♀♀ PATHOPHYSIOLOGYPATHOPHYSIOLOGYKashmeera N.A.II Sem MSc.ZoologyRoll no: 37Christ college
FEMALE PRECOCIOUS PUBERTYPrecocious pseudopuberty True precocious pubertyEarly devpt of 2° sexualcharacteristics withoutgametogenesisCaused by abnormalexposure of immature ♀♀ toestrogenDue to early secretion ofgonadotropin from pituitaryDue to hypothalamicdamage– lesions of ventralhypothalamus nearinfundibulum.-this lesions interrupt neuralpathways that produceinhibition of GnRH
Delayed puberty• Primary amenorrhea – menstrual bleeding neveroccured• Turner’s syndrome [45 XO] – gonadaldysgenesis• Testicular feminization/androgen resistance –• Patients are genetic ♂♂ [46 XY]• Lack testosterone receptors – insensitivity to androgen –wolffian structures primordial• MIS present – mullerian structures absent• External genitalia ♀,but vagina ends blindly because there is no♀ internal genitalia
Hypogonadotropic hypogonadism• Caused by defect in GnRH or LH/FSHsecretion.• LH & FSH levels are low.• Gonad is hypofunctional due to decreasedstimulation.
DEFECTS IN OVULATORYFUNCTIONOvulatory defects can be classified into threegroups based on the World Health Organization(WHO) definition.1. Group I: hypogonadotropic hypogonadism:• These patients have low LH & FSH levels.• This category includes women withhypothalamic amenorrhea (HA), stress-relatedamenorrhea etc
2. Group II: eugonadotropic hypogonadism: Patients are eugonadotropic ,normoestrogenic, but anovulatory .• They exhibit normal FSH and estradiollevels.• This category includes women withpolycystic ovary syndrome (PCOS)
3. Group III: hypergonadotropichypogonadism:Caused by defective gonads,resulting inhypogonadism and high gonadotropinlevel (as hypothalamus & pituitary fnnormally)These patients tend to be amenorrheicand hypoestrogenic,category includes all variants of prematureovarian failure(POF)
Hypothalamic amenorrhea (HA)• Functional abnormality in GnRH secretion -LH & FSH levelsare low.• Result in low gonadotropin level & secondaryamenorrhea.• Common in young women with increased psychologicalstress.
• lesions of the hypothalamus or pituitarygland can lead to hypothalamicamenorrhea• Hypothalamic tumors can lead to HA
Polycystic Ovary Syndrome• It is a disorder of chronic anovulationleading to increased estrogen production& infertility.In ovaries, androgens are produced throughde novo synthesis from cholesterol.They can be aromatized to estrogens
• Excessive androgen levels may alsodirectly inhibit follicle development at theovarian level,• Which may result in the accumulation ofmultiple small cysts• within the ovarian cortex, the so-calledpolycystic ovary
FEMALE PSEUDOHERMAPHRODITISMA pseudohermaphrodite is an individual withgenetic constitution and gonads of one sex andgenitalia of the other.After 13thweek, genitalia are fully formed,butexposure to androgens cause hypertrophy of theclitorisCongenital adrenal virilismBy androgens administered to mother.
Chiari –Frommel syndrome• Persistence of lactation(galactorrhea) &amenorrhea in women who donot nurseafter delivery.• Associated with some genital atrophy• Due to persistent prolactin secretionwithout secretion of FSH & LH necessaryto produce maturation of new follicles &ovulation.• Non pregnant ♀ - pituitary tumour -CFS
HORMONES & CANCERHORMONES & CANCER• About 35% of carcinomas of the breast inwomen of childbearing age are estrogen-dependent.• Their continued growth depends upon thepresence of estrogen in the circulation.
• Women with estrogen dependent tumoursoften have a remission when their ovariesare removed.• There is also some evidence that growthhormone & prolactin stimulate the growthof breast carcinomas.