Gynecology
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| Primary estrogen in PG | Estriol (E3); produced in placenta
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| Before menopause, primary circulating estrogen = | Estradiol (E2); serum estradiol levels 30-200 pg/mL
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| After menopause, primary circulating estrogen = | Estrone (E1); secreted by ovary; mean serum estradiol levels < 15 ng/mL
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| Induces glandular secretion in endometrium: | Progesterone
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| Main role of testosterone in women | estrogen precursor
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| Decreased testosterone levels in females cause: | decline in libido, mood changes
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| Progesterone produced where? | in corpus luteum after ovulation; by placenta in PG
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| Progesterone levels rise rapidly after: | ovulation
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| FSH fn: | binds to granulosa cells and stimulates estradiol secretion
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| In a state of estrogen deficiency, more ____ is secreted | FSH
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| During luteal (secretory) phase, ______ are suppressed to low levels | FSH and LH
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| Plasma LH surge precedes ovulation by | 24-36 hrs
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| Estrogen pattern during menstrual cycle | Secretion peaks just before midcycle, drops sharply with ovulation, rises again to plateau, then decreases again before menstruation
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| During luteal (secretory) phase, predominant hormone changes from: | estradiol to progesterone
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| Adequate progesterone production is necessary to facilitate: | implantation and sustain early pregnancy
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| Progesterone MOA | Acts primarily on endometrium, initiates secretory phase
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| Results of hyperprolactinemia | Loss of libido; Galactorrhea; Oligomenorrhea/ amenorrhea; Infertility; Decreased muscle mass; Osteoporosis
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| Decreased _____ levels in females cause decline in libido, mood changes | testosterone
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| Hormone levels in PG: | FSH/LH low; progesterone high
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| Primary test of menopause: | FSH
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| GnRH Low: | hypothalamic hypogonadism, dopamine, opiates
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| GnRH high: | primary hypopituitary hypogonadism, epinephrine
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| GnRH testing: avoid: | steroids, ACTH, gonadotropin or estrogen medications for ≥48hrs
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| FSH low: | secondary gonadal failure, stress, malnutrition/anorexia, severe illness, hyperprolactinemia, PG
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| FSH high: | primary gonadal failure, castration, alcoholism
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| LH low | pit or hypothalamic failure, severe stress, anorexia, malnutrition, severe illness, PG, hemochromatosis, sickle cell anemia, hyperprolactinemia
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| LH high | gonadal failure, precocious puberty, pituitary adenoma, menopause, PCOS
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| LH: Best time to obtain single specimen | between 11am and 3pm
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| Progesterone low | preeclampsia, threatened abortion, placental failure, fetal demise, ovarian neoplasm, amenorrhea, ovarian hypofunction, PCOS
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| Progesterone High: | ovulation, PG, hyperadrenocorticalism, adrenocortical hyperplasia, luteal cysts, molar pregnancy, choriocarcinoma
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| Induces glandular secretion in endometrium: | Progesterone
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| Physiologically most important estrogen | Estradiol (E2); produced in ovary; peaks in ovulatory phase; FB to inc LH & decrease FSH
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| Major circulating estrogen after menopause | estrone (E1); secreted by ovary
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| part of maternal serum quad test | Estriol (tests looking for trisomy/Down syndrome)
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| main role of testosterone in women | estrogen precursor
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| Decreased testosterone levels in females cause: | decline in libido, mood changes
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| FSH assays done to dx: | menopause, menstrual irregularities, gonadal failure, predicting ovulation, evaluating infertility, pituitary disorders
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| Progesterone produced where? | in corpus luteum after ovulation; by placenta in PG
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| Progesterone levels rise rapidly after: | ovulation
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| Estrogen: high | precocious puberty, ovarian tumor, adrenal tumor, gonadal tumor, normal pregnancy, cirrhosis, liver necrosis, hyperthyroidism
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| Estrogen: Low | failing PG, Turner syndrome, hypopituitarism, hypogonadism, Stein-Leventhal syndrome, menopause, anorexia, PCOS
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| Major estrogen in PG | Estriol (E3); produced in placenta
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| Max testosterone values when: | around 7am and 8pm
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| testosterone high: | ovarian tumors, adrenal tumor, congenital adrenocortical hyperplasia, trophoblastic tumor, PCOS, idiopathic hirsutism, drugs
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| testosterone low: | primary/ secondary ovarian failure, drugs
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| FSH fn: | binds to granulosa cells and stimulates estradiol secretion
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| In a state of estrogen deficiency, more ____ is secreted | FSH
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| During luteal phase, ______ are suppressed to low levels | FSH and LH
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| Plasma LH surge precedes ovulation by | 24-36 hrs
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| Estrogen during menstrual cycle | Secretion peaks just before midcycle, drops sharply with ovulation, rises again to plateau, then decreases again before menstruation
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| During luteal phase, predominant hormone changes from: | estradiol to progesterone
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| Adequate progesterone prodn necessary to facilitate: | implantation and sustain early pregnancy
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| Progesterone MOA | Acts primarily on endometrium, initiates secretory phase
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| Progesterone w/drawal test evaluates: | H-P-gonadal axis
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| Progesterone withdrawal test: in normal cycle, progesterone surge: | inhibits FSH/LH and leads to withdrawal bleeding
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| Progesterone withdrawal test: probs causing failure of bleeding: | Estrogen production inadequate; Hypothalamic dysfunction; Uterus abnormal
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| Prolactin high | pit adenoma, 2d amenorrhea, galactorrhea, hypothyroid, hypoglycemia, PCOS, anorexia, paraneoplastic syndromes, dz of hypothalamus /pituitary stalk, renal fail, drugs lowering dopamine, high estrogen
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| Prolactin low | Sheehan syndrome, pituitary destruction by tumor
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| Prolactin levels should be collected: | 3-4hrs after waking
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| Prolactin level: to dx: | pituitary adenoma, amenorrhea, galactorrhea, hypothalamic pituitary disorders
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| Results of hyperprolactinemia | Loss of libido; Galactorrhea; Oligomenorrhea/ amenorrhea; Infertility; Decreased muscle mass; Osteoporosis
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| Current hCG test is what type test: | monoclonal Ab
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| Urine hCG tests may be negative when: | serum test is positive
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| hCG high: | PG, ectopic, molar pregnancy, choriocarcinoma, germ cell tumors, hepatomas, lymphoma
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| hCG low: | threatened or incomplete abortion, fetal demise
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| Half life of hCG: | 3-7 days
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| Decreased _____ levels in females cause decline in libido, mood changes | testosterone
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| PCOS: lab values | LH, testosterone, prolactin high; progesterone, estrogen low
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