Pathophysiology NU545-- Unit
3--Endocrine
Leiomyomas - ANS (myomas/uterine fibroids) are benign smooth muscle tumors of the
myometrium. Cause is unknown but size of tumor related to estrogen, progesterone, growth
factor, angiogenesis, and apoptosis. Also possible genetic components. Classified as:
Subserous, Submucous, and Intramural based on location. Unlike cancer, it cannot proliferate.
Endometrial Carcinoma - ANS arise from glandular epithelium of the uterine lining. Primary risk
factor is prolonged exposure to estrogen without presence of progesterone (known as
unopposed estrogen). Other risk factors include obesity, diabetes, gallbladder disease, and
hypertension. Adenocarcinoma: is most common
Uterine Sarcoma - ANS rare and arise from mesenchymal tissues of and near the uterus and
can be divided into: endometrial stromal sarcoma, leiomyosarcoma, and adenosarcoma (based
on involved tissues). Lack of epidemiological and treatment data due to low occurrence. Risk
factors may include chronic excess estrogen exposure, tamoxifen, and African American race.
Histology Uterine Tumor Type I - ANS results from estrogen exposure leading to endometrial
hyperplasia
Histology Uterine Tumor Type II - ANS result from estrogen exposure leading to endometrial
hyperplasia -more invasive and can metastasize resulting in increase risk of death
Amenorrhea - ANS lack of menstruation
Primary amenorrhea - ANS is the failure of menarche and the absence of menstruation by age
13 years without the development of secondary sex characteristics or by age 15 regardless of
the presence of secondary sex characteristics.
Secondary amenorrhea - ANS is the absence of menstruation for a time equivalent to three or
more cycles in women who have previously menstruated. Pregnancy is the most common
condition to rule out prior to further evaluation.
Compartment II - ANS (etiology of primary amenorrhea) disorders involve the ovary and are
often linked with genetic abnormalities. These include gonadal dysgenesis (Turner syndrome),
androgen insensitivity syndrome or male pseudohermaphroditism.
Signs of Puberty - ANS A series of hormonal events promote sexual maturation
,Signs of Puberty in boys - ANS Testosterone secretion causes growth of the testes, scrotum,
and penis.The scrotal skin thins and testes begin to produce mature sperm. Increased
production of growth factors causes rapid skeletal growth. Increased adrenal androgens causes
axillary and pubic hair growth. Puberty begins between the ages of 8 and 14 and is complete
when the first ejaculation contains mature sperm.
Signs of Puberty in girls - ANS begins at about ages 8-9 with thelarche (breast
development).About a year before puberty in girls, there is an increase in frequency and
amplitude of nocturnal pulses of gonadotropin secretion, LH, and FSH, and an increased
response in the pituitary to GnRH. This stimulates gonadal maturation (gonadarche) with
estradiol secretions that in boys causes testosterone secretion, but in girls, causes breast
development, maturation of the reproductive organs (vagina, uterus, ovaries), and fat deposit in
hips.
Constitutional Delay of Puberty - ANS In 95% of cases, delayed puberty is physiologic delay in
which hormonal levels are normal and the hypothalamic-pituitary-gonadal (HPG) axis is intact,
but maturation is happening slowly.
Delayed Puberty - ANS no signs by the age of 14. 95% are physiological, hormones and
hypothalamic-pituitary-gonadal (HPG) axis is intact but maturation is happening slowly. This
tends to be familial and is more common in boys. It can also be caused by any condition that
causes delayed bone growth. The other 5% are caused by a disruption of the HPG axis such as
tumors, genetic.
Menopause - ANS the cessation of ovulation due to loss of ovarian follicles resulting in reduced
ovarian production of estradiol, increased FSH and LH, and decreased inhibin (inhibits release
of FSH).
Premenopause Signs - ANS approx. 90% of women note mild-extreme variability in menstrual
flow. Changes in hormones occur during this time including erratically higher estradiol levels,
decreased progesterone levels, and a disturbed ovarian-pituitary-hypothalamic feedback
causing premenopausal symptoms.
Premenopause Signs - ANS Uterine changes occur primarily in the endometrium. The increase
in anovulatory cycles allows proliferative growth of the endometrium. The physiology of
vasomotor flushes (hot flashes) is poorly understood. One theory proposes that rapid changes
in estrogen may result in loss of negative feedback over hypothalamic noradrenaline synthesis.
Breastmilk - ANS composition change over time to meet the changing digestive capabilities and
nutritional requirements of the infant but it also contains immune cells, specific
immunoglobulins, especially IgA, and nonspecific antimicrobial factors, such as lysozymes and
lactoferrin, that protect the infant against infection, allergies, and asthma. It reduces the
incidence of adult obesity, atheroserotic disease, and type 1 & 2 diabetes.
, Testes - ANS the essential organs of reproduction. They produce gametes (sperm) and
produce sex hormones (androgens and testosterone).
Epididymis - ANS comma shaped structure that curves over the posterior portion of each testis
and consists of a single highly packed and markedly coiled duct whose structural function is to
conduct sperm from the efferent tubules to the vas deferens.
Vas Deferens - ANS continuous with the tail of the epididymis, a duct with muscular layers
capable of powerful peristalsis that transports sperm toward the urethra.
Scrotum - ANS encloses the testes, epididymides, and spermatic cord. It is a skin-covered
fibro-muscular sac. Skin is thin and has rugae (wrinkles or folds) that enable is to enlarge or
relax away from the body depending on temperature. The tunica dartos forms a septum that
separates the two testes. Cold temperatures cause the tunica dartos to contract and pull the
testes close to the body.
Functions of Penis - ANS delivery of sperm to the vagina and elimination of urine.
External Penis - ANS Externally, it consists of a shaft with a tip, the glans, which contains the
opening of the urethra. For protection, the skin of the glans folds over the tip, forming the
prepuce or foreskin.
Internal Penis - ANS It consists of the urethra and 3 compartments: 2 corpora cavernosa and
the corpus spongiosum.
Internal Ducts of Penis - ANS consists of the two vasa deferentia, ejaculatory duct, and the
urethra. They conduct sperm and glandular secretions from the testes to the urethral opening of
the penis. The ejaculatory duct contracts rhythmically during emission and ejaculation.
Glands - ANS consists of the prostate gland, two seminal vesicles, and two Cowper
(bulbourethral) glands. They secrete fluids that sever as a vehicle for sperm transport and
create an alkaline, nutritious medium that promotes sperm motility and survival.
Seminal Vesicles - ANS are a pair of glands that provide fructose as a source of energy for
ejaculated sperm, and secrete prostaglandins that promote smooth muscle contraction assisting
with sperm transport.
prostate gland - ANS is regulated by androgens and the androgen receptor. Without them the
prostate is at risk for hyperplastic and malignant growth. Prostate secretions contribute to the
ejaculate and helps sperm survive in the acid environment of the female reproductive tract.
Cowper glands - ANS the last pair of glands to add fluid to the ejaculate.
