CM- Endo -5- Gonads lect 13-14
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| What duct in fetal gonadal development is called paramesonphrenic and which is mesonephric | paramesonephric= mullerian
mesonephric= wolffian
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| where do seminiferous tubules devlope in male fetal development | develop in internal part of gonadal ridge and become continous w/ wolffian duct
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| what does the vas defrens develop from | develops from wolffian duct
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| What do sertoli cells do in male gonadal development | secrete mullerian inhibiting substance that causes regression of mullerian duct
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| What virilizes the wolffian ducts | testosterone produced by testes
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| what does 5 alpha reductase do to testosterone | turns it into dihydrotestosterone DHT
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| what does DHT do in male gonadal development | modulates differentiation of male external genitalia
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| what does the mullerian duct develop into during female gonadal development | develops into fallopian tube
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| what does the cuadal prortion on mullerian duct develop into | forms uterine canal
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| if the mullerian ducts don't fuse during fetal development what can result | congenital defect known as uterus bicornis
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| what does the wolffian duct do in female gonadal development | it degenerates and forms the broad ligament
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| wht do the genital swellings develop into in males and females | males-scrotal swellings
females-labia majora
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| What does the genital tubercle develop into in males | develops into penis, urethral fold forms corpus spongiosum and remains unfused only at the tip to form urethral opening
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| what does the genital tubercle develop into in the female | forms clitoris urethral folds don't fuse and become labia minora, Genetal swellings also remain unfused and form labia majora
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| what is it called when a persons genotype doesn't match their phenotype (ie male XY with a vagina) | pseudohermaphrodites
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| what is a true hermaphrodite | has both ovaries and testicular tissue.
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| What is hypospadias | urethral opening on the ventral surface of penis
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| what is epispadias | urethral opening on the dorsal side of the penis
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| What can happen clinically if you have urethral defects | obstruction of flow leading to frequent UTI's
if near base of penis normal ejaculation can be hampered or blocked leading to sterility
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| What guides the testes into the scrotum | gubernaculum
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| what is it called if the testes fail to descend | cryptorchidism
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| what is spermatogenesis | development of male gametes, (sperm) via meiosis
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| in female gamete development what is the cell called that doesn't develop ultimately into oocyte | polar body
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| Meisosis disorder where you end up with only 1 x chromosome | Turner's syndrome
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| Your patient is short, low set ears and fish like mouths and has puffiness of the dorsum of the hands and feet. You are already pretty confident of your dx and to confirm it have the patient make a fist what is your dx and what did you see | turner's syndrome patient has a short fourth metacarpal so has knuckle, knuckle dimple knuckle
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| What fails to develop in turners syndrome and what is the genotypical problem in turner's syndrome | ovaries patient only has one X chromosome
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| what is the most common sex chromosome abnormality | Kleinfelter's syndrome
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| What is the genotypical problem in kleinfelters | male has y chromosome and 2 X chromosomes
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| Your wife just gave birth and you are concerned your son may have kleinfelters what should you look for | generally no defect is noticeable at birth expresses itself chiefly during puberty
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| Why do kleinfelters patients often have azoospermia and infertility | FSH and LH increase but the seminiferous tubules don't enlarge resulting in firm atrophic testes which eventually lead to sterilization
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| What clinical features might you notice during puberty of kleinfelters patient | diminished facial and chest hair, gynecomastia due to elevated LH and fact that leydig cells can't produce testosterone = estradiol and breast development
Upper extremities grow longer than lower extremities
intellectual impairment (dissocial behavior)
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| Since you don't get testosterone development in kleinfelters what happens to the Penis | is it underdeveloped during puberty
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| What is the tx for kleinfelters | give them testosterone replacement therapy
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| what is the signal from the hypothalamus that controls FSH and LH release from anterior pituitary | GNRH
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| What is the signal for sertoli cells | FSH which tells them to bind testosterone and stimulate spermatogeneisis
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| What does LH doe in male gamete development | binds interstitial cells and stimulates them to secrete testosterone and small amounts of estrogen
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| What does rising levels of testosterone in the blood do to GnRH, FSH and LH | inhibits them
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| What signal shuts off the anterior pituitary when sperm count is high | inhibin
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| what signals male pubertal development of glands, ducts, penis, causing them to grow and assume adult function what happens if you don't get this signal | testosterone if not all will atrophy
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| what promote secondary sex charachteristics in males | testosterone
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| In women what hormone is the Basis for sex drive (libido) | testosterone
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| In men what hormone is the basis for sex drive (libido) | testosterone
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| Why don't girls ovulate until puberty | ovaries secrete small amounts of estrogen that inhibit hypothalamic release of GnRH. At puberty the hypothalmus become less sensitive to estrogen and releases GnRH stimulating secretion of FSH and LH from ant. pituitary starting puberty in girls
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| what is menarche | menstrual cycle
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| How many phases are there in the ovarian cycle and name them | three phases, follicular phase, Ovulatory Phase, Luteal Phase
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| What phase occurs in the first ten days of the ovarian cycle and is started by FSH action on the ovary. | Follicular phase, primordial follicle surrounding pirmordial oocyte is activated by the FSH to secrete estrogen
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| what are the actions of estrogen (secreted by follicle) on the cervix | widens cervix and changes mucus consistency to allow sperm in
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| How does the follicle create estrogen | follicle enlarges and forms zona granulose around oocyte until it forms the theca folliculi. LH targets thecal cells to produce androgen and FSH converts androgens to estrogen in the granulosa cells
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| Why do FSH and LH levels fall after development of the follicle | rising estrogen levels have negative feedback on pituitary and FSH and LH secretion
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| Why do you get and LH surge in ovarian cycle | critical high concentration of estrogen causes replaces negative feedback at pituitary with positive feedback causing LH to surge
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| When does meiosis one finish with developing first polar body in oocyte development in women | after follicle develops
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| When does the ovulatory phase begin in the ovarian cycle | at about day 14 the LH surge from the positive feedback from estrogen causes ovary to release ripened egg
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| What happens to the follicle during ovulatory phase | follicle matures into a graafian follicle and bulges from the external ovarian surface. LH surge causes its wall to rupture and release the secondary oocyte into the peritoneal cavity
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| Some women can feel the egg actual being released from the follicle into the peritoneal cavity what is this called | mittleschmerz sign
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| During ovarian cycle is there only one follicle that develops | yes and no, generally only one will fully develop but you have multiple follicles at different stages of development they will degenerate with the principle follicle and are called atretic follicles
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| what are atretic follicles | follicles that were developing along with the principle follicle that don't develop completely
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| How common is it that more than one oocyte will be secreted | 1-2% may result in twins
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| What is the final phase of the ovarina cycle when the follicle starts to secrete progesterone | luteal phase, follicle actual becomes known as the corpus luteum
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| What is the role of progesterone | prepares uterine lining to nourish fertilized egg
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| If a fertilized egg implant in the uterus what signal is generated to keep the uterus wall intact and keep the corpus luteum going for a copule more months | HCG
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| What secretes the estrogen and progesterone required to maintain the pregnancy after the corpus luteum has degenerated | the placenta itself
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| What are the three phases of the uterine cycle | menstrual phase, proliferative phase, secretory phase
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| what is the menstrual phase of the uterine cycle | thickened endometrium detaches from uterine wall and passes out of the vagina
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| what is the proliferative phase of the uterine cycle | uterus wall become highly vascularized stimulated by estrogen from follicle. Also progesterone receptors are inserted in endometrial cells
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| what is the secretory phase in the uterine cycle | progesterone causes spiral arteries to elaborate and coil, glands enlarge and secrete glycogen to sustain embryo if fertilized egg implants
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| if you have endometrial stroma in abnormal locations outside the uterus what is this called | endometriosis
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| what are the clinical features of endometriosis | severe dysmenorrhea
pelvic pain
pain with defecation
dysuria
infertility can develop from the scar tissue
heavy or irregular menstruation
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| What is the tx for endometriosis | if women wants to get pregnant can use drugs that lower hormone levels.
Danazol and Depo-provera (when pregnancy is not wanted)
Laproscopic laser- cauterize and excise abnormal endometrial tissue
-total hysterectomy ( works 90% of the time)
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| What is the most common type of lesions on the ovaries | ovarian functional or benign cysts
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| what are functional ovarian cysts | unruptured graafian follicles they can get as large as 2cm and are painful if they rupture and leak their serous fluid into the peritoneal cavity
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| What is the tx for ovarian cysts | ablation by laser or electrocautery if ruptures are frequent
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| What is an ovarian pahtology that can lead to hirsutism caused by high levels of LH leading to increased ovarian androgens that cause the hirsutism | Polycystic ovarian syndrome
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| Why do patients with polycystic ovarian syndrome have higher risk of endometrial cancer | they have high levels of androgen especially estrogen which leads to endometrial hyperplasia increasing risk of endometrial cancer
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| what are the clinical features of polycystic ovarian syndrome | oligomennorrhea
persistent anovulation
obesity (40%)
Hirsutism (70%)
insulin resistance
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| Your patient has hirsutism what do you need to do to confirm it is from polycystic ovarian syndrome | draw labs looking for
DHEA- NL
Testosterone- high
LH:FSH ratio: >3:1
Cortisol: NL
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| what is the tx for polycystic ovarian syndrome | endometrial biopsy r/o malignancy
oral birth control pills
spironolactone-competes with androgens for receptor binding site
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| Why is metformin useful in tx of polycystic ovarian syndrome | can be sued to decrease insulin resistance because insulin resistance and obesity are major problems in polycystic ovarian syndrome
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| Should an ovarian tumor be a huge concern for a patient. | Not likely 80% are benign but most ovarian malignancy go unnoticed until they have metastazied
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| What are serous tumors | ovarian tumor 75% benign tumor is often on ovarian surface more likely to extend into peritoneal cavity and cause intestinal obstruction.
if tumor is resected 90-100% 5 yr survival
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| what ovarain neoplasm accoutns for 25% of them and appear mostly in middle adulthood filled with sticky gelatinous fluid | mucinous tumors
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