan (looking for advanced skeletal maturation)
  • brain MRI
  • labs w/ and w/o stimulation (FSH/LH/testosterone/DHEA)
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11
Q

when does menarche occur?

A

first menses- between 11-14, average 12.5 (later than 2.5 years after beast development is abnormal)

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12
Q

pathway of sexual differentiation

A 
genetic sex (chromosomes) 
gonadal sex (testes/ovaries) 
genital sex (external genitalia)
gender sex (behavior)
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13
Q

what is required for testicular development?

A

SRY on Y chromosome

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14
Q

what is required for ovary development?

A

two X chromosomes (still get female ducts & genitalia b/c default pathway is female, don’t have Y, progression to female structures occurs when male hormones are absent)

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15
Q

when does the female germ cell arrest?

A

during meiosis 1, substage of prophase

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16
Q

what is the product of male vs female meiosis?

A

Male- 4 daughter cells/germ cell (spermatogenesis)

Female- 1 daughter cell/germ cell + polar body

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17
Q

what does normal sperm development require?

A

reduced body temperature

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18
Q

what are some defects in genetic sex?

A
  • aneuploidy- # chromosomes
  • mosaicism- different genotypes in different cells
  • chimerism - fused zygotes
  • structural errors- unequal recombination
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19
Q

T/F Sexual dimorphism of phenotypic sex due to male vs female hormones/receptors

A

False- due to differences in the amounts of hormones and patterns of secretion

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20
Q

what happens if, while genital ducts are maturing they encounter testosterone? antimullerian hormone?
what produces each?

A

w/ testosterone from leydig cells (normally from testes), keep wolffian ducts

w/ antimullerian hormone from sertoli cells- degrade mullarian ducts

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21
Q

what happens if, while genital ducts are maturing they encounter no testosterone or antimullerian hormone? (aka have no testes)

A

no testosterone- wolffian ducts regress

no AMH- keep mullarian ducts, develop fallopian tube, cervix, upper vagina

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22
Q

what does 5 alpha reductase do?

A

converts testosterone to more potent DHT, which is important for male genitalia development via androgen receptors

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23
Q

what does finesteride (propecia) block?

A

5 alpha reductase; DHT has mitogenic effect on prostate gland, can cause benign prostatic hypertrophy
BUT
if encountered by fetus, can prevent male external genitalia development

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24
Q

differentiation of external genitalia?

A
  • genital tubercle- citorus/glans penis
  • urogenital folds- labia minora/ventral penis
  • labioscrotal folds- labia majora/scrotum
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25
male psudohermaphroditism and example
if testes + some/all female tract, female external genitalia e.g. androgen resistance - no public hair, undescended testes
26
what is turner's syndrome?
2nd x chromosome is inactivated, get streak gonads instead of ovaries
27
female pseudohermaphroditism
if ovaries + some/all of male tract+ male external genitalia e. g. adrenal hyperplasia/virilizing ovarian tumor in mom - clitoral hypertrophy, get fusion of urogenital sinus - androgens lead to advanced skeletal age
28
describe kleinfelter's syndrome
XXY - phenotypic male w/ no seminiferous tubule development, low testosterone, long legs, flat topped pubic hair
29
where does spermatogenesis occur?
seminiferous tubules
30
what do germ cells become?
spermatogonia in male, oogonia in female
31
what do coelomic epithelium cells become?
sertoli cells in male, granulosa cells in female (nurse cells)
32
what do mesenchymal cells become?
leydig cells in males, theca cells in females (hormone cells)
33
what converts testosterone to estadiol?
aromatase
34
what converts testosterone to DHT?
5 alpha reductase
35
what does testosterone do during fetal development?
epididymis vas deferens seminal vesicles
36
what does DHT do during fetal development?
penis/urethera scrotum prostate
37
what does testosterone do during puberty?
``` penis seminal vesicles musculature voice skeleton spermatogenesis ```
38
what does DHT do during puberty?
``` scrotum prostate male pattern baldness happy trail beards sebaceous glands ```
39
T/F Hormones come from the testes and seminal vesicles
FALSE- only from the testes
40
spermatogenesis
process of sperm production
41
spermiogenesis
cellular remodeling of spermatids into spermatazoa - get nuclear condensation - shrink the cytoplasm - form the acrosome - develop the tail
42
spermeation
extrusion of flagellated spermatozoa into the lumen of the tubule - residual body is formed
43
what are intracellular bridges?
connect secondary spermatocytes to sertoli cells; synchronizes development of a group of cells, allows sharing of resources
44
what does the first meiotic division produce in men? the second?
first- secondary spermatocytes with 23 chromosome pairs | second- spermatids with 23 single chromosomes
45
what is the acrosome?
a cap of membranes containing digestive enzymes
46
function of the epididymis
- sperm maturation (gain motility, lose cytoplasm) - reservoir for sperm - stabilize acrosome
47
function of prostate
- secrete alkaline fluids to neutralize vagina | - makes PSA (prostate specific antigen)
48
function of seminal vesicle
- secrete prostaglandins which stimulate uterus & fallopian tube contraction
49
describe the male neuroendocrine axis
hypothalamus (arcuate and POA)- GnRH pituitary (gonadotrophs)- FSH/LH gonads- testosterone in men, estradiol in women
50
what kind of feedback do the gonads provide?
``` negative on hypothalamus/pituitary * testosterone/estradiol * follistatin * inhibin positive on pituitary * activin ```
51
what stimulates the hypothalamus in the gonad endocrine pathway?
stimulated by: NE (norepinephrine) | inhibited by: dopamine/endorphins
52
what are leydig cells stimulated by and what do they do?
- stimulated by LH to secrete testosterone - GPCR/PKA mechanism to increase transcription - also increases expression of carrier protein & activating protein - stimulated indirectly by FSH-inhibin
53
what are sertoli cells stimulated by and what do they do?
- stimulated by androgens and FSH to facilitate sperm development - GPCR/PKA mechanism to increase transcription - also increases androgen binding protein/androgen receptors - activates aromatase, converting testosterone to estradiol - increases growth factors - increases inhibin, AMH
54
what is the paracrine function of inhibin?
stimulates testosterone secretion (activin inhibits testosterone secretion)
55
what happens if spermatogenesis is too fast?
germ cells stimulate sertoli cells to increase inhibin (acts on hypothalamus/pituitary)- decreases spermatogenesis
56
erection is under ___ control releasing __ and __ which produces ___, leading to vasodilation
parasympathetic, Ach, NO, cGMP
57
emission is under ___ control
sympathetic; direct innervation by alpha adrenergic receptors
58
ejaculation is under ____ control
spinal reflex: - entry of semen - afferents reach S2-S4 - trigger pudendal nerve - get rhythmic contractions of ischio and bulbo muscles
59
what is primary hypogonadism?
- hypergonadotropic hypogonadism - high LH/FSH, decreased testosterone/DHT includes * defective antrogen synthesis * kleinfelters (XXY) * hermaphroditism
60
what is secondary/tertiary hypogonadism?
- hypogonadotrophic hypogonadism - decreased LH/FSH, decreased testosterone/DHT includes * Kallmann's syndrome * hyperprolactinemia * anorexia * estrogen supression of LH
61
what does the follicle consist of?
- one oocyte surrounded by a cluster of granulosa cells
62
stages of follicular development
- primordial follicle- inactive, 90-95% - primary follicle- gains granulosa cells, oocyte grows - secondary follicle - a couple induced by FSH, antrum forms - graafian (mature) follicle - antrum enlarges, one is dominant, exponential growth
63
events of ovulation
- follicle ruptures, proteolysis of basement membrane, oocyte in peritoneal cavity - fimbriae draw oocyte in - meiotic division is completed - other follicles die - corpus luteum is formed
64
what does the corpus luteum secrete?
progesterone (moderate levels of estradiol and inhibin A)
65
how is inhibin involved in the female pathway? two types?
- produced by granulosa cells of follicle following stimulation by FSH - inhibin inhibits FSH release by gonadotrophs inhibin B- dominant follicle inhibin A- corpus luteum - lull between the two at ovulation
66
dominant estrogen in ovary
estradiol (E2) - from cholesterol, aromatase is necessary, transported via SHBG
67
where does GnRH come from? what is it inhibited/stimulated by?
- arcuate nucleus and preoptic area of hypothalamus; - inhibitors: dopamine, endorphins, CRH stimulator: NE
68
what type of neurons is oxytocin secreted by?
magnocellular
69
describe GnRH's actions in pituitary
- cuts phospholipase into IP3 and DAG 1) IP3 releases Ca2+ from ER, causes exocytosis of FSH/LH vesicles 2) DAG activates PKC which increases the synthesis of FSH/LH
70
T/F Have distinct gonadotrophs for FSH and LH
FALSE
71
what does FSH do?
stimulate follicular development | estradiol secretion
72
what does LH do?
promotes ovulation and leutinization
73
What inhibits activin?
follistatin
74
what hormones do you find in the ovaries?
- estrogens - progesterone - androgens (testosterone, DHT, DHEA) - inhibins and activins and follistatin
75
3 menstrual phases
follicular (cycle length differences), ovulatory (1-3 days), luteal (14 days)
76
hormone actions during follicular phase
1) GnRH causing FSH/LH release (pulsatile) 2) increasing FSH/LH stimulate ovary to develop follicle 3) follicle secretes E2 (estradiole) 4) E2 has positive feedback on follicle BUT 5) E2 has negative feedback (with inhibin) on pituitary/hypothalamus on FSH cells - keeps volume down as capacity builds (LH rising)
77
hormone actions during ovulatory phase
1) E2 gets past a certain threshold for a sustained period of time, switches to positive feedback (timing determined by ovary) 1b) increase GnRH receptors on gonadotrophs 2) get LH surge - reinforcing self and E2 3) causes rupture of follicle 4) everything dips because it's all disorganized
78
hormone actions during luteal phase
1) corpus luteum becomes dominant- makes E2 (not as high as surge) and progesterone (off the charts) 2) switch back to inhibition, get little LH/FSH/GnRH 3) no LH causes corpus luteum to degrade 4) once CL degrades, lose E2 and progesterone, FSH levels recover 5) lose functional endometrial layer
79
which hormone prevents the corpus luteum from degrading?
HCG
80
what happens to androgens during the menstrual cycle?
testosterone bumps at the end of the follicular phase, increasing libido during ovulation
81
modes of gonadotropin release in males vs females
males- tonic mode- low, pulsatile LH release | females- surge mode- periodic, massive LH release
82
what are the relative ratios of LH:FSH throughout life?
FSH>LH during childhood LH>FSH during reproductive period FSH>LH in menopause (and in old males)
83
What does a lack of LH/FSH receptors or lack of estrogen cause?
primordial follicles without primary follicles
84
what are the actions of estradiol secreted by the dominant follicle?
- inhibits growth of other follicles - makes mucus thin - prepares fallopian tubes - potentiates action of progesterone so uterus goes into secretory mode - primes GnRH action on LH surge to get more LH
85
what is the 2 compartment theory?
theca cells take up cholesterol, make androstenedione, release it to granulosa cells, which have aromatase to convert testosterone to estradiol
86
how does the corpus luteum start to form during follicular phase?
- increase LH receptors on theca cells due to FSH actions - LH converts granulosa and theca--> lutein cells - lutein cells make lots of progesterone and estradiol
87
phases in terms of endometrial functions?
proliferative, secretory, ischemic
88
what hormone dominates in proliferative phase?
estradiol
89
what hormone dominates the secretory phase?
progesterone - shift to secreting glycogen, mucus, increasing vascularization
90
what changes the viscosity of cervical mucus?
estrogen's actions in follicular phase
91
what happens during menopause?
- loss of negative feedback from estradiol - cause massive increase in FSH/LH - still have pulsatile secretion but no cyclicity causes: osteoporosis, CV disease, decreased breast mass, vascular flushing
92
risks/benefits of hormone replacement therapy
- when given late, can increase CHD, stroke, breast cancer (but decreases bone breaks) - when given early, might be beneficial

Physiology (22 decks)

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