endometrial cycle and the occurrence of ovulation- the menstrual cycle consist of

Reproductive:

endometrial cycle and the occurrence of ovulation- the menstrual cycle consist of three phases: the follicular/proliferative phase (postmenstrual), followed by the luteal/secretory phase (premenstrual), and the ischemic/menstrual phase.*Ovarian hormones control the uterine (endometrial) events of the menstrual cycle. During the follicular/proliferative phase of the ovarian cycle estrogen produced by the follicle causes the endometrium to proliferate (proliferative phase) and induces the LH surge and progesterone production in the granulosa layer. During the luteal/secretory phase, estrogen maintains the thickened endometrium, and progesterone causes it to develop blood vessels and secretory glands (secretory phase). As the corpus luteum “starved” endometrium degenerates and sloughs off, causing menstruation, the ischemic/menstrual phase.uterine prolapse- the descent of the cervix or entire uterus into the vaginal canal due to weakened pelvic fascia and musculature and poor support from the vaginal muscles and fascia.polycystic ovarian syndrome- most common cause of anovulation and ovulatory dysfunction in women. Defined as having at least two of the following three features: irregular ovulation, elevated levels of androgens (e.g., testosterone), and the appearance of polycystic ovaries on ultrasound. PCOS is associated with metabolic dysfunction, including dyslipidemia, insulin resistance, and obesity.One of the most common endocrine disturbances affecting women, especially young women, and is a leading cause of infertility in the U.S. Strong genetic component to PCOS, various features of the syndrome may be inherited. PCOS patients are three times as likely to have insulin resistance, higher for obese women. Tend to have increased leptin levels. Symptoms within 2 years of puberty & include: dysfunctional bleeding or amenorrhea, hirsutism, acne, acanthosis nigricans, and infertility. 60% are obese. Increased risk for gestational DM, pregnancy-induced HTN, preterm birth, and perinatal mortality.testicular cancer and conditions that increase risk- most common cancer in men, age 15-35. Slightly more common on the right than on the left. 90% of testicular

cancers are germ cell tumors arising from the male gametes. Two types:

Seminomas-most common, least aggressive, make up 30-35% of testicular cancers & Nonseminomas-include embryonal carcinomas, teratomas, and choriocarcinomas, which are the most aggressive, but rare form of testicular cancer. Risk factors include: genetic predisposition, history of cryptorchidism, abnormal testicular development, HIV, AIDS, Klinefelter syndrome, and history of testicular cancer. Can arise from specialized cells of the gonadal stroma-these tumors, which are named for their cellular origins, are Leydig cell, Sertoli cell, granulosa cell, and theca cell tumors and constitute less than 10% of all testicular cancers.symptoms that require evaluation for breast cancer- painless lump, palpable nodes in the axilla, retraction of tissue (dimpling), chest pain, dilated blood

vessels, edema, edema of the arm, hemorrhage, local pain, nipple/areolar eczema, nipple discharge in non-lacting woman, pitting of the skin (like surface of an orange peel), reddened skin, local tenderness and warmth, skin retraction, ulceration.signs of premenstrual dysphoric disorder- One of these symptoms must be present for a diagnosis: marked affective lability, marked irritability or anger or increased interpersonal conflicts, marked anxiety, tension. One of these must also be present: decreased interest, difficulty concentrating, easy fatigability, low energy, increase or decrease in sleep, feelings of being overwhelmed, physical

symptoms, such as: breast tenderness, muscle or joint aches, bloating or weight

gain. (Greater than 5 of these symptoms occur during the week before menses onset, improve within a few days after menses onset, and diminish in the week postmenses).dysfunctional uterine bleeding- bleeding that is abnormal in duration, volume, frequency, or regularity; and has been present for the majority of the previous 6 months. May be acute or chronic. PALM-COEIN System for classification of abnormal uterine bleeding: PALM-structural causes: Polyp, Adenomyosis,

Leiomyoma, Malignancy. COEIN-nonstructural causes: coagulopathy, ovulatory

dysfunction, endometrial, iatrogenic, not yet classified. Increased endometrial bleeding is correlated with a change from ovulatory to anovulatory cycles due to high estrogen levels.pathophysiology of prostate cancer- More than 95% of prostatic neoplasms are histologically similar to adenocarcinomas and rely on androgen-dependent signaling for their development and progression. Most of these neoplasms occur in the periphery of the prostate. Prostatic adenocarcinoma is a heterogeneous group of tumors with a diverse spectrum of molecular and pathologic characteristics, and therefore clinical behaviors and challenges. The biologic aggressiveness of the neoplasm appears to be related to the degree of differentiation rather than the size of the tumor. Testicular testosterone provides the main source of androgens in the prostate and is the major circulating androgen, whereas DHT predominates in prostate tissue and binds to the androgen receptors with greater affinity than does testosterone. Androgen production outside of the testes, or extra testicular sources. Testosterone is converted to dihydrotestosterone, DHT is the most potent intraprostatic androgen.HPV and the development of cervical cancer- almost exclusively caused by cervical human papillomavirus (HPV) infection. HPV strains 16 & 18 are most often implicated as causing 70% of all cervical cancers and also contribute to many vaginal, vulvar, penile, anal, and oropharyngeal cancers. Most HPV infections are cleared from the immune system; vast majority of infections do not cause cervical cancer. Screening before age 21 not recommended. Women with multiple sex partners are more likely to be exposed to high-risk HPV, but women with only one lifetime sexual partner can also become infected. Transformation zone is where the two cell types of squamous epithelium cells and columnar

epithelial cells come together and this is where carcinoma in situ is most likely to develop. PAP test or HPV screening necessary for early detection; 90% can be detected by these. Viral DNA becomes integrated into the genomic DNA of the infected basal cell of the cervix and directs the persistent production of viral oncogenes. Persistence of infection with high-risk HPV is a prerequisite for the development of cervical intraepithelial neoplasia, lesions, and invasive cervical cancers.

Endocrine:

body’s process for adapting to high hormone levels- Feedback systems. Most hormone levels are regulated by negative feedback, in which tropic hormone secretion raises the level of a specific hormone. The elevated level of the specific hormone then causes negative feedback, decreasing secretion of the tropic hormone. Positive feedback systems, in which elevated hormone levels increase a response which then further increases hormone secretion, is seen most often in reproductive hormones. Negative feedback is the most common & occurs when a chemical, neural, or endocrine response decreases the subsequent synthesis and secretion of a hormone. Positive feedback occurs when a neural, chemical, or endocrine response increases the synthesis and secretion of a hormone. Positive feedback also occurs when an increased hormone level further increases the synthesis and secretion of that same hormone. The sensitivity or affinity of the target cell to a particular hormone is related to the concentration of receptors per cell: the more receptors, the higher the affinity or the more sensitive the cell is to the stimulating effects of the hormone. Thus the cell can adjust its sensitivity to the concentration of the signaling hormone. hormone is distributed throughout the body, only target cells with specific receptors for that hormone are affected.Target cell response depends on blood levels of the hormone, the concentration of target cell receptors, and affinity of the receptor for the hormone. Hormone

receptors of the target cell have two main functions: (1) to recognize and bind

with high affinity to their particular hormones and (2) to initiate a signal to appropriate intracellular effectors. See Chapter 1 for cell signaling pathways, particularly.Cushing’s Syndrome- the clinical manifestations resulting from chronic exposure to excess endogenous cortisol and is more common in women. Cushing’s disease is excess endogenous secretion of ACTH. ACTH dependent hypercortisolism (about 80%) results from overproduction of pituitary ACTH by a pituitary adenoma (most common and can occur at any age) or by an ectopic secreting nonpituitary tumor, such as a small cell carcinoma of the lung (more common in older adults). ACTH-independent hypercortisolism (about 20%) is caused by cortisol secretion from a rare benign or malignant tumor of one or both adrenal glands (more common in children). A Cushing-like syndrome may develop as a side effect of long-term pharmacologic administration of glucocorticoids. With ACTH-dependent hypercortisolism, the excess ACTH stimulates excess production of cortisol and there is loss of feedback control of ACTH secretion. Whatever the cause, two observations consistently apply to individuals with Cushing’s syndrome: 1.) They don’t have diurnal or circadian

secretion patterns of ACTH and cortisol, and 2.) They do not increase ACTH and cortisol secretion in response to a stressor. In individuals with ACTH-dependent hypercortisolism, secretion of both cortisol and adrenal androgens is increased, and corticotropin-releasing hormone (CRH) secretion is inhibited. Weight gain is the most common feature; “moon face” due to excess sodium and water retention, truncal obesity, buffalo hump. DM develops in approximately 20% of individuals with hypercortisolism. Polyuria is a manifestation of hyperglycemia and resultant glycosuria. Differentiation among pituitary, ectopic, and adrenal causes is essential for effective treatment.causes of hypoparathyroidism- most commonly caused by damage to or removal of the parathyroid glands during thyroid surgery and occurs because of the anatomic proximity of the parathyroid glands to the thyroid. Also associated with genetic syndromes, including familial hypoparathyroidism and DiGeorge syndrome (velocardiofacial syndrome), and an idiopathic or autoimmune form of the disease. A lack of circulating PTH causes depressed serum calcium levels and increased serum phosphate levels. In the absence of PTH, resorption of calcium from bone and regulation of calcium reabsorption from the renal tubules are impaired. Therefore phosphate rea sorption by the renal tubules is increased, causing decreased renal phosphate excretion and hyperphosphatemia.Hypomagnesemia also can cause a decrease in PTH secretion and function, because it inhibits PTH secretion. When serum magnesium levels return to normal, however, PTH secretion returns to normal, as does the responsiveness of peripheral tissues to PTH. Hypomagnesemia may be related to chronic alcoholism, malnutrition, malabsorption, increased renal clearance of magnesium caused by the use of aminoglycoside antibiotics or certain chemotherapeutic agents, or prolonged magnesium-deficient parenteral nutritional therapy.lab results that point to primary hypothyroidism- increased levels of TSH, and decreased levels of TH (total T3 and both total and free T4). When hypothyroidism is caused by pituitary deficiencies, serum TSH levels are decreased or are inappropriately normal in the face of low levels of TH.pathophysiology of thyroid storm- usually occurs in individuals who have undiagnosed or partially treated severe hyperthyroidism and who are subjected to excessive stress from other causes. These causes may include infection, pulmonary or cardiovascular disorders, trauma, burns, seizures, surgery (especially thyroid surgery) obstetric complications, emotional distress, or dialysis. The symptoms of thyroid storm are caused by the sudden release and increased action of thyroxine (T4) and tri-iodothronine (T3) exceeding metabolic demands. Without treatment, death can occur quickly. One hypothesis suggests the incidence of thyroid storm is due to the rapid increase in thyroid hormone levels, rather than the absolute hormone level that occurs during thyroid surgery, following radioactive iodine treatment, after sudden discontinuation of the antithyroid drug, or after administration of the large dose of iodine in contrast studies. The hyperactivity of sympathetic nervous system with increased response to catecholamine along with an increased cellular response to thyroid