Week 12 Reproductive
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Questions and Answers

What is the primary role of human placental lactogen (hPL) during pregnancy?

  • Inhibits the production of progesterone
  • Nourishes the fetus and stimulates milk glands (correct)
  • Regulates menstrual cycles
  • Stimulates ovulation in the ovaries

    • Which hormone is primarily responsible for increasing blood flow to the womb during pregnancy?

  • Progesterone (correct)
  • Oxytocin
  • Relaxin
  • Estrogen

    • Which hormone is known to ease pain during labor and promote bonding after childbirth?

  • Testosterone
  • Anti-Müllerian hormone
  • Oxytocin (correct)
  • Inhibin B

    • What is the effect of Inhibin B during menopause on other hormones?

    <p>Inhibits secretion of LH and FSH</p> Signup and view all the answers

    How does Anti-Müllerian hormone (AMH) levels change as a woman approaches menopause?

    <p>It begins to decrease approximately 5 years before menopause</p> Signup and view all the answers

    What major change occurs to testosterone production during menopause?

    <p>It shifts from ovaries to adrenal glands</p> Signup and view all the answers

    Which of the following factors is associated with an increased risk of breast cancer?

    <p>Nulliparity</p> Signup and view all the answers

    Which phase of the menstrual cycle typically lasts from the onset of menses to the day before LH surge?

    <p>Follicular phase</p> Signup and view all the answers

    What is the most significant prognostic indicator for breast cancer?

    <p>Tumor stage</p> Signup and view all the answers

    During which phase of the menstrual cycle are hormone levels raised to support a potential pregnancy?

    <p>Luteal phase</p> Signup and view all the answers

    Which of the following describes the 'perimenopause' stage?

    <p>An interval of menstrual irregularities leading up to menopause</p> Signup and view all the answers

    Which type of breast cancer is most commonly associated with the mammary duct epithelium?

    <p>Invasive ductal carcinoma</p> Signup and view all the answers

    What factors can lead to shorter follicular phases during the menstrual cycle?

    <p>Perimenopause</p> Signup and view all the answers

    Which type of breast cancer is less commonly diagnosed and does not typically arise from the mammary duct epithelium?

    <p>Angiosarcoma</p> Signup and view all the answers

    What is the primary cause associated with McUne Albright Syndrome?

    <p>Mutation of the GNAS1 gene</p> Signup and view all the answers

    Which hormonal tests are essential for diagnosing gonadotropin-independent precocious puberty?

    <p>DHEAS, HcG, and 17-OHP</p> Signup and view all the answers

    Which Tanner stage corresponds with prepubertal development in females?

    <p>Tanner 1</p> Signup and view all the answers

    What might be the first indication of an occult metabolic disorder in the context of delayed puberty?

    <p>Irritable Bowel Syndrome (IBS)</p> Signup and view all the answers

    In terms of pubertal development, what is the significance of breast buds in Tanner stage 2?

    <p>They are the first indication of puberty in females.</p> Signup and view all the answers

    Which of the following conditions can lead to an inactive hypothalamic pituitary ovarian axis?

    <p>Kallmann syndrome</p> Signup and view all the answers

    What is a primary role of gonadotropin-releasing hormone (GnRH) in the hypothalamic-pituitary-ovarian (HPO) axis?

    <p>To signal the anterior pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH).</p> Signup and view all the answers

    During puberty, what initiates the pulsatile secretion of GnRH from the hypothalamus?

    <p>The interaction of kisspeptin neurons with neurokinin B and dynorphin.</p> Signup and view all the answers

    Which of the following hormones is responsible for converting cholesterol into androgens during female puberty?

    <p>Luteinizing hormone (LH)</p> Signup and view all the answers

    What is the eventual outcome of the hormonal signaling through the HPO axis?

    <p>Signal for ovulation.</p> Signup and view all the answers

    Which of the following age ranges is considered normal for the onset of puberty in girls?

    <p>8-13 years</p> Signup and view all the answers

    How do the zona reticularis of the adrenal glands function in relation to the hypothalamic-pituitary-gonadal axis?

    <p>They operate independently and secrete androgens such as DHEA.</p> Signup and view all the answers

    What effect does follicle-stimulating hormone (FSH) have on granulosa cells during puberty?

    <p>FSH directs granulosa cells to convert androgens to estradiol.</p> Signup and view all the answers

    What is the relationship between the hormones neurokinin B and dynorphin in the process of initiating puberty?

    <p>They stimulate the pulsatile release of GnRH.</p> Signup and view all the answers

    What is indicated by a strong family history of precocious puberty in males?

    <p>Familial male-limited precocious puberty</p> Signup and view all the answers

    Which of the following is NOT a characteristic of central precocious puberty?

    <p>Increased mental development for chronological age</p> Signup and view all the answers

    Which of the following sequences accurately describes the onset of puberty in boys?

    <p>Growth of testes → pigmentation of scrotum → growth of penis</p> Signup and view all the answers

    In the context of precocious puberty, what does a rapid physical and osseous maturation with loss of linear growth indicate?

    <p>Common occurrence in girls under 6 years old</p> Signup and view all the answers

    Which of the following conditions is a characteristic of gonadotropin dependent precocious puberty?

    <p>Early activation of the HPO axis</p> Signup and view all the answers

    Which symptom would warrant evaluation in girls under 6 years old?

    <p>Headaches and neuro defects</p> Signup and view all the answers

    What is typically true about the growth patterns seen in precocious puberty for girls compared to boys?

    <p>Girls have a higher prevalence of major growth restriction</p> Signup and view all the answers

    What can an excess secretion of sex steroids from ovaries lead to in girls?

    <p>Gonadotropin dependent precocious puberty</p> Signup and view all the answers

    What is the average length of the menstrual cycle from the day of LH surge until the next menses?

    <p>14 days</p> Signup and view all the answers

    During which phase of the endometrial cycle does the shedding of the endometrial lining occur?

    <p>Desquamation phase</p> Signup and view all the answers

    What triggers ovulation within the menstrual cycle?

    <p>Surge of luteinizing hormone (LH)</p> Signup and view all the answers

    What is the primary function of follicle-stimulating hormone (FSH) in the menstrual cycle?

    <p>Stimulates follicular development and egg maturation</p> Signup and view all the answers

    Which hormone is primarily responsible for the conversion of testosterone to estradiol in the ovaries?

    <p>Luteinizing hormone (LH)</p> Signup and view all the answers

    What is the primary role of the hormones released by the anterior pituitary in relation to the menstrual cycle?

    <p>Stimulate ovarian function</p> Signup and view all the answers

    Which phase of the menstrual cycle occurs after the proliferative phase?

    <p>Secretory phase</p> Signup and view all the answers

    What role does the hypothalamus play in the menstrual cycle?

    <p>Secretes gonadotropin-releasing hormone (GnRH)</p> Signup and view all the answers

    What effect do estrogens primarily have during most of the menstrual cycle?

    <p>Inhibit further secretions of FSH and LH</p> Signup and view all the answers

    What is a primary function of progesterone in relation to the endometrium?

    <p>Stabilize and mature the endometrium for implantation</p> Signup and view all the answers

    How do activins influence gonadotropes during the menstrual cycle?

    <p>Enhance secretion of LH, especially midcycle</p> Signup and view all the answers

    What role does β-hCG play during the early stages of pregnancy?

    <p>Indicates the presence of pregnancy</p> Signup and view all the answers

    Which hormone is primarily responsible for the surge of LH that triggers ovulation?

    <p>Estradiol</p> Signup and view all the answers

    What effect does inhibin have on gonadotropin secretion?

    <p>Inhibits further secretion of FSH</p> Signup and view all the answers

    What physiological change is typically associated with progesterone during the luteal phase?

    <p>Inhibition of milk production</p> Signup and view all the answers

    What triggers menstrual bleeding at the end of the luteal phase?

    <p>Progestin withdrawal</p> Signup and view all the answers

    What is primarily indicated by a strong family history of precocious puberty in males?

    <p>Familial male-limited precocious puberty</p> Signup and view all the answers

    Which of the following sequences accurately describes the onset of puberty in girls?

    <p>Thelarche → Pubarche → Menarche</p> Signup and view all the answers

    What type of precocious puberty is characterized by early activation of the hypothalamic-pituitary-ovarian (HPO) axis?

    <p>Gonadotropin Dependent</p> Signup and view all the answers

    Which condition should prompt an evaluation for girls under 6 years old?

    <p>Thelarche or Pubarche</p> Signup and view all the answers

    What percentage of girls experience major growth restriction as adults due to precocious puberty?

    <p>30%</p> Signup and view all the answers

    Which of the following is a characteristic of gonadotropin independent precocious puberty?

    <p>Excess secretion of sex steroids from ovaries.</p> Signup and view all the answers

    What is often the most common cause of gonadotropin independent precocious puberty?

    <p>Autonomously functioning ovarian cysts</p> Signup and view all the answers

    What type of precocious puberty often demonstrates slowly progressive osseous maturation while preserving linear growth?

    <p>Gonadotropin Dependent</p> Signup and view all the answers

    Which condition may result from ovarian insufficiency in girls?

    <p>Turner Syndrome</p> Signup and view all the answers

    What is one of the first signs of puberty in females according to Tanner stages?

    <p>Breast buds</p> Signup and view all the answers

    Which test would be important to assess delayed puberty related to hypothalamic issues?

    <p>LH and FSH levels</p> Signup and view all the answers

    Which hormone is associated with stimulating adrenal androgen production in females during puberty?

    <p>Luteinizing hormone (LH)</p> Signup and view all the answers

    Which hormone is primarily tested to confirm the presence of precocious puberty?

    <p>Estrogen</p> Signup and view all the answers

    What is a characteristic symptom of McUne Albright Syndrome?

    <p>Polystotic fibrous dysplasia</p> Signup and view all the answers

    What role does relaxin play during pregnancy?

    <p>Loosens muscles and ligaments for delivery</p> Signup and view all the answers

    How does the level of Anti-Müllerian hormone (AMH) change as a woman approaches menopause?

    <p>It begins to decrease</p> Signup and view all the answers

    What hormone increases during menopause and has a significant effect on FSH levels?

    <p>Inhibin B</p> Signup and view all the answers

    What symptom is primarily associated with increased estrogen levels during pregnancy?

    <p>Nausea</p> Signup and view all the answers

    What is the primary source of testosterone production in women during menopause?

    <p>Adrenals</p> Signup and view all the answers

    What effect does progesterone have during pregnancy?

    <p>Causes heartburn and mood swings</p> Signup and view all the answers

    Study Notes

    Breast Cancer Risk Factors

    • Most breast cancers develop from mammary duct epithelium or lobular glands.
    • Less common types include mucinous, tubular, medullary, papillary, and angiosarcoma.
    • Tissue biopsies are tested for hormone receptors (estrogen, progesterone) and the HER2 protein.
    • Tumor staging is crucial for prognosis, assessing size, lymph node involvement, and metastasis.
    • The upper quadrant is the most frequent location for breast cancer.
    • Significant risk factors include increased estrogen exposure (early menses, late menopause), nulliparity, obesity, and PCOS.

    Normal Menstrual Cycle

    • Menarche marks the first menstrual period; menopause is defined as 12 months of no menses.
    • Perimenopause involves months to years of cycle irregularities before cessation.
    • Average menstrual cycle lasts 28-35 days; "normal" cycles range between 24-38 days.
    • Regular cycles have a variation in length of ≤ 7-9 days.
    • Ovarian cycle consists of two phases:
      • Follicular Phase: Occurs from menstruation onset to LH surge, lasting 14-21 days.
      • Luteal Phase: Follows ovulation; hormones support potential pregnancy.

    Menopause

    • Anti-Müllerian hormone (AMH) decreases and serves as a marker for ovarian reserve, dropping five years before the last period.
    • Inhibin B decreases, leading to increased FSH levels around age 35.
    • During menopause, LH and FSH levels rise due to reduced inhibin B.
    • Testosterone production shifts from ovaries to adrenal glands, with a 25% decline in levels.

    Hypothalamic-Pituitary-Ovarian (HPO) Axis

    • Regulates female reproduction and menstrual cycle through hormonal communication between the hypothalamus, pituitary gland, and ovaries.
    • Involves positive and negative feedback loops for hormones like GnRH, LH, FSH, estrogen, and progesterone.
    • The main goal is to coordinate ovulation.

    Puberty and Expected Changes

    • Puberty spans from the onset of secondary sexual characteristics to full sexual maturity, occurring between ages 8-13 for girls and 8-12 for boys.
    • An increase in GnRH secretion from the hypothalamus triggers hormonal changes.
    • LH and FSH stimulate steroid production in testes and ovaries, leading to secondary sexual traits.
    • Adrenarche results from androgens secreted by the adrenal zona reticularis, functioning separately from the HPO axis.

    Clinical Features of Precocious Puberty

    • Secondary sex characteristics develop early, with varied patterns:
      • Girls: Thelarche → Pubarche → Menarche.
      • Boys: Testes growth → Scrotum pigmentation → Pubarche.
    • In cases of precocious puberty, evaluation of girls under 6 with any secondary characteristic is essential.
    • Types include:
      • Gonadotropin Dependent: Early activation of HPO axis, often idiopathic.
      • Gonadotropin Independent: Caused by excess sex steroids; may follow birth control exposure.

    Delayed Puberty

    • Characterized by inactive HPO axis or ovarian insufficiency, presenting in conditions like Turner syndrome.
    • Hypergonadotropic hypogonadism suggests ovarian failure.
    • Conditions can include metabolic issues like hypothyroidism or Kallman syndrome, warranting tests for FSH, LH, estradiol, and prolactin.

    Tanner Stages

    • Tanner 1: Prepubertal stage; only villus hair and elevation of nipple with no breast development.
    • Tanner 2: Initial signs of puberty occur between ages 8-11.5, presenting sparse pubic hair and palpable breast buds.

    Menstrual Cycle

    • Lasts approximately 28 days, with the luteal phase spanning 14 days from LH surge to menses.
    • Endometrial Cycle Phases:
      • Desquamation: Shedding of the endometrial lining during menses.
      • Proliferative Phase: Development of endometrial lining with straight, tubular glands.
      • Secretory Phase: Maturation of spiral arteries and endometrial glands for potential pregnancy.

    Hormonal Regulation

    • Menstrual cycle regulated by the hypothalamic-pituitary-ovarian axis.
    • Hypothalamus: Secretes gonadotropin-releasing hormone (GnRH) in a pulsatile manner influenced by biological rhythms and stress.
    • Anterior Pituitary: Responds to GnRH by releasing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that stimulate ovarian functions.
    • FSH Functions:
      • Stimulates follicular development and egg maturation.
      • Promotes estradiol production from granulosa cells.
    • LH Functions:
      • Triggers ovulation via surge mid-cycle.
      • Stimulates theca cells to produce testosterone, converted to estradiol in granulosa cells.

    Ovarian Hormones

    • Estrogens (Estradiol):
      • Secreted by ovarian follicles in response to FSH.
      • Stimulates endometrial growth and follicle sensitivity to FSH.
      • Inhibits further secretion of FSH, LH, and GnRH during most of the cycle.
      • Positive feedback mid-cycle increases FSH and LH to trigger ovulation.
    • Progestins (Progesterone):
      • Secreted by corpus luteum post-ovulation.
      • Prepares endometrium for implantation by stabilizing and thickening the lining.
      • Withdrawal triggers menstrual bleeding.

    Pregnancy Hormones

    • β-hCG: Major analyte for pregnancy detection produced by the embryo, essential for maintaining pregnancy.
    • hCG: Produced by the placenta, increases during the first trimester, linked to nausea.
    • Human Placental Lactogen (hPL): Supports fetal nourishment and mammary gland development.
    • Estrogen and Progesterone: Regulate pregnancy-related changes, support fetal organ development, and may lead to side effects like nausea and mood swings.
    • Oxytocin and Relaxin: Facilitate labor, bonding, and physiological adaptations.

    Menopause

    • Anti-Müllerian Hormone (AMH): Declines and serves as a marker of ovarian reserve, decreases prior to menarche.
    • Inhibin B: Decreases around age 35, impacts FSH secretion levels.
    • LH and FSH: Increase due to loss of inhibin B inhibition, reflecting ovarian insufficiency.
    • Testosterone: Production shifts from ovaries to adrenal glands, decreases due to adrenal cortex hypoplasia.

    Precocious Puberty

    • Identification of potential underlying causes involves a detailed history: CNS infections, exposure to endocrine disruptors, family history.
    • Early sexual characteristics with specific sequences in girls and boys:
      • Girls: Breast development (thelarche) → Pubic hair (pubarche) → Menarche.
      • Boys: Testicular growth → Scrotal pigmentation → Pubic hair.
    • Distinguishing patterns of pubertal progression:
      • Rapid growth and osseous maturation (common in girls).
      • Slow maturation with preserved growth (typical in older girls).
      • Transient central precocious puberty (rarest).

    Types of Precocious Puberty

    • Gonadotropin Dependent: Early activation of the HPO axis; primarily idiopathic; associated with CNS lesions.
    • Gonadotropin Independent: Excess sex steroid secretion from ovaries, often due to autonomously functioning cysts or tumors.
    • McCune-Albright syndrome presents with café au lait spots and various endocrine effects.

    Delayed Puberty

    • May indicate inactive hypothalamic-pituitary-ovarian axis or ovarian insufficiency.
    • Can signal metabolic problems, hypothalamic tumors, or Kallmann syndrome.
    • Assessment includes evaluating FSH, Estradiol, LH, and Prolactin levels.

    Tanner Stages for Female Puberty

    • Stage 1 (Prepubertal): Villus hair, only elevation of papillae.
    • Stage 2 (8-11.5 years): Sparse pubic hair and noticeable breast buds; thelarche begins.

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