Tietz Chapter 43: Reproduction-Related Disorders

8. In nonpregnant women, progesterone is synthesized and secreted by the: a. corpus luteum. b. placenta. c. pituitary gland. d. Both a and b are correct.

ANS: A After ovulation, the granulosa and thecal cells of the follicle become the corpus luteum. These luteal cells produce estrogen and progesterone. If fertilization and pregnancy occur, the corpus luteum persists and continues to produce estrogen and progesterone. If pregnancy does not occur, the corpus luteum regresses and is eventually replaced by scar tissue. DIF: 1 REF: Page 832 OBJ: 3 | 4

1. Which one of the following hormones causes the hypothalamus to trigger the surge of luteinizing hormone (LH) from the anterior pituitary just before ovulation? a. Estrogen b. Progesterone c. Follicle-stimulating hormone (FSH) d. Gonadotropin-releasing hormone (GnRH)

ANS: A Just before ovulation, estrogen secretion by the follicle increases dramatically; this positively stimulates the hypothalamus and triggers the LH surge. The LH surge is a reliable predictor of ovulation. DIF: 2 REF: Page 835 OBJ: 3 | 4

17. A 30-year-old female visits her physician with a complaint of excess facial and body hair, weight gain, and oligomenorrhea. She has read online that her symptoms indicate possible Cushing syndrome. Laboratory values indicate plasma cortisol levels within the reference intervals, elevated estrogen and LH, and decreased FSH. What other disorder might this patient have? a. Polycystic ovarian syndrome (PCOS) b. Conn syndrome c. Ovarian tumor d. Adult onset congenital adrenal hyperplasia

ANS: A PCOS is considered to be a hypothalamic disorder. It is clinically defined by hyperandrogenism with chronic anovulation in women without underlying disease of the adrenal or pituitary glands. This syndrome is characterized by infertility, hirsutism, obesity, and various menstrual disturbances ranging from amenorrhea to irregular bleeding. Relatively low FSH concentrations and high LH concentrations are common in PCOS. PCOS patients have substantial estrogen production because of the peripheral conversion of androgens to estrogens. DIF: 3 REF: Page 839 OBJ: 1 | 6 | 7

12. Early activation of the hypothalamic-pituitary-gonadal axis in a young child will lead to: a. GnRH-dependent precocious puberty. b. GnRH-independent precocious puberty. c. pseudoprecocious puberty. d. pseudohermaphroditism.

ANS: A Precocious puberty has been classified as GnRH dependent or independent. GnRH-dependent precocious puberty is due to precocious activation of the hypothalamic-pituitary-gonadal axis. GnRH-independent precocious puberty (also called pseudoprecocious puberty) refers to precocious sex steroid secretion that is independent of pituitary gonadotropin release. DIF: 2 REF: Page 837 OBJ: 1 | 5

2. What would the laboratory results be in a male patient exhibiting characteristic symptoms of hypogonadotropic hypogonadism? a. Elevated testosterone, decreased FSH b. Decreased testosterone, decreased FSH c. Elevated testosterone, elevated FSH d. Decreased testosterone, elevated FSH

ANS: B Decreased concentrations of testosterone (<200 ng/dL) and decreased concentrations of FSH (<10 mIU/mL) are suggestive of hypogonadotropic hypogonadism. DIF: 1 REF: Page 842 OBJ: 5 | 7

14. The peptide hormone responsible for the discharge of the gonadotropins from the anterior pituitary gland, which causes Kallmann syndrome when deficient, is: a. FSH. b. gonadotropin-releasing hormone. c. testosterone. d. DHEA-S.

ANS: B Gonadotropin-releasing hormone (GnRH) is a decapeptide synthesized in the hypothalamus and transported to the anterior pituitary gland, where it stimulates the release of both FSH and LH. Kallmann syndrome, the most common form of hypogonadotropic hypogonadism, results from a deficiency of GnRH in the hypothalamus. DIF: 1 REF: Page 826-827 OBJ: 2 | 5

19. Regarding the phases of the menstrual cycle, the suppression of luteinizing hormone synthesis by progesterone occurs during which one of the following phases? a. Follicular phase b. Luteal phase c. Ovulation d. Both a and b

ANS: B LH production is suppressed during the luteal phase by negative feedback from progesterone combined with estradiol. DIF: 2 REF: Page 836 OBJ: 4

16. A 14-year-old male comes to his physician with infantile genitalia and the lack of development of any secondary sex characteristics. The patient is short in stature. Upon discussion of family history, it was discovered that several male relatives had similar defects in testicular development. Based on this information, laboratory results would indicate: a. decreased testosterone and decreased follicle-stimulating hormone (FSH)/luteinizing hormone (LH). b. decreased testosterone and elevated FSH/LH. c. elevated testosterone and elevated FSH/LH. d. elevated testosterone and decreased FSH/LH.

ANS: B Patients with primary testicular failure have elevated concentrations of LH and FSH and decreased concentrations of testosterone. One cause for primary hypogonadism is chromosomal defects, such as Klinefelter syndrome (47, XXY). DIF: 3 REF: Page 830 OBJ: 2 | 5 | 7

4. Which one of the following hormones shuts off synthesis and release of LH from the male pituitary gland? a. FSH b. Testosterone c. Prolactin d. Inhibin

ANS: B Sex steroids and inhibin provide negative feedback control of LH and FSH secretion, respectively. LH secretion is inhibited by testosterone and by its metabolites, estradiol and dihydrotestosterone (DHT). DIF: 1 REF: Page 827 OBJ: 3

11. Dehydroepiandrosterone sulfate (DHEA-S): a. concentrations exhibit a circadian rhythm that reflects the secretion of adrenocorticotropic hormone (ACTH). b. is an important screening test used to evaluate women with hirsutism and virilization. c. concentration is increased in 17a-hydroxylase deficiency-caused amenorrhea. d. analysis is performed using heparinized plasma.

ANS: B The two most important screening tests used in the evaluation of women for hirsutism and virilization are serum total or free testosterone and DHEA-S. Elevation of DHEA-S concentration suggests an adrenal origin of androgens, whereas elevations in testosterone indicate an adrenal or ovarian source. DHEA-S in circulation originates primarily from the adrenal glands, although in men some may be derived from the testes. None is produced by the ovaries. DIF: 2 REF: Page 840 OBJ: 1 | 6

15. Inhibin: a. augments release of LH from the male pituitary gland. b. promotes synthesis of testosterone by the Sertoli cells. c. inhibits release of FSH from the male pituitary gland. d. increases in males with elevated GnRH.

ANS: C Inhibin is a protein that is released by seminiferous tubules of Sertoli cells and acts to inhibit FSH release by cells of the anterior pituitary. It serves as the negative feedback control. DIF: 2 REF: Page 826-827 OBJ: 1 | 2

5. Laboratory assessment of which of the following hormones is used to evaluate ovulation? a. FSH b. Estradiol c. Progesterone d. All of the above

ANS: C Measurement of the concentration of serum progesterone is the primary assay used for the evaluation of ovulation. DIF: 1 REF: Page 842-843 OBJ: 3 | 6

7. A typical characteristic in a woman with polycystic ovary disease (PCOS) includes: a. markedly increased serum FSH concentration. b. decreased serum androstenedione concentration. c. increased serum LH concentration. d. persistent ovulation.

ANS: C Relatively low FSH and disproportionately high LH concentrations are common in PCOS. Serum androstenedione and testosterone concentrations (total and free concentrations) are elevated. DIF: 1 REF: Page 839 OBJ: 1 | 6

13. In measurement of testosterone in blood: a. assessment of serum 17-ketosteroids is included. b. specimens must be collected in EDTA anticoagulant. c. morning specimens are preferred because of the diurnal release of testosterone. d. 5-androstenediol derivatives are actually measured.

ANS: C Testosterone is subject to a diurnal variation, reaching a peak concentration between 4 and 8 AM. Therefore morning specimens are preferred. DIF: 1 REF: Page 844 OBJ: 6

6. Which of the following statements concerning amenorrhea is (are) correct? a. One cause of primary amenorrhea is Turner syndrome, in which there is no estrogen production by the ovaries. b. Hirsutism is a typical side effect of amenorrhea caused by androgen excess. c. Primary amenorrhea is defined as the absence of menstrual bleeding in women who have never menstruated. d. All of the above are correct.

ANS: D Amenorrhea, the absence of menstrual bleeding, is traditionally categorized as primary (women who have never menstruated) or secondary (women in whom menstruation is present for a variable time and then ceases). About 40% of phenotypic females who have primary amenorrhea have Turner syndrome (45,X karyotype). Patients with androgen excess often will have acne, obesity, and variable degrees of excess hair on the face, chest, abdomen, and thighs. DIF: 2 REF: Page 837 OBJ: 1 | 5

3. During the luteal phase, which hormone, when decreased in the absence of conception, releases its inhibition on pituitary gland synthesis and release of FSH? a. Chorionic gonadotropin b. Progesterone c. Estrone d. Estradiol

ANS: D FSH is suppressed by negative feedback from E2 during the luteal phase. In the absence of conception, the corpus luteum resolves, resulting in a decrease in estrogen and progesterone concentrations. The decrease in negative feedback from E2 on the anterior lobe of the pituitary gland triggers the FSH surge that begins the development of an ovarian follicle for the next cycle. DIF: 2 REF: Page 835 OBJ: 4

18. The benign growth of glandular breast tissue in men is referred to as: a. galactorrhea. b. glanduloma. c. andropause. d. gynecomastia.

ANS: D Gynecomastia, the benign growth of glandular breast tissue in men, is a common finding among males of varied ages. DIF: 1 REF: Page 830 OBJ: 1

10. Which one of the following statements regarding FSH/LH is incorrect? a. LH acts to stimulate Leydig cells in the testes to synthesize testosterone. b. FSH, secreted by the anterior pituitary, induces follicular maturation. c. FSH acts on the cells of the follicle to increase responsiveness of LH receptors. d. Progesterone produced by the corpus luteum causes LH levels to increase.

ANS: D In the luteal phase of the menstrual cycle, there is increasing production of progesterone and estrogen from the corpus luteum with consequent gradual lowering of LH and FSH concentrations. DIF: 2 REF: Page 835 OBJ: 3 | 4

9. Typical findings in a woman in menopause include: a. increased progesterone. b. decreased serum LH/FSH. c. hirsutism. d. decreased estrogen and inhibin.

ANS: D Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity. The ovaries fail to produce adequate amounts of estrogen and inhibin, and gonadotropin production then increases in a continued attempt to stimulate the ovary. DIF: 1 REF: Page 836 OBJ: 1 | 6