Endocrine and Metabolic Disorders

Unit 7: Endocrine and Metabolic Disorders

• SIADH results from excessive ADH from the posterior pituitary, leading to dilutional hyponatremia and water retention
• Acromegaly causes increased growth hormone, leading to increased insulin-like growth hormone in the liver
• Diabetes Insipidus has the hypofunction of the posterior pituitary, causing the inability to concentrate urine
• Central/neurogenic DI is caused by insufficient ADH
• Nephrogenic DI is when the kidneys are resistant to ADH, resulting in hypernatremia
• Primary Hypothyroidism is when the thyroid does not function properly, causing high TSH and low T3/4
• Central/Secondary Hypothyroidism is due to hypothal/pituitary issues, causing low TSH and T3/4
• Peripheral Hypothyroidism is when body tissues cannot use thyroid hormone, causing normal/high TSH and low T3/4
• Iodine deficiency leads to low iodine, high TSH, low T3/T4, and hypertrophy
• Hashimoto's Thyroiditis is an autoimmune disease causing destruction of the thyroid, leading to hypothyroidism
• Hashimoto's Thyroiditis has anti-TPO & anti-thyroglobulin, is T-helper (CD4+) mediated, and Type 2 & 4 hypersensitivity
• Myxedema is a key sign of Hashimoto's
• Graves disease is a type II autoimmune disorder and TSI mimics TSH
• Graves's disease causes increased T3/4, thyroid hypertrophy/goiter, bulging eyes, sweating, hypertension, and tachycardia
• Primary Hyperparathyroidism involves too much PTH, often from a benign adenoma, leading to calcium reuptake in bones, kidneys, and the GI tract
• Primary Hyperparathyroidism results in hypercalcemia/hypophosphatemia which presents as "moans, groans, bones, and stones"
• Calcitonin is the opposite of PTH
• Secondary Hyperparathyroidism responds to an external stimulus like CKD or Vitamin D deficiency that leads to hypocalcemia
• Secondary Hyperparathyroidism stimulates PTH, but not enough Vitamin D, causing calcium depletion and bone demineralization with low/normal calcium
• Tertiary Hyperparathyroidism involves constant PTH release, leading to hypercalcemia again
• Hypoparathyroidism is caused by autoimmune conditions, post-surgical injury, or hypomagnesemia, causing low calcium and high phosphate
• Hypoparathyroidism presents as cramps, tetany, paresthesia, and seizures
• Type I Diabetes Mellitus is autoimmune, targeting pancreatic beta cells with a strong genetic predisposition
• In Type I DM, the pancreas does not produce insulin, making it more likely for DKA to occur
• Type II Diabetes Mellitus involves insulin resistance in the liver, muscles, and adipose tissues with a strong genetic predisposition
• In Type II DM, visceral fat is present, and pancreatic beta cells have a slower onset
• Gestational diabetes occurs when pregnancy hormones like human placental lactogen (HPL), estrogen, and progesterone impair insulin action, exacerbating insulin resistance
• Diabetic Ketoacidosis is usually associated with T1DM
• DKA involves the breakdown of fat that creates ketones, resulting in metabolic acidosis and is life-threatening
• Hyperosmolar Hyperglycemic Nonketotic Syndrome is typically associated with T2DM
• HHNKS involves severe hyperglycemia with no ketones, extreme dehydration, polyuria/polydipsia that can lead to confusion/lethargy or coma
• The Polyol Pathway involves aldose reductase turning glucose into sorbitol and fructose with the help of NADPH and sorbitol dehydrogenase during chronic hyperglycemia
• In the Polyol Pathway, sorbitol increases osmotic stress, leading to increased ROS and AGE that bind glucose to proteins
• AGE impairs cellular function, tissue damage, causes inflammation, leading to micro and macrovascular complications
• Cushing's disease occurs with a pituitary adenoma producing excessive ACTH, leading to excessive cortisol
• Cushing's disease causes hyperglycemia, fat redistribution (buffalo hump/moon face), hypertension, purple striae, and osteoporosis
• Cushing's syndrome involves excessive cortisol levels from Cushing's disease, adrenal adenoma, or long-standing use of glucocorticoids with the same symptoms as Cushing's disease
• ACTH-dependent Cushing's syndrome is also known as Cushing's disease
• ACTH-Independent Cushing's syndrome involves direct cortisol release leading to suppression of ACTH
• Addison's disease is an autoimmune disease destroying the adrenal gland, resulting in decreased cortisol and aldosterone
• Addison's presents with hypoglycemia, hypotension, dehydration, dark pigmented skin (bronze), lethargy, muscle weakness, hyponatremia, and hyperkalemia with high ACTH but low cortisol
• The Adrenal gland zones are GFR, from outermost to innermost: salt (glomerulosa), sugar (fasciculata), sex (reticularis)
• GFR produces aldosterone, cortisone and androgens

Unit 8: Neurology

• Catecholamines, including epinephrine and norepinephrine, bind with alpha and beta receptors, are short-lived, and are used in the stress response and released by the adrenal medulla
• Alpha 1 and Beta 1 catecholamines are excitatory
• Alpha and Beta 2 catecholamines are inhibitory
• Glucocorticoids, such as cortisol, are released from the adrenal cortex during the stress response, causing long-lasting changes to metabolism
• The frontal lobe is responsible for personality, behaviors, and speech
• The parietal lobe is responsible for somatosensory (pain, vibration, pressure, proprioception)
• The temporal lobe is responsible for hearing
• The occipital lobe is responsible for vision
• The cerebellum is responsible for balance and coordination of movement
• The brain stem controls eye movement, coordination of breathing and other involuntary functions, arousal, and sleep
• The basal ganglia control motor movements
• The amygdala controls emotion and memory
• The thalamus is responsible for integration and is a relay center for motor and sensory movements
• The hypothalamus is involved in homeostasis and behavioral drive and is a control center of the brain for many hormones (CRH, ACTH, Cortisol)
• The limbic system regulates autonomic and endocrine function in response to emotional stimuli
• The limbic system sets the level of arousal and is involved in motivation and reinforcing behaviors
• Limbic system dysfunction correlates with mental health disorders
• The hippocampus controls memory formation and emotional regulation
• The prefrontal cortex (PFC) is involved in higher cognitive functions such as planning, decision-making, and regulating emotions
• Glutamate is the primary excitatory neurotransmitter in the brain
• Serotonin is critical for emotional stability, and deficits can lead to mood swings, irritability, and feelings of hopelessness
• The Serotonergic system maintains sleep-wake cycle, emotional tone and sensory perceptions
• Increased serotonin is associated with schizophrenia, and decreased serotonin is associated with depression and anxiety
• Dopamine is an excitatory neurotransmitter involved in reward processing and motivation and is a precursor of norepinephrine
• Dopamine converts to norepinephrine via dopamine beta-hydroxylase
• Substance P is a neuropeptide consisting of 11 amino acids, primarily involved in pain perception and inflammation that is released from sensory nerves and found in both the central and peripheral nervous systems
• Neurotransmitters in Schizophrenia: decreased GABA and glutamate, dysregulated serotonin, increased dopamine, and variable norepinephrine levels

Schizophrenia Symptoms

• Positive symptoms of schizophrenia: hallucinations, delusions, disorganized behavior/speech, and distractedness
• Negative symptoms of schizophrenia: avolition, anhedonia, affective flatness, alogia, and attention deficits

Mood Disorders

• Neurotransmitters in Major Depressive Disorder: decreased serotonin, dopamine, and norepinephrine
• Neurotransmitters in Bipolar Disorder (manic phase): increased serotonin, dopamine, and norepinephrine

Eating Disorders

• Anorexia Nervosa has some genetic component, with a body weight 85% less than expected
• Anorexia Nervosa symptoms include body dysmorphia with starvation, HPA axis dysregulation, electrolyte disturbances, hypoglycemia, cardiac issues, cachexia, serotonin, GABA and dopamine dysregulation, a history of bullying/trauma/sexual abuse, and endocrine dysregulation
• Bulimia Nervosa has some genetic components and involves restrictive dieting with periods of binge eating and purging
• Bulimia Nervosa is related to guilt and shame, causing esophagitis, rotten enamel, symptoms of anorexia, and low or fluctuating serotonin levels
• Binge Eating Disorder has some genetic components and is related to obesity and metabolic syndrome
• Binge Eating Disorder involves binge eating in periods of stress with guilt and shame, but without purging
• The Dopamine, Leptin (satiety), and Ghrelin (hunger) are dysregulated in BED

Stress Disorders

• The hypothalamus releases cortico-tropic releasing hormone (CRH), which signals the anterior pituitary to release ACTH
• Panic Disorder involves an overactive ANS (particularly SNS) that can lead to tachycardia, hyperventilation, and dizziness
• Panic Disorder involves imbalances in GABA, serotonin, and norepinephrine and dysfunction in the limbic system, particularly in the amygdala and PFC
• Generalized Anxiety Disorder involves decreased serotonin, norepinephrine, & GABA, with the PFC and amygdala being involved
• GAD also involves HPA axis dysfunction
• Post-Traumatic Stress Disorder has HPA axis dysregulation, decreased cortisol production, and elevated CRF levels
• The amygdala and PFC are involved in PTSD
• BDNF (helps repair neurons) is decreased in PTSD
• There is decreased GABA and serotonin, and elevated norepinephrine in PTSD
• Obsessive Compulsive Disorder involves reduced serotonin levels and has a strong genetic component
• Allostatic load is a combination of perceived stress with the physiologic response long term
• The body will adapt short term called Allostasis (“stability through change”)
• Allostatic load is long term dysregulation which could cause diseases

Unit 9: Brain Injuries

• Acquired brain injuries can be focal or diffuse
• Focal brain injuries are localized and result in hematomas or contusions from direct force which can present in coup and countercoup
• Diffuse brain injuries involve multiple spots in the brain and are caused by shearing forces and high-velocity impact such as diffuse axonal injury, cerebral edema, and increased ICP
• Diffuse brain injuries also have glutamate release leading to neurotoxic effects and mitochondrial dysfunction with oxidative stress
• Mild traumatic brain injuries present as concussions
• Moderate traumatic brain injuries have a loss of consciousness for minutes to hours, with symptoms lasting weeks to months and a Glasgow Coma Scale (GSC) of 8-13
• Severe traumatic brain injuries cause LOC for hours to days, coma, and seizures. Lifelong disabilities are possible and the GCS is under 8

Cerebrovascular Disorders

• Thrombotic stroke symptoms develop gradually, often over hours mostly affecting large arteries
• Embolic stroke symptoms develop suddenly with severe symptoms in any artery, but typically the middle cerebral arteries
• Lacunar strokes often cause specific, localized symptoms like weakness on one side of the body caused by the small area of brain damage due to chronic hypertension
• Hemorrhagic strokes involve a ruptured blood vessel leading to pooling of blood in the intracerebral or subarachnoid space, causing pressure on areas of the brain and toxic effects of hemoglobin
• Hemorrhagic strokes present suddenly like a headache, and N/V (d/t ICP), loss of function

Brain Infections

• Meningitis affects the 3 layers of the meninges (dura, arachnoid, pia), causing inflammation, brain necrosis/ischemia, and disruption in the BBB
• Microorganisms gain access to the CNS by surgery, blood, or nearby infection
• Common bacterial include Neisseria Meningitidis, strep pneumoniae, group B strep and Haemophilus influenzae type B
• Viruses include enterovirus (coxsackievirus, echovirus) and Herpes Simplex Virus (HSV-2)
• Meningitis symptoms include nuchal rigidity (stiff neck), fever, genderized headache, Kernig's sign and Brudzinski's sign
• Encephalitis involves inflammation of the brain parenchyma (brain tissue) and is more severe than meningitis, leading to neurological deficits
• Encephalitis causes direct neurological damage with focal neuro deficits
• Common viruses causing Encephalitis include HSV-1 , Arboviruses, and rabies
• Bacterial Encephalitis is rare. Symptoms include severe localized headache, seizures, altered mental status, neurological deficits, cranial nerve deficits

Neurological Disorders

• Parkinson's disease: caused by dopaminergic degradation in the substantia nigra
• Parkinson's symptoms: shuffled gait, bradykinesia, resting tremor, rigidity, memory deficits, psychological effects like depression/anxiety
• Multiple sclerosis is a chronic autoimmune disorder that results in destruction of the myelin sheath and axons in the CNS
• MS involves CD4+, Th-1 & Th-17 which are the primary cells affecting this process, and CD8+ and B cells
• MS symptoms include ataxia, sensory disturbances, vision problems, and muscle weakness
• Myasthenia Gravis is an autoimmune disorder that affect the neuromuscular junction, causing fluctuating muscle weakness which worsens with activity and improves with rest
• AChR autoantibodies are produced in MG
• MG symptoms include muscle weakness in skeletal and ocular muscles, ptosis, diplopia, dysphagia and dysarthria

Dementia and Headaches

• Alzheimer's disease is an autoimmune disease that results in neurodegeneration affecting memory and cognitive function with neurofibrillary tangles in neuron cell bodies and dendrites, and senile plaques in the brain
• Alzheimer's causes brain atrophy, decreased acetylcholine, and increased glutamate
• Bells Palsy involves Acute ipsilateral paralysis of CN VII characterized by a sudden onset of facial weakness that worsens over 48-72 hours, then gradual recovery over 3 weeks
• Migraines are strong genetic factors causing changes in brainstem activity, leading to cerebral vasoconstriction followed by vasodilation
• Migraines involves altered levels of serotonin, dopamine and calcitonin gene-related peptide (CGRP) and unilateral headache
• ClusterHeadaches involve neurovascular changes in the hypothalamus, CGRP and Substance P which occur at the same time each day, usually at night and will cause unilateral, sharp/burning/stabbing pain
• Tension Headaches involve muscle tension and nervous system sensitivity and bilateral pain like a tight band
• ALS affects motor neurons in the brain and spinal cord, but does not affect sensation

Ischemic cascade:

• Excitotoxicity is the accumulation of Ca+ in the cell which leads to cell death, where neurons release glutamate to excite other cells
• Oxidative stress occurs when Ischemia results in ROS which damages cell membrane, DNA and proteins
• Inflammation is when microglia and astrocytes release cytokines which are toxic to neurons while inflammation disrupts the BBB producing cerebral edema

Unit 10: Bone Disorders

• Simple fractures are when the bone remains in alignment

• Comminuted fractures are when the bone shatters into several pieces

• Compound fractures are when the bone pierces the skin

• Greenstick is a partial break, often in children

• Pathologic means that condition or disease weakens bone

• Metabolic bone disorders include: osteopenia, osteoporosis, and osteomalicia

• A DeXA T score of -1 to -2.5 is osteopenia and less than -2.5 is osteoporosis

• Osteoporosis is a significant loss of bone mass and density leading to brittle bone susceptible to fractures

• Osteoporosis increases osteoclasts and decreases osteoblasts leading to excessive resorption of bone and not enough new bone formation

• Osteopenia is defined as low bone mass with reduced bone mineral density (BMD) that leads to osteoporosis

• Osteopenia is caused by an imbalance of increased bone resorption and/or decreased bone formation, more in trabecular bone and Ca2+ and vitamin D deficiency

• Osteomalicia is a condition where the bones become soft due to defective bone mineralization

• Osteomalicia is caused by vitamin D deficiency, abnormal calcium or phosphate metabolism, which primarily affects bone mineralization rather than bone density

• Magnesium is involved in bone formation and the regulation of calcium and vitamin D metabolism

• OA is degeneration of the articular cartilage that causes joint stiffness in weight-bearing joints that worsens with activity, improves with rest, and is present in late stages

• RA is an autoimmune disease that is a systemic condition leading to synovitis in the small joints with bilateral effects, deformities, and elevated IgG and IgM

• Gout is the deposition of monosodium urate (MSU) crystals that will dislodge in the joints and tissues causing inflammatory response and will result in cartilage destruction, bone erosion, & kidney damage

• Osteoarthritis is hypertrophic

• Rheumatoid Arthritis is atrophic

• Gout is metabolic

Mechanisms of Pain (Tiny Timmy Made Perry Cry):

• Transduction: Nociceptors detect noxious stimuli
• Transmission: Pain signals are sent to the spinal cord via A-delta and C fibers
• Modulation: Signals are processed and modified in the spinal cord and brain
• Perception: Pain is consciously perceived in the brain
• Central Sensitization: is when pain becomes amplified, leading to chronic pain conditions

Sensitization of Pain

• Peripheral Sensitization occurs at the site of injury, where nociceptors become hyper-sensitive to local stimuli and is involved in acute pain
• Central Sensitization occurs within the central nervous system, where spinal cord neurons and brain areas become hyper-excitable and is involved in chronic pain, with pain disproportionate to the original injury or stimulus
• Neurogenic claudication causes people to experience pain, cramping, or weakness in the legs when walking or standing for long periods
• Red Flag Symptoms of lower back pain (require urgent evaluation):
  • Severe pain not relieved by rest or OTC medications may indicate a more serious underlying condition
  • Loss of bowel or bladder control can signal cauda equina syndrome
  • Unexplained weight loss or fever that could suggest infection or malignancy
  • Progressive weakness or sensory loss in the lower limbs may indicate nerve damage

Musculoskeletal Injuries

• Osteomyelitis is a bacterial infection of the bone, typically in long bones
• Hematogenous Spread happens via bloodstream and is typical in children in the metaphysis of long bones
• Contiguous Spread is from adjacent tissues
• Direct Inoculation is due to trauma, surgery, or fracture
• Osteochondroma is benign except Giant cell tumor of bone
• Malignant bone tumors end in “Coma”
• RANK is like a button on the surface of osteoclasts that break down old bone
• RANKL is like a key to the RANK button and tells the osteoclasts to breakdown old bone
• OPG is like a shield that can stop the key (RANKL) from reaching the RANK button.

Bone cells

• RANK is the button on bone-breaker cells (osteoclasts)
• RANKL is the key that turns the button on, telling bone-breakers to get to work
• OPG is the shield that stops the key from working too much, keeping your bones strong.
• Receptor Activated Nuclear factor Kappa-B (RANK) Pathway is expressed on the surface of osteoclasts
• RANKL Pathway is a ligand for RANK and is a protein produced by osteoblasts
• OPG- osteoprotegeren: glycoprotein produced by osteoblasts, a natural inhibitor of RANKL

Unit 11: Anemias

• Anemias are classified by the size of the RBC and include
  • Microcytic (MCV under 80)
  • Normocytic (MCV 80-100)
  • Macrocytic (MCV greater than 100)
• Macrocytic Normal Chromic Anemia is AKA Megaloblastic anemia and involves large immature RBCs that didn’t divide properly and that do not function properly
• Folate Deficiency (B9) plays a crucial role in DNA synthesis and repair, but deficient amounts will disrupt cell division
• Pernicious Anemia is a Vitamin B12 deficiency where people lack intrinsic factor and do not uptake VB12 in the ileum
• Common signs and symptoms of Macrocytic anemias is increased MCV, elevated levels of homocysteine and methylmalonic acid, anemia, pallor, fatigue, and jaundice
• Macrocytic anemias include pernicious anemia, causing neurological problems such as paresthesia, ataxia, and memory loss, while folate deficiency does not
• Microcytic Hypochromic: small cells associated with iron and sidero
• Iron Deficiency is the most common anemia from insufficient iron available for hemoglobin production, causing the body to make small and pale RBC's
• Iron Deficiency Side effects include fatigue/weakness, pallor/SOB, Pica, brittle nails, glossitis, tachycardia, and low serum ferritin/iron with high TIBC
• Sideroblastic involves a defective heme synthesis d/t issues incorporating iron into hemoglobin
• Sideroblastic often accumulates iron in mitochondria of RBCs
• Sideroblastic symptoms include splenomegaly or hepatomegaly, high serum ferritin/iron with low TIBC
• Normocytic Normochromic is when MCV, MCH and MCHC levels are normal
• Aplastic Anemia has a bone marrow issue failing to produce adequate amounts of ALL blood cell types leading to pancytopenia
• Anemia of chronic inflammation is caused by chronic conditions that lead to increased production of inflammatory cytokines that interfere with iron metabolism
• Post hemorrhagic anemia happens after large blood loss, and heart rate increases to redistribute blood to vital organs
• Hemolytic Anemia: is a destruction of RBCs faster than they can be produced
• Intrinsic Hemolytic Anemia is when RBCs are built wrong ( internal issue)
• Extrinsic Hemolytic Anemia is when RBCs are attacked or damaged

“Hemolysis = HEM-BROKE”

• H — Hemoglobin released (↑ LDH, ↑ bilirubin)
• E — Elevated reticulocytes (bone marrow trying to keep up)
• M — Membrane defects (like spherocytosis)
• B — Bite cells / Heinz bodies
• R — RBCs destroyed in spleen or vessels
• O — Oxidative stress triggers
• K — K+ leaks from destroyed cells

Platelet Disorders

Platelet disorders: HIT, ITP, TTP

• Normal Platelet levels are 150-450,000
• Heparin induced thrombocytopenia (HIT) is a drug-induced reaction where the body will react to unfractionated heparin (typically), causing immune reaction
• Immune Thrombocytopenic Purpura (ITP) is an autoimmune disorder in which the body’s immune system produces antibodies (IgG) against platelets
• Thrombotic Thrombocytopenic Purpura is rare but life threatening that can be idiopathic, presents with ADAMTS13 deficiency, and can produce VWF

Comparison of Platelet Disorders

• HIT is drug-induced, while ITP is autoimmune and targets platelets directly, and TTP is due to ADAMTS13 deficiency

• Thrombosis is common in HIT and TTP, but rare in ITP

• TTP is associated with microangiopathic hemolytic anemia, that result in schistocytes, unlike HIT and ITP

• Neurological and renal symptoms are hallmark for TTP

• Vitamin K and liver disease prevent the body from producing all the clotting factors including all the proteins.

Leukemias, Lymphomas

• Hodgkins Lymphoma affects people aged 15-35 or over 55 y/o, with the presence of Reed-Sternberg cells
• Non-Hodgkins Lymphoma is Abnormal B and T cell lymphoma
• B-cell lymphomas involve mutations in oncogenes
• T-cell lymphomas involve mutations in genes that control T-cell differentiation

Leukimias Acute vs Chronic

• Acute is immature cells and chronic is more mature cells.

Types of lukemia

• Acute Myelogenous Leukemia (AML) is associated with chromosomal abnormalities, proliferation of immature myeloid precursor cells in bone marrow and blood, and can present with Auer rods in blasts
• Chronic Myelogenous Leukemia (CML) has the Philadelphia chromosome and involves proliferation of mature and maturing granulocytes, has three phases:, and can be asymptomatic in chronic phase
• Acute Lymphocytic Leukemia (ALL) is common in children, but also affects adults and causes mutations in the Philadelphia chromosome with bone marrow failure Chronic Lymphocytic Leukemia (CLL) is a disease in older adults and involves clonal expansion of mature B cells that are defective

Stages of RBCs

• normoblasts eject nucleus, resulting an a reticulocyte that becomes a RBC

Unit 12: The Reproductive System

Ovarian Cycle: Follicular (1st day after menstruation)  Ovulation  Luteal Uterine Cycle: Menstruation  Proliferative (both 1-14 days)  Secretory

Analogy to making a food

• Follicular phase = preheating the oven
• Ovulation = timer goes off
• Luteal phase = baking mode
• If no baby = oven clears itself → menstruation

Amenorrhea

• Amenorrhea Primary is no period after the age of 15/16 because of anatomical issues
• Amenorrhea Secondary are stoped periods for at least 3 months due to PCOS, thyroid disorders, or hypothalamic-pituitary dysfunction
• Abnormal uterine bleeding(AUB) is bleeding that is abnormal in duration, volume, frequency, or regularity for the majority of 6 months outside of pregnancy
• AUB is classified by the cause of bleeding using an internationally recognized PALM-COEIN acronym (Polyp, Adenomyosis, Leiomyoma, Malignancy Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic, and Not otherwise classified
• Menorrhagia is abnormally heavy or prolonged menstrual bleeding that affects a woman's quality of life caused by structural issues that leads to excessive bleeding
• Dysmenorrhea Primary is an increase in prostaglandins that cause uterine muscle contractions
• Secondary Dysmenorrhea is such as endometriosis, uterine fibroids, adenomyosis, or pelvic inflammatory disease

Gynecology conditions

• Endometriosis is retrograde menstruation causing a reaction to proliferate tissue on the outer lining of the uterus
• Premenstrual Syndrome (PSM) and Premenstrual Dysphoric Disorder (PMDD) are characterized by physical and emotional symptoms during the luteal phase
• FSH is responsible for stimulating and developing ovarian follicles & secretion of estrogen
• LH stimulates the release of progesterone and stimulates endometrial glands
• Estrogen inhibits contractions of uterus and increases flexibility of pubic symphysis, and uterine/cervix dilation Estrogen inhibin inhibits release of FSH by the corpus luteum

Spermatogenesis

• starts in the testes and seminiferous tubules and Leydig cells
• Leydig cells produce androgens specifically testosterone, while Sertoi cells support cells
• Polycystic Ovarian Syndrome (PCOS) is a common metabolic (endocrine) disorder
• PCOS causes irregular periods, cysts from immature follicles
• Increased diabetes, HTN, uterine cancer, depression, high cholesterol and sleep apnea

Sexually transmitted infections

• GoNorrhea is caused by Neisseria Gonorrhea and presents as a mucosal surface infection

• Chlamydia is caused by Chlamydia Trachomatis

• HPV stands for Human Papillomavirus

• Syphilis is caused by Treponema Pallidum bacteria

• HSV is a Herpes Simplex Virus STI Causative Organism Pathophysiology

                                     Infects CD4+ T cells, causing immune dysfunction,
  

HIV/AIDS HIV leading to AIDS.

Herpes Simplex Latent infection in sensory ganglia, reactivates during HSV-1, HSV-2 Virus immunosuppression.

              HPV (e.g., HPV-16, Oncoproteins E6/E7 cause cell dysplasia leading to

HPV Infection HPV-18) cancer

                                     Systemic spread during secondary stage, leading to

Syphilis Treponema pallidum tertiary syphilis

              Neisseria              Inflammation of mucosal surfaces

Gonorrhea gonorrhoeae infertility.

              Chlamydia              Intracellular replication,

Chlamydia trachomatis infertility.

Cervical cancer

• Leiomyomas are benign smooth muscle tumors in the uterus
• Lynch syndrome is caused by a genetic mutation that increases risk of several types of cancers
• Cervical Cancer: caused by HPV which disrupts normal cell regulation
• Endometrial Ca is from estrogen-derived proliferation, resulting in hyperplasia
• Ovarian Ca: results from genetic mutation

Disorders of the Testes and Breast

• Spermatocele is a benign cystic formation in the epididymis
• Varicocele is a swelling of the spermatic cord
• Testicular Torsion is a twisting of the spermatic cord
• Hydrocele is a swelling around the testicle
• Cryptorchidism is the failure of nuts to drop
• BRCA 2 is linked to Breast Ca with Men and BRCA1 with women easy is the key
• There are Non-Proliferative Lesions such as simple cysts, fibrocystic changes
• Proliferative Lesions Without Atypia such as intraductal papillomas, sclerosing adenosis, or radial scars
• Proliferative Lesions With Atypia is linked to atypical ductal hyperplasia or atypical lobular hyperplasia Prostate disorders
• -Prostatitis: is an inflammation of prostate caused by infections and release of prostaglandins
• BPH: Benign swelling in the transitional zone of the prostate, causing decreased testosterone with prostate swelling
• Prostate Ca: Glandular epithelial cells resulting from genetic and environmental factors