Term
| What is normal fasting plasma glucose? For DM? |
|
Definition
| <100 mg/dL, 5.6 mmol/L; >126 mg/dL, >7.0 mmol/L |
|
|
Term
| What are symptoms of hyperglycemia? |
|
Definition
| polyuria, glycosuria, polydipsia, dehydration |
|
|
Term
| What are symptoms of starvation? |
|
Definition
| weight loss, wasting, weakness (breakdown of fats and proteins, particularly in IDDM) |
|
|
Term
| What are symptoms of ketoacidosis? |
|
Definition
| lipolysis-->+ FFA-->ketoacidosis (in IDDM) |
|
|
Term
| What are the complications of diabetes? |
|
Definition
+F-->atherosclerosis-->ischemia in brain, heart, kidneys, legs
+F-->microvasucular disease: retina (retinopathy), kidneys (nephropathy), peripheral nerves (peripheral neuropathy), brain |
|
|
Term
| What are the sensorimotor problems associated with diabetic neuropathy? |
|
Definition
muscular: muscle weakness, atrophy, ataxic gait
sensory: pain, paresthesia, numbness, paralysis, cramping, falls |
|
|
Term
| What are the cardiovascular problems assoicated with diabetes? |
|
Definition
| exercise intolerance, fatigue, sustained HR, syncope, dizziness, lightheadedness, balance |
|
|
Term
| GI complications of diabetes? |
|
Definition
| dysphagia, bloating, nausea and vomiting, diarrhea, constipation |
|
|
Term
| GU complications of diabetes? |
|
Definition
| loss of bladder control, UTI, urinary frequency or dribbling, erectile dysfunction, loss of libido, dyspareunia, vaginal dryness, anorgasmia |
|
|
Term
| Sudomotor complications of diabetes? |
|
Definition
| pruritis, dry skin, limb hair loss, calluses, reddened areas |
|
|
Term
| Endocrine complications with diabetes? |
|
Definition
|
|
Term
| some other general complications associated with diabetes? |
|
Definition
| difficulty driving at night, depression, anxiety, sleep disorders, cognitive changes |
|
|
Term
|
Definition
| increase glycogenolysis, increase gluconeogenesis, increase lipolysis, and increas ketoacid formation |
|
|
Term
| How does GH increase blood glucose? |
|
Definition
| reduces insulin sensitivity |
|
|
Term
| How does EPI increase blood glucose? |
|
Definition
| responds to stress, inhibits insulin secretion |
|
|
Term
| HOw does cortisol increase blood glucose? |
|
Definition
| responds to stress, reduces insulin sensitivity |
|
|
Term
| Which hormones stimulate glycogenolysis and gluconeogenesis? |
|
Definition
| glucagon, GH, EPI, and cortisol |
|
|
Term
| FSH acts on what cells in the testis? |
|
Definition
|
|
Term
| LH acts on which cell of the testis? |
|
Definition
|
|
Term
| Explain why testosterone has both endocrine and paracrine effects? |
|
Definition
| it effects both target cells and neighboring Sertoli cells |
|
|
Term
| What is the specific action of LH at the level of Leydig cells? |
|
Definition
| increases cholesterol desmolase activity (cholesterol to pregnenlone) |
|
|
Term
| What are the 4 androgens secreted by Leydig cells |
|
Definition
testosterone
DHT
androstenedione
dehydropiandrosterone (DHEA) |
|
|
Term
| What enzyme converts testosterone to DHT? |
|
Definition
|
|
Term
| What are the effects of testosterone? |
|
Definition
| fetal differentiations of epididymis, vas deferens, seminal vescicles; development of muscle, pubertal growth spurt, epiphyseal closure, growth of penis, seminal vesicles, deepening voice, spermatogenesis, libido, negative feedback on pituitary |
|
|
Term
| What are the effects of DHT? |
|
Definition
| fetal differentiation of penis, scrotom, and prostate; male hair pattern and baldness; sebaceous gland activity; prostate growth |
|
|
Term
| How are primordial germ cells produced? |
|
Definition
| by mitotic division until gestational week 20-24: 7 million oogonia |
|
|
Term
| How are primary oocytes produced? |
|
Definition
from about weeks 8 to 9, some oogonia enter meiosis and become primary oocytes
completed by about 6 months after birth
oocyte attrition
• birth-2 million oocyte
• puberty-400K oocytes
• menopause-0 oocytes |
|
|
Term
| What is the first stage of follicle development? |
|
Definition
primary oocyte grows
• granulose cell proliferation-nurtures oocyte, produces hormones
• primordial follicle develops into a primary follicle
• no progression beyond this first stage before puberty |
|
|
Term
| What is the second stage of follicle development? |
|
Definition
takes place over 70-85 days
occurs only during reproductive period
during each menstrual cycle, a few follicles enter this stage, develop a cavity around ovum-antrum formation
• fluid containing steroid hormones and FSH in addition to other proteins and muccopolysaccharides accumulates in the central area
granulose cells and theca cells continue to grow |
|
|
Term
| What is the third state of follicle development? |
|
Definition
takes 5-7 days after menses
one follicle becomes dominant over the other follicles
• non-dominant follicles regress
• dominant follicle grows to 20 mm in diameter
Day 15 of a 28 day menstrual cycle-ovulation occurs
• dominant follicle ruptures (corpus hemorrhagicum)
• releases oocyte into peritoneal cavity |
|
|
Term
| What happens after ovulation in the peritoneum and fallopian tube? |
|
Definition
Peritoneum and fallopian tube
• 1st meiotic division is completed
• 2nd oocyte enters fallopian tube and begins 2nd division
o 2nd meiosis completes if fertilized |
|
|
Term
| What happens in the ovary after ovulation? |
|
Definition
• residual elements of ruptured follicle (Graafian follicle) form corpus luteum
o primarily granulosa cells, theca cells
o synthesizes and secretes steroid hormones needed for implantation and zygote maintenance
o Fertilization: continues hormone secretion until placenta takes over
o No fertilization: regresses during the next 14 days get corpus albicans |
|
|
Term
| What controls the process leading up to ovulation? |
|
Definition
hormone control: GnRH (hypothalamus)FSH and LH (anterior pituitary)Theca cells (LH) and Granulosa cells (FSH) Theca cells (progesterone and testosterone) and Granulosa cells (converts testosterone into estradiol)
• steroid hormones
o estrogen
o progesterone
• pituitary hormones
o FSH
o LH
• hypothalamus
o GnRH |
|
|
Term
| What is the division of labor for theca cells? |
|
Definition
synthesize and secrete progesterone
expresses 17-beta-hydroxysteroid dehydrogenase
synthesize and secrete testosterone, an androgen
under control of LH (stimulates cholesterol desmolase or side chain cleavage enzyme-->stimulates androgen |
|
|
Term
| What is the division of labor for granulosa cells? |
|
Definition
express aromatase
converts testosterone to 17-beta-estradiol
FSH stimulates aromatase |
|
|
Term
| What is the danger of continuous secretion of GnRH from the arcuate nucleus? |
|
Definition
• crucial: continuous GnRH release leads to desensitization and down regulation-leads to inhibition of gonadotropin reelase
• continual stimulation of the pituitary leads to down regulation of the GnRH receptor and inhibition of LH and FSH synthesis and release by the pituitary |
|
|
Term
| What happens during the follicular phase? |
|
Definition
o GnRH pulses are frequent with small amplitude
estrogen at low levels inhibits GnRH (negative feedback)
estrogen at higher levels stimulates GnRH (positive)
o **Inhibin from ovary attempts to inhibit FSH but spike in GnRH overrides the effects** |
|
|
Term
| What happens during the luteal phase? |
|
Definition
o GnRH pulses are large but less frequent
o progesterone decreases frequency (negative feedback) |
|
|
Term
| What are the effects of LH in females? |
|
Definition
effects mediated by a LH receptor located on the theca cellsstimulates synthesis of androstenedione and testosterone
required for the rupture of the dominant follicle (Graafian)
induces expression of FSH receptor on the granulosa cells |
|
|
Term
| What are the effects of FSH in females? |
|
Definition
Effects mediated by a FSH receptor
stimulates growth of developing follicles
induces expression of LH receptors on theca and granulose cells
regulates the activity of aromatase-stimulation of estradiol production |
|
|
Term
| What are the general effects of estrogen? |
|
Definition
Maturation and maintenance of uterus, fallopian tubes, cervix, and vagina
Puberty, secondary sex characteristics
Proliferation of granulosa cells |
|
|
Term
| What are the general effects of progesterone? |
|
Definition
Maintenance of secretory activity of uterus during luteal phase
Reduces estrogen proliferative effects on uterus |
|
|
Term
| What are the feedback effects of estrogen? |
|
Definition
| Negative and positive feedback regulation of FSH and LH |
|
|
Term
| What are the feedback effects of progesterone? |
|
Definition
| Negative feedback effects on FSH and LH |
|
|
Term
| What are the effects of estrogen and progesterone on pregnancy? |
|
Definition
|
|
Term
| How does estrogen influence uterine contractions? |
|
Definition
| Lowers uterine threshold to contractile stimuli |
|
|
Term
| How does progesterone influence uterine contraction? |
|
Definition
| Raises uterine threshold to contractile stimuli to pregnancy |
|
|
Term
| How does estrogen effect the breast? |
|
Definition
| Blocks action of prolactin on the breast (inhibits milk production) |
|
|
Term
| How does progesterone affect the breast? |
|
Definition
| Stimulates transient breast epithelial proliferation-followed rapidly by growth arrest |
|
|
Term
| What are estrogens effects on bones? |
|
Definition
• increase, maintenance of bone mass
• deficiency states lead to osteoporosis
• major effect on bone is to decrease osteoclast activity
• minor effect is to increase osteoblast activity
• estrogen replacement will prevent bone loss |
|
|
Term
| What are the effects of progesterone on temperature? |
|
Definition
| Increases body temperature: mid-cycle increase 1 degree, persists through cycle, alteration of CNS temperature regulatory center? |
|
|
Term
| Where are more ER alpha receptors found? |
|
Definition
| female reproductive tract, lung, brain, vasculature |
|
|
Term
| Where are more ER beta receptors found? |
|
Definition
|
|
Term
| What does progesterone receptor A do? |
|
Definition
act as a transcriptional inhibitor of other steroid receptors
estrogen, glucocorticoids, androgen receptor activation is suppressed |
|
|
Term
| What does progesterone receptor B do? |
|
Definition
| mediates the stimulatory activities of progesterone |
|
|
Term
| What hormone output is highest during implantation |
|
Definition
| Progesterone from corpus luteum |
|
|
Term
|
Definition
| outer rim of cells of blastocyst that invades endometrium and secretes HCG at 8 days after ovulation |
|
|
Term
| What is the function of HCG? |
|
Definition
HCG rescues corpus luteum
• stimulates corpus luteum to continue to synthesize progesterone and estrogen to maintain the endometrium
HCG levels are maximal at gestation week 9 and then decline |
|
|
Term
| What happens during the first trimester? |
|
Definition
| Fetal development: most organs develop during the first trimester (sensitive period for chemically induced birth defects) |
|
|
Term
| What occur during the 2nd and 3rd trimester? |
|
Definition
placenta becomes producer of steroid hormones
progesterone
• produced from maternally derived cholesterol
Estrogen-required by mother, placenta, and fetus |
|
|
Term
| What are the roles of physical stimuli, estrogen, progesterone, and prostaglandins during delivery? |
|
Definition
• physical: distension increases contractility
• estrogen/progesterone ratio increases
o increase uterine sensitivity to contractile stimuli
• Prostaglandins of E and F series
o increase uterine contractility |
|
|
Term
| What is the role of oxytocin? |
|
Definition
o can stimulate uterine contraction but levels do not increase near term
o receptors for oxytocin are up regulated
o Stimulated by receptors on the cervix and the mammary gland
stretching of the cervix stimulates oxytocin secretion
• stimulates frequency and force of contraction
secreted as a response to suckling
• can also be a conditioned reflex
• stimulates milk ejection from the mammary gland
o acts via G-protein coupled receptors |
|
|
Term
| What are the three stages of labor? |
|
Definition
• 1st: uterine contractions move head toward cervix, progressive widening and thinning of cervix
• 2nd: fetus forced through cervix and delivered through vagina
• 3rd: placenta separates from uterine tissue and is delivered (uterine contractions constrict uterine blood vessels and limit postpartum bleeding) |
|
|
Term
| What is the process of lactation? |
|
Definition
o during pregnancy, estrogen and progestone stimulate growth and development of breast
o estrogen stimulates prolactin (PL) secretion: levels increase over course of pregnancy
estrogen and progesterone block the action of PL on breast
o after parturition, estrogen and progesterone levels fall and their inhibitory effect o PL activity in breasts are remove
o lactation is maintained by suckling
stimulates oxytocin and prolactin secretion |
|
|
Term
|
Definition
| dopamine D2 receptors on lactotropes when stimulated inhibit PL secretion |
|
|
Term
| What stimulates prolactin? |
|
Definition
suckling, TRH can stimulate release
hypothyroidism can lead to hyperprolactinemia and galactorrhea |
|
|
Term
|
Definition
| yes, at levels such as that provided by lactation |
|
|
Term
|
Definition
|
|
Term
| Does prolactin inhibit GnRH? |
|
Definition
|
|
Term
| What is the axis beginning at CRH? |
|
Definition
| CRH-->ACTH-->aldosterone (zona glommerulosa), cortisol (glucocorticoids), androgens (zona reticularis) |
|
|
Term
| What is the axis beginning at TRH and continuing with TSH? |
|
Definition
|
|
Term
| What is the axis for GnRH and LH in females? |
|
Definition
| GnRH-->LH-->theca cells of follicle, rupture of follicle, estogen and progesterone |
|
|
Term
| What does dopamine do to prolactin? |
|
Definition
|
|
Term
| What is the GnRH and FSH axis in women? |
|
Definition
| GnRH-->FSH-->granulosa cells (aromatase-->estrogen), developing follicles |
|
|
Term
| What is the GnRH and LH axis in males? |
|
Definition
| GnRH->LH->Leydig (testosterone)->sertoli and target cells |
|
|
Term
| What is the GnRH and FSH axis in males? |
|
Definition
| GnRH->FSH->Sertoli cells (sperm maturation) |
|
|
Term
|
Definition
| GHRH->GH->protein synthesis, organ growth, amino acid uptake, DNA and RNA synthesis, linear growth, insulin resistance: increased plasma glucose, lipolysis, and use of fat stores |
|
|
Term
| What is the connection between ACTH and MSH? |
|
Definition
| the more ACTH, the more MSH (increased pigmentation) |
|
|
Term
| What is the function of cortisol? |
|
Definition
| increases gluconeogenesis, vascular response to EPI and NE (alpha 1, beta 2); decreases inflammatory and immune response |
|
|
Term
| What are the effects of T3 and T4? |
|
Definition
| skeletal growth, oxygen consumption, heat, protein/carb/fat usage; CNS maturation |
|
|
Term
| What is the function of estradiol? |
|
Definition
| growth and development of sex organs, spikes LH for ovulation, inhibits prolactin secretion, maintains pregnancy |
|
|
Term
| Which hormones are secreted by the corpus luteum? |
|
Definition
| estradiol and progesterone |
|
|
Term
| How role does the suprachiasmatic nucleus play in sleep cycles? |
|
Definition
| light->retinohypothalamic tract->SCN->pineal gland and melatonin secretion decreases |
|
|
Term
| What does the arcuate nucleus do? |
|
Definition
|
|
Term
| What are the roles of the supraoptic and paraventricular nuclei? |
|
Definition
| release of ADH and oxytocin |
|
|
Term
| What receptor senses increased plasma osmolarity? |
|
Definition
|
|
Term
| ADH in circulations acts via which receptor? |
|
Definition
|
|
Term
| Cortisol has negative feedback on ___________. |
|
Definition
|
|
Term
|
Definition
| insulin-like growth factor, secreted in liver, acts like insulin, negative feedback on GH and GHRH |
|
|
Term
| What does somatostatin do? |
|
Definition
| inhibits cAMP, opposite of GH |
|
|
Term
| What does prolactin inhibit? |
|
Definition
|
|
Term
| Panhyperpituitarism leads to _________. |
|
Definition
| amenorrhea (prolactin), gigantism or acromegaly (GH), infertility (LH,FSH), high cortisol (ACTH), hyperthyroidism (TSH) |
|
|
Term
| What does hypopituitarism do? |
|
Definition
| failure to lactate (PL), dwarfish (GH), gonadal insufficiency (LH,FSH), adrenal insufficiency (ACTH), hypothyroidism (TSH) |
|
|
Term
| What are the signs and symptoms of hyperthyroidism? |
|
Definition
| weight loss, excess heat, increased heart rate and contractility, afib, tremor, increased BMR, exophthalmos, goiter |
|
|
Term
| Signs and symptoms of hypothyroidism? |
|
Definition
| increased weight, lower heat, lower HR and CO, lower BMR, drooping eyelids, goiter |
|
|
Term
| What inhibits peroxidase activity? |
|
Definition
|
|
Term
| What are the signs and symptoms of Cushing disease? |
|
Definition
| high blood glucose, muscle weakness, atrophy, fatigue, bruising, fat distribution, poor healing, HTN |
|
|
Term
| Signs and symptoms or Addison's disease? |
|
Definition
| hypoglycemia, high ACTH (low ACTH if secondary adrenal insufficiency), skin darker (MSH), hypotension (low mineralocorticoid) |
|
|
Term
| What will pheochromocytoma do? |
|
Definition
| increase EPI and NE, HTN, tachycardia, glucose intolerance, HA, sweating, anxiety, tremor |
|
|
