Terms in this set (224)

CC: Secondary AM. Mom hirstuism, father has diabetes. She's obese.

LABS: LH higher than FSH, Low Progesterone (no ovulation), increased androgens.
- more symptoms the higher your androgen level.
- virillism worst

ULTRASOUND: string of pearls of cysts- they are actually cysts. Tend to be a large ovary. Black = sign of anovulation.

ANDROGENS IN WOMEN:
50% of T/androstenedione from ovary, rest from adrenal.
DHEA - 90% from adrenal, rest from ovar.


HORMONAL FACTORS:
. Androgens converted to estrogens in fat (by aromatase)
. More fat, more conversion
. Estrogens ~↑ LH . LH ↑ ovarian androgens
. Estrogens (low levels) ↓FSH

COMPLICATIONS: They are already overweight.
PCOS have an innate insulin resistance. More insulin to try to overcome - IGF1 - goes to ovary and leads to higher androgen levels (and that feeds back to more IGF-1)
- Insulin also leads to less SHBG (free androgen sucked up) - therefore tons of free androgen/testosterone.
- Insulin also drives LH up
- Note: metformin actually lowers androgen levels.

RISKS: -Risk obesity, hypertension, diabetes, endometrial
hyperplasia/cancer

SYMPTOMS: Acanthosis nigricans- dirty neck.

TREATMENT:
Provide Estrogen / Progestin treatment
(eg: oral contraceptive pills)
-Cycles endometrium, prevents hyperplasia
-Lowers LH (from PG) and FSH
-Prevents ovarian cysts
-Decreases androgens
-Increases SHBG (via estrogen)
¨Decreases free androgens

For fertility
-Ovulation induction, Clomiphene citrate (tricks brian to think no E- induces more FSH) , Gonadotropins (FSH)
Prolactin is produced by the maternal adenohypophysis, fetal adenohypophysis, and decidual tissue of the uterus.
3 major actions of prolactin:
1) ↑ proliferation of mammary ducts at puberty and during pregnancy (with help of estrogen and progesterone)
2) ↑ milk production and secretion in breast in response to suckling by inducing synthesis of milk components: lactose, casein (the protein of milk), and lipids
3) ↓ synthesis and release of GnRH

During pregnancy, levels of prolactin, estrogen and progesterone increase. But estrogen and progesterone down-regulate prolactin receptors, preventing lactation from occurring during pregnancy

At parturition, there is a precipitous drop in estrogen and progesterone → prolactin receptors are no longer down-regulated, allowing the high levels of prolactin seen during pregnancy to take action → lactation can occur

Suckling is required to maintain milk production as increased nerve stimulation increases oxytocin and prolactin levels [1]

↓ Synthesis and release of GnRH → ↓ FSH and LH ∴ no LH surge ∴ inhibits ovulation → ↓ fertility while breast-feeding [Breastfeeding only provides 6 weeks of birth control protection] [2]

The ↓ fertility following parturition is only temporary. In lactating women, ovulation may return within 10 weeks postpartum, and the birth control protection afforded by lactation is ensured for only 6 weeks [3]

Males with high prolactin (e.g. prolactinoma) → ↓ GnRH → ↓ FSH and ↓ LH. Decreased FSH compromises spermatogenesis by Sertoli cells → infertility. Decreased LH → ↓ testosterone production by Leydig cells → ↓ energy, ↓ libido, impotence
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