Week 12 Reproductive

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?

Inhibits secretion of LH and FSH Signup and view all the answers

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

It begins to decrease approximately 5 years before menopause Signup and view all the answers

What major change occurs to testosterone production during menopause?

It shifts from ovaries to adrenal glands Signup and view all the answers

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

Nulliparity 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?

Follicular phase Signup and view all the answers

What is the most significant prognostic indicator for breast cancer?

Tumor stage Signup and view all the answers

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

Luteal phase Signup and view all the answers

Which of the following describes the 'perimenopause' stage?

An interval of menstrual irregularities leading up to menopause Signup and view all the answers

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

Invasive ductal carcinoma Signup and view all the answers

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

Perimenopause 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?

Angiosarcoma Signup and view all the answers

What is the primary cause associated with McUne Albright Syndrome?

Mutation of the GNAS1 gene Signup and view all the answers

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

DHEAS, HcG, and 17-OHP Signup and view all the answers

Which Tanner stage corresponds with prepubertal development in females?

Tanner 1 Signup and view all the answers

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

Irritable Bowel Syndrome (IBS) Signup and view all the answers

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

They are the first indication of puberty in females. Signup and view all the answers

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

Kallmann syndrome Signup and view all the answers

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

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

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

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

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

Luteinizing hormone (LH) Signup and view all the answers

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

Signal for ovulation. Signup and view all the answers

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

8-13 years Signup and view all the answers

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

They operate independently and secrete androgens such as DHEA. Signup and view all the answers

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

FSH directs granulosa cells to convert androgens to estradiol. Signup and view all the answers

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

They stimulate the pulsatile release of GnRH. Signup and view all the answers

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

Familial male-limited precocious puberty Signup and view all the answers

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

Increased mental development for chronological age Signup and view all the answers

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

Growth of testes → pigmentation of scrotum → growth of penis 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?

Common occurrence in girls under 6 years old Signup and view all the answers

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

Early activation of the HPO axis Signup and view all the answers

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

Headaches and neuro defects Signup and view all the answers

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

Girls have a higher prevalence of major growth restriction Signup and view all the answers

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

Gonadotropin dependent precocious puberty 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?

14 days Signup and view all the answers

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

Desquamation phase Signup and view all the answers

What triggers ovulation within the menstrual cycle?

Surge of luteinizing hormone (LH) Signup and view all the answers

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

Stimulates follicular development and egg maturation Signup and view all the answers

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

Luteinizing hormone (LH) 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?

Stimulate ovarian function Signup and view all the answers

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

Secretory phase Signup and view all the answers

What role does the hypothalamus play in the menstrual cycle?

Secretes gonadotropin-releasing hormone (GnRH) Signup and view all the answers

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

Inhibit further secretions of FSH and LH Signup and view all the answers

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

Stabilize and mature the endometrium for implantation Signup and view all the answers

How do activins influence gonadotropes during the menstrual cycle?

Enhance secretion of LH, especially midcycle Signup and view all the answers

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

Indicates the presence of pregnancy Signup and view all the answers

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

Estradiol Signup and view all the answers

What effect does inhibin have on gonadotropin secretion?

Inhibits further secretion of FSH Signup and view all the answers

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

Inhibition of milk production Signup and view all the answers

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

Progestin withdrawal Signup and view all the answers

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

Familial male-limited precocious puberty Signup and view all the answers

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

Thelarche → Pubarche → Menarche Signup and view all the answers

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

Gonadotropin Dependent Signup and view all the answers

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

Thelarche or Pubarche Signup and view all the answers

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

30% Signup and view all the answers

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

Excess secretion of sex steroids from ovaries. Signup and view all the answers

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

Autonomously functioning ovarian cysts Signup and view all the answers

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

Gonadotropin Dependent Signup and view all the answers

Which condition may result from ovarian insufficiency in girls?

Turner Syndrome Signup and view all the answers

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

Breast buds Signup and view all the answers

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

LH and FSH levels Signup and view all the answers

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

Luteinizing hormone (LH) Signup and view all the answers

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

Estrogen Signup and view all the answers

What is a characteristic symptom of McUne Albright Syndrome?

Polystotic fibrous dysplasia Signup and view all the answers

What role does relaxin play during pregnancy?

Loosens muscles and ligaments for delivery Signup and view all the answers

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

It begins to decrease Signup and view all the answers

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

Inhibin B Signup and view all the answers

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

Nausea Signup and view all the answers

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

Adrenals Signup and view all the answers

What effect does progesterone have during pregnancy?

Causes heartburn and mood swings 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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