Week 3 Flashcards
What do fetal testes secrete that cause regression of female related ducts?
Mullerian inhibiting factor
What part of the prostate is susceptible to BPH?
Infections?
Cancer?
Involved with continence?
Transitional
Central
Peripheral
Anterior Fibromuscular stroma
What secretion from the male testes induces male phenotype?
Androgens (primarily testosterone)
What stimulates the burst of m-inhibiting factor and testosterone from the fetal testes?
LH and FSH
When does the sexual dimorphic change in the brain occur?
Six months-burst of gonadotropins
How does puberty start in males?
GnRH neurons–>LH & FSH bursts
Increase gonadotropins–>sperm production and steroidogenesis
Androgen secretion–>secondary sex characteristics
Where is most 5-alpha reductase activity?
Target tissue (there is some in testes though)
What inhibits gonadotropin secretion?
Prolactin
Testosterone and growth? How are they related?
1) stimulate increase in GH that stimulates linear growth (IGF1)
2) growth plate closure
Major stimulator of spermatogenesis
FSH stimulation and local testosterone stimulation
What cell does LH stimulate?
FSH?
Leydig cell (testosterone and stimulates Sertoli cell) Sertoli cell (inhibin-inhibits FSH release)
What is the purpose of ABP?
Increases local testosterone concentration
What happens if the SRY does not express in a fetus?
Absence of Y chromosome leads to formation of ovaries.
Formation leads to absence of androgens and MIF.
Wolffian ducts regress and Müllerian ducts form.
After ovulation, what do the cells that remain in the follicle form?
corpus luteum (rich in steroidogenic cells)
When do the number oogonia peak in the fetal ovary?
How many are there?
How many are present at birth?
6 months of fetal development
7 million
600,000
What stimulates oogonia production in ovaries?
hCG from placenta
fetal FSH and LH
What is secreted by the pituitary before the first menstrual cycle?
FSH, LH (induce ovarian function)
What are the primary secretory products of the ovary?
Which estrogen is usually only found in significant amounts in pregnant women?
Estradiol and estrone
Estriol
Which gonadal steroids bind mostly albumin?
Which gonadal steroids bind mostly to SHBG?
Which gonadal steroid binds CBG a bit?
Estrogen and androstenedione
Testosterone and DHT
Progesterone (still more to albumin)
What “wakes up” hypothalamus in girls to produce GnRH (pulsatile)?
Theory: signals from adipose tissue (leptin etc.)
What do GnRH pulses increase?
FSH and LH
What happens if hCG is not released by trophoblast into blood?
corpos luteum dies
progesterone and estrogen decrease
What provides the negative feedback to FSH (and LH)?
estrogen being secreted from dominant follicle
When does the switch from estrogen inhibiting LH and FSH to stimulating LH occur?
estrogen peak (switch in hypothalamus-pituitary) Inhibin preferentially inhibits FSH (from ovaries) so smaller surge
What cells do LH act upon?
FSH?
Theca cells (produce androgens) Granulosa cells (stimulate aromatase activity)
What stimulates follicular phase of myometrial cycle?
Secretory phase?
Estrogens
Progesterone
When does hCG peak?
first trimester of pregnancy
3 main functions of male reproductive system
1) produce and store male gamete
2) produce male sex hormones (androgens)
3) deliver male gametes to female reproductive tract
Two type of cells in seminiferous tubules
germinal/spermatogenic
sertoli
Three phases of spermatogenesis
spermatocytogenesis
spermatocyte (meiosis)
spermiogenesis
What drives spermiation?
actin mediated contraction of Sertoli cells
How many cycles of the seminiferous epithelium cycle are needed to form a mature sperm?
four
How are the following hormones involved with the testes? FSH LH Testosterone Inhibin B
- Maturation of Sertoli and Leydig cells, maintain spermatogenesis
- Synthesis and release of testosterone by interstitial cells
- Maintains spermatogenesis, male duct morphology/function, accessory sex gland structure/function, secondary sex characteristics
- Modulate FSH release
Factors affecting spermatogenesis
premature thickening of tunica propria steroid hormones and related meds infections radiation diet deficiency toxic agents elevated testicular temp
What mediates smooth muscle relaxation in an erection?
What mediates flaccidity(detumesence)?
NO and PDE2
PDE5
Aromatase deficiency in men causes what?
Osteoporosis (epiphyses do not close)
Treat with estradiol
Why can’t testosterone be given orally?
High first pass effect, catabolized by liver
Side effects of testosterone
acne, gynecomastia, more aggressive sexual behavior, growth plate closure
What drug is good for treating angioedema?
Stanozol
17-alkylated androgens stimulate synthesis of C1-esterase inhibitor
Side effects of steroid abuse
diminished fertility, diminish testicular size, gynecomastia
17-alkylated androgens–>hepatotoxicity
What are androgen receptor antagonists used in conjunction with?
GnRH analog
What drugs should not be combined with PDE5 inhibitors?
Organic nitrate vasodilators
can cause extreme hypotension
Which of the drugs don’t have trouble with avoiding the first padd effect/hepatic metabolism?
17-alpha alkylated testosterones
stanozolol
Most common neoplasm in males in reproductive age
testicular neoplasms
What are the nonseminomatous testicular tumors?
embryonal
yolk sac
choriocarcinoma
teratoma
Second most common germ cell tumor?
Most common germ cell tumor in infants?
Which is worse: mature or immature teratoma?
Which metastasize to brain and lungs?
embryonal
yolk sac
immature
choriocarcinoma
Most common malformation of penis?
hypospadias
ventral surface
Which squamous cell carcinoma in situ does not invade?
bowenoid papulosis
What is the first test you should do with a male with premature puberty?
What is the diagnosis if the levels are elevated?
LH
If elevated, GDPP (gonadotropin dependent)
What should you administer if LH levels are not elevated in premature puberty?
GnRH agonist
What nerves provide the sympathetic innervation to the bladder?
hypogastric nerves
What parts of the brain control the micturition reflex?
Pons-facilitative and inhibitory
Cerebral cortex-mainly inhibitory
What can a lesion between the sacral spinal cord and brainstem/pons cause?
What can a lesion in the brain above the pons cause?
What can a lesion below the sacral spinal cord cause?
- hyperactive bladder or detrusor-sphincter dyssynergia
- hyperactive bladder
- damages micturition reflex
Host defenses against UTIs?
flow of urine
AMPS
Tamm-Horsfall protein
exfoliating bladder epithelia
Bacteria seen most often in hematogenously spread UTIs?
staph aureus
candida
mycobacterium tuberculosis
What increases for UTI?
reduced urine flow
promote colonization
facilitate ascent
What do e.coli pili adhere to in a UTI?
(type 1 pili) mannose in urinary epithelial mucupolysaccharide lining and to PMNs
Mechanical issues the predispose to UTI?
urethral length, completeness of bladder emptying, integrity of natural uretervesical junction valve
Biochemical properties that make bacterial survival difficult in urine?
acid pH, high urea content, high osmolality
Nitrite in urine indicates what type of bacteria in UTI?
gram negative
What (mentioned) drug has the highest concentration in urine? What (mentioned) drug has the lowest?
Cabrenicillin
Nitrofurantoin
In what phase of spermatogenesis does genetic recombination occur?
Pachytene phase
How long does it take for maturation of the sperm?
90 days
What are responsible for the only source of fructose in semen?
seminal vesicles
How many semen analyses should a patient have?
At least two
What should all men with azoospermia or severe oligospermia be offered (test)?
karyotypic and genetic testing, including evaluation of Y chromosome microdeletions
Two more common genetic alterations associated with male infertility
Klinefelter’s syndrome, Y chromosome deletions
What is CBAVD typically associated with?
Mutation of CFTR gene
What is usually the cause for CBAVD without genetic deletions?
Insult to the mesonephric (wolffian) duct
What side does a variocecle typically occur on?
left
Exfoliated cells are collected from what area during a PAP smear?
Transformation zone (between simple columnar and stratified squamous epithelium)
Which of the SERMs treats osteoporosis?
Raloxifene
What should be monitored in women taking Drospirenone?
risk for hyperkalemia
Two phases of the menstrual cycle
Follicular: 10-17 days
Luteal: 14 days
Contraindications to estrogen containing contraceptives?
history of venous thromboembolic event
How to evaluate ovarian reserve?
- FSH and Estradiol (elevated = diminished)
- Antimullerian hormone
- Antral follicle counts by ultrasound
Mech of action of aromatase inhibitors in treating infertility
inhibition of E2 production, negative feedback causing increase in FSH levels
How does anovulation occur in AUB?
Chronic exposure of endometrium of estrogen without exposure to postovulatory progesterone
Most common locations of endometriosis
in pelvis and near tubal fimbria:
ovaries–cul-de-sac–broad ligament–uterosacral ligaments
bowel is most common extragenital location
