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What are the ovaries part of? (What axis?)
Hypothalamic-pituitary-gonadal axis
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What secretes the follicle stimulating hormone?
Anterior pituitary
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What does the follicle stimulating hormone do?
- Stimulates growth of the ovarian follicles
- Increases the plasma estrogen level
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What secretes the luteinizing hormone?
Anterior pituitary
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What does the luteinizing hormone do?
Stimulates production of progesterone at ovulation
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How are FSH and LH synthesis regulated?
Estrogen and progesterone exert negative feedback to the hypothalamus and pituitary
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Name the principal female sex hormones
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What secretes estrogen?
- Ovarian follicles
- Placenta in pregnancy
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Name the 3 primary estrogens
- Estradiol-17 beta
- Estrone
- Estradiol
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Name the principal estrogen synthesized by the ovaries
Estradiol
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What secretes progesterone?
- Ovarian follicles
- Corpus luteum following ovulation
- Placenta in pregnancy
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What hormone promotes development and maintains the female reproductive system, including the uterus, fallopian tubes and vagina; it is responsible for development and maintenance of secondary female sex characteristics?
Estrogen
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What is secreted by the corpus leteum following ovulation, and in prenancy is secreted by the placenta to maintain the uterus?
Progesterone
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In the 1st half of the menstrual cycle, what hormone promotes growth of ovarian follicles and an increase in esterogen?
FSH
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What hormone peaks a the midcycle of the menstrual cycle?
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What hormone triggers ovulation during the menstrual cycle?
LH
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What is the clinical significance of hyperestrinism in females?
- Precocious puberty: ovarian tumor, hypothalamic tumor, adrenal tumor, disorders of the hypothalamus or pituitary
- Infertility and irregular menses: polycystic ovaries, estrogen producing ovarian tumors, disorders of the hypothalamus or pituitary
- Postmenopausal bleeding: cervial or endometrial carcinoma, estrogen producing ovarian tumors, exogenous estrogen consumption
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What is the clinical significance of hyperestrinism in males?
- Testicular atrophy
- Enlargement of the breasts
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What is the clinical significance of hypoestrinism?
- Ovarian insufficiency: can be primary or secondary to disorders of the hypothalamus or pituitary
- Delayed puberty: primary amenorrhea due to lack of ovarian functionor secondary disorders of the hypothalamus or pituitary
- Amenorrhea: occurs at menopause, radiation, chemotherapy, severe stress, intense athletic training, excessive weight loss
- Turner syndrome: genetic defect in females where there is partial or complete loss of one of the 2 X chromosomes, resulting in nonfunctioning ovaries
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What is the clinical significance of Hyperprogesteronemia?
Prevents mentrual cycle from occurring
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What is the clinical significance of hypoprogesteronemia?
- Infertility
- Abortion of the fetus
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What is the main source of estrogen synthesis during pregnancy, and what does it make?
- Placenta is the main source of estrogen synthesis
- Making primarily estriol
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What is included in the triple test?
- Alpha1-fetoprotein (AFP)
- Unconjugated estriol (uE3)
- Human chorionic gonadotropin (hCG)
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What is the triple test used for and what are the results that suggest it?
- Helps to estimate the risk of Down syndrome
- Decreased AFP
- Decreased uE3
- Increased hCG
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What is suggestive in pregnant women if:
Decreased AFP
Decreased uE3
Increased hCG
Down syndrome
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What is included in the Quadruple test?
- Alpha1-fetoprotein (AFP)
- Unconjugated estriol (uE3)
- Human chorionic gonadotropin (hCG)
- Inhibin A
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What is suggestive in pregnant women if:
Decreased AFP
Decreased uE3
Increased hCG
Increased Inhibin A
Down Syndrome
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What is the function of Inhibin A?
Inhibit production of FSH
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Name what the placenta synthesizes and secretes
- Estrogens
- Progesterone
- Humon chorionic gonadotropin
- Human placental lactogen
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What is the clinical significance of increased hCG?
- Hyadatidiform mole
- Choriocarcinoma
- Pre-eclamptic toxemia
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What is the clinical significance of decreased hCG?
- Threatened abortion
- Ectopic pregnancy
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What else is hCG monitored for, besides pregnancy?
Monitor sucess of surgery and chemotherapy
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What 2 things work together to produce estrogen and progesterone during pregnancy?
- Human placental lactogen (HPL)
- hCG
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What is the clinical significance of decreased HPL (human placental lactogen)?
- Placental malfunction
- Potential fetal distress
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What axis are the testes part of?
Hypothalamic-pituitary-gonadal axis
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What hormone stimulates spermatogenesis?
FSH
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What stimulates the production of testosterone?
LH (luteinizing hormone)
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What is the clinical significance of abnormal synthesis of testosterone?
- Disorder of the testes (primary disorder)
- Disorder of pituitary or hypothalamus (secondary disorder)
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What is the principal male sex hormone?
Testosterone
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What is the function of testosterone?
- Promotes development and maintains the male reproductive system
- Responsible for the development and maintenance of secondary male sex characteristics
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What is the clinical significance of hyperandrogenemia?
- Prepubertal males: precocious puberty occurs
- Adult males: no observable symptoms
- Female children: development of male secondary characteristics, virilization occurs
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What condition:
Increased 17-OHP
Increased ACTH
Decreased Cortisol
Enzyme defect of 21-Hydroxylase
Prevents cortisol production
Results in accumulation of cortisol precursors, including 17-alpha-hydroxyprogesterone (17-OHP)
Congenital adrenal hyperplasia (CAH)
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What is the clinical significance of hypoandrogenemia?
- Adult males: Impotence, loss of secondary sex characteristics
- Prepubertal males: delayed puberty
- Klinefelter syndrome (extra X chromosome)
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