Chapter 13 Companion site for Basic Medical Endocrinology, 4th Edition Author: Dr. Goodman.

Chapter 13Companion site for Basic Medical Endocrinology, 4th Edition

Author: Dr. Goodman

Companion site for Basic Medical Endocrinology, 4th Edition. by Dr. Goodman Copyright © 2009 by Academic Press. All rights reserved.

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Drawing of a human ovary showing the progression of the various stages of follicular and luteal development. (From Netter, F.H. (1997) Atlas of Human Anatomy, 2nd ed., plate 349. Novartis, Hanover, NJ.)

FIGURE 13.1


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Development of ovarian follicles. A. Primordial follicle. B. Primary follicle, the ovum has grown to full size, and there has been some proliferation of granulosa cells. C. Secondary follicle. Follicular cells have multiplied, and the theca intern is apparent. D. Early antral follicle. Granulosa cells have proliferated further, the theca has thickened, and a small amount of fluid has begun to appear. The follicle is now sensitive to FSH. E. Mature preovulatory follicle. Continued accumulation of fluid and further proliferation of granulosa cells have increased the follicle diameter some twentyfold. (Redrawn from Erickson, G.F. (1995) Endocrinology and Metabolism, 3rd ed., 973–1015. McGraw Hill, New York, with permission of the McGraw-Hill Companies.)

FIGURE 13.2


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Follicular development at various stages of a woman’s life. (Adapted from McGee, E.A. and Hsueh, A.J.W. (2000) Endocr. Rev. 21: 200–214, with permission of the Endocrine Society.)

FIGURE 13.3


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Ovulation in a rabbit. Follicular fluid, granulosa cells, some blood, and cellular debris continue to ooze out of the follicle even after the egg mass has been extruded. (From Hafez, E.S.E. and Blandau, R.J. (1969) Gamete transport-comparative aspects. In The Mammalian Oviduct, Hafez, E.S. E. and Blandau, R.J., eds. University of Chicago Press, Chicago.)

FIGURE 13.4


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Uterus and associated female reproductive structures. The right side of the figure has been sectioned to show the internal structures. Insert on the left shows surface anatomy. (Adapted from Netter, F.H. (1997) Atlas of Human Anatomy, 2nd ed., plate 346. Novartis, Hanover, NJ.)

FIGURE 13.5


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Biosynthesis of ovarian hormones. Cleavage of the cholesterol side chain between carbons 21 and 22 gives rise to 21-carbon progestins. Removal of carbons 20 and 21 by the two-step reaction catalyzed by P450c17 (17-hydroxylase/lyase) produces the 19-carbon androgen series. Aromatization of ring A catalyzed by P450c19 (CYP19 aromatase) eliminates carbon 19 and yields 18-carbon estrogens. 3HSD = 3-hydroxysteroid dehytdrogenase; 17HSD = 17-hydroxysteroid dehydrogenase.

FIGURE 13.6


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Theca and granulosa cell cooperation in estrogen synthesis. Theca cells produce androgens in response to luteinizing hormone (LH) . Granulosa cells respond to follicle-stimulating hormone (FSH) mainly by aromatizing androgens to estrogens and to some extent by producing pregnenolone from cholesterol. LDL, low density lipoproteins; cAMP, cyclic adenosine monophosphate. PKA, protein kinase A; CREB, cyclic AMP response element binding protein; StAR, steroid acute regulatory protein; P450c17, 17-hydroxylase/lyase; 17HSD, 17-hydroxysteroid dehydrogenase.

FIGURE 13.7


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Proliferation of granulosa cells during follicular development. Initially, granulosa cells are few and have receptors only for FSH (FR) on their surfaces. In response to continued stimulation with both FSH and estradiol, granulosa cells proliferate and by the midfollicular phase LH receptors (LR) begin to appear. By late in the follicular phase a large number of granulosa cells are present and they are responsive to both LH and FSH. They are now competent to secrete sufficient estradiol to trigger the ovulatory surge of gonadotropins.

FIGURE 13.8


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Endometrial changes during a typical menstrual cycle. Simultaneous events in the ovary are also indicated. The endometrium thickens during the follicular phase, uterine glands elongate, and spiral arteries grow to supply the thickened endometrium. During the early luteal phase there is further thickening of the endometrium, marked growth of the coiled arteries, and increased complexity of the uterine glands. As the corpus luteum wanes, endometrial thickness is reduced by loss of ground substance. Increased coiling of spiral arteries causes ischemia and finally sloughing of endometrium. The upper portion of the figure shows the corresponding events in the ovary. (Modified from Hansen, J.T. and Koeppen, B.W., eds. (2002) Netter’s Atlas of Human Physiology, 206. Icon Learning Systems, Teterboro, N.J.)

FIGURE 13.9


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Mean values of LH, FSH, progesterone, estradiol, and inhibin in daily serum samples obtained from nine women during ovulatory menstrual cycles. Data from various cycles are combined, using the midcycle peak of LH as the reference point (day 0). Vertical bars indicate standard errors of means. The portion shaded in pink represents the time of menstruation, and the gray shaded bar indicates the time of ovulation. (Redrawn from Groome, N.J., Illingworth, P.J., O’Brien, M., Pal, R., Faye, E.R., Mather, J.P., and McNeilly, A.S. (1996) Measurement of dimeric inhibin B throughout the human menstrual cycle. J. Clin. Endocrinol. Metab. 81: 1401–1405.)

FIGURE 13.10


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Ovarian-pituitary interactions at various phases of the menstrual cycle. Green arrows represent stimulation, red arrows indicate inhibitory effects.

FIGURE 13.11


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Mean plasma concentrations of reproductive hormones at the luteal-follicular transition. The data are similar to those shown in Figure 13.10, but are normalized around the start of menstruation instead of the LH peak value, and highlight the changes in FSH concentrations associated with development and selection of the ovulatory follicle. (Adapted from Welt, C.K., Martin, K.A., Taylor, A.E., Lambert-Messerlian, G.M., Crowley, W.F. Jr., Smith J.A., Schoenfeld, D.A., and Hall, J.E. (1997) Frequency modulation of follicle-stimulating hormone (FSH) during the luteal-follicular transition: Evidence for FSH control of inhibin B in normal women. J. Clin. Endocrinol. Metab. 82: 2645–2652.)

FIGURE 13.12


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Results of ovulation induction employing a physiological frequency of GnRH administration to hypogonadotropic hypogonadal women upon ovarian steroid secretion. Normal values are represented by the light green and pink shaded areas. (From Crowley, W.F. Jr., Filicori, M., Spratt, D.J., et al. (1985) The physiology of gonadotropin-releasing hormones (GnRH) secretion in men and women. Rec. Prog. Horm. Res. 41: 473.)

FIGURE 13.13


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The effects of frequency of GnRH pulses on FSH and LH secretion. After destruction of the GnRH pulse generator in the arcuate nuclei, monkeys were fitted with pumps that delivered intermittent sixminute pulses of GnRH at the frequencies indicated. (From Wildt, L., Häusler, A., Marshall, G., Hutchison, J.S., Plant, T.M., Belchetz, P.E., and Knobil, E. (1981) Frequency and amplitude of gonadotropin-releasing hormone stimulation and gonadotropin secretion in the Rhesus monkey. Endocrinology 109: 376–379.

FIGURE 13.14

Chapter 13 Companion site for Basic Medical Endocrinology, 4th Edition Author: Dr. Goodman.

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