Library of the Health Sciences - Urbana

Gynecologic Endocrinology Learning Program,
640 slides

Lecture A: Hormones - Chemistry and Physiology - 37 slides

• Models of hormone systems
  • The life and function of an estradiol molecule
  • Synthesis, secretion, and function of gonadotropin releasing hormone
• Specific characteristics of protein hormones
  • Hormones of the anterior pituitary
• Structure and characteristics of gonadotropic hormones
  • Structure of prolactin
  • Mechanism of synthesis and secretion of pituitary hormones
  • Mechanism of action of pituitary hormones
• Biosynthesis of steroid hormones
  • Steroid hormone secretion and metabolism
  • Mechanism of action of steroid hormones
• Prostaglandins and thromboxanes

Lecture B: Reproductive Neuroendocrinology - 38 slides

• The hypothalamic-pituitary portal circulation
• Hypothalamic neurosecretion - GnRH
  • Source, pathways, controls
• Neurochemotransmitter concept
  • The hypothalamic - pituitary axis
    • Neurosecretion
• Pathways in the hypothalamic - pituitary axis
  • The tonic center
  • The cyclic center
  • Tanycytes
  • The posterior pituitary pathway
• Hypothalamic control of GnRH secretion
  • The role of catecholamines
• The pituitary response of GnRH
• Heterogeneity of the peptide hormones
• The pineal gland
• Hormone secretion from conception to puberty

Lecture C: Regulation of the Menstrual Cycle - 33 slides

• The three phases of the menstrual cycle
• Follicle growth phase
  • Initial follicle growth
    • Gonadotropin independent phase
    • Gonadotropin dependent phase
  • The mid-follicular stage of follicle growth
  • Stimulation of follicle development
  • The feedback systems
  • The preovulatory phase
• Ovulation
• Luteal phase
• Inhibition of follicle development
  • The role of androgen in follicle atresia
  • Intragonadal loop
  • Extragonadal loop
• Key events in the human menstrual cycle

Lecture D: Menopause - 27 slides

• Embryology and differentiation of the ovary
  • Neonatal ovary
• Adult ovary
  • Follicle growth
  • Ovulation
  • Corpus luteum
  • Correlation of follicle maturation and follicle estrogen secretion
• Hormone production in the postmenopause
  • The role of androgen: extraglandular conversion to estrogen
  • Estrogen in postmenopausal women
  • Postmenopausal conversion of androgens to estrogens
• Impact of steroids on female
  • Reproductive years
  • Clinical implications of progressive estrogen withdrawal
  • Symptoms of "early" climacteric (perimenopause)
  • Symptoms of "late" climacteric
• Postmenopausal estrogen replacement therapy
  • Proposed advantages of estrogen therapy
  • Disadvantages of estrogen replacement therapy
  • Method of estrogen replacement therapy

Lecture E: Endocrinology of Pregnancy - 36 slides

• The maternal-placental-fetal compartments
• Steroid hormones in pregnancy
  • Progesterone
  • Estrogens
  • The fetal adrenal gland
    • Regulation of fetal adrenal steroid production
    • Fetal zone function
  • Protein hormones of the placenta
    • Human chorionic gonadotropin (HCG)
    • Human placental lactogen (HPL)
  • Endocrinology of partruition
    • Sheep
    • Humans
  • Prostaglandins
    • Role of oxytocin
    • Muscle contraction

Lecture F: Normal and Abnormal Sexual Differentiation - 36 slides

• Normal sexual differentiation
  • Gonadal differentiation
  • Internal genitalia
  • External genitalia
  • Central nervous system
• Abnormal sexual differentiation
  • Female pseudohermaphrodites
    • Congenital virilizing adrenal hyperplasia (CAH)
    • Types of enzyme blocks and their consequences
    • CAH - genetic aspects, diagnosis, and treatment
    • Masculinization due to elevated androgens in maternal circulation
  • Male pseudohermaphrodites
    • Syndromes of androgen insensitivity
    • Abnormal androgen synthesis
    • Abnormal Mullerian inhibiting factor (MIF)
  • Abnormal gonadogenesis
    • True agonadism
    • Anorchia
    • True hermaphrodites
    • Gonadal dysgenesis
    • Mixed gonadal dysgenesis
    • Noonan's syndrome
  • Diagnosis of ambiguous genitalia
    • Assignment of sex of rearing

Lecture G: Normal and Abnormal Puberty - 34 slides

• Normal female development
  • Fetal endocrine development
  • Infancy and childhood
  • Adolescence - puberty
    • Timing of puberty
    • Pubertal development
    • Pubarche and thelarche
    • Growth spurt
    • Menarche
    • Hormone changes in puberty
• Abnormal female development
  • Precocious puberty
    • Definitions
    • Classification of causes
    • Special cases of precocious development
    • Diagnosis of precocious puberty
    • Treatment of precocious puberty
  • Delayed puberty
    • Differential diagnosis of delayed puberty and primary amenorrhea
    • Laboratory assessment of delayed puberty
    • Treatment of sexual infantilism
• Growth problems in normal adolescents
  • Short stature
  • Tall stature

Lecture H: Amenorrhea - 43 slides

• Definition
• Diagnostic evaluation
  • Workup summary
  • Compartment I disorders
    • Mullerian agenesis
    • Mullerian anomalies
    • Testicular feminization
    • Asherman's syndrome
  • Compartment II disorders
    • Turner's syndrome
    • Mosaicism
    • The resistant ovary syndrome
  • Compartment III disorders
    • Abnormal polytomography and elevated prolactin
    • Abnormal polytomography and normal prolactin
    • Normal polytomography and elevated prolactin
    • Normal polytomography and normal prolactin
    • The empty sella syndrome
  • Compartment IV disorders
    • Anorexia
    • Amenorrhea and anosmia
    • Postpill amenorrhea
  • Hormone replacement therapy

Lecture I: Anovulation - 42 slides

• Clinical presentation of anovulation
• The ovulatory process
• Categorical classification of causes leading to anovulation
  • Hypothalamic defects
    • Homeostatic interaction
    • Reflex intervention
    • Complex modulation
  • Anterior pituitary defects
  • Pathogenesis of inappropriate feedback signals
    • Specific causes
  • Ovarian defects
  • Precise etiology of chronic anovulatory states
• Diagnostic categories of chronic anovulatory states
  • Hypergonadotropic hypogonadism
  • Hypogonadotropic hypogonadism
  • Persistent anovulation
  • Clinical presentation of chronic anovulatory states
• The polycystic ovary syndrome (persistent anovulation)
  • Clinical features and frequency
  • Laboratory findings
• Therapy of anovulation

Lecture J: Induction of Ovulation - 27 slides

• General principles
• Pretreatment evaluation
• Principles of therapy
  • Clomid
    • Mechanism of action
    • Associated biologic effects
    • Clinical application
    • Administration
  • Clomid and HCG
  • Clomid and estrogen
  • Clomid and dexamethasone
    • Results of Clomid therapy
    • Complications and side effects of Clomid therapy
  • Ovarian wedge resection
  • Pergonal
    • Patient selection
    • Administration
    • Results
    • Hyperstimulation
    • What to do with the Pergonal failure
  • Clomid-Pergonal sequence
  • Gonadotropin releasing hormone
  • Ergot alkaloids
• Summary: treatment of anovulatory infertility

Lecture K: Dysfunctional Uterine Bleeding - 39 slides

• Definition
• Major categories of endometrial bleeding
  • Estrogen breakthrough bleeding (EBB)
  • Estrogen withdrawal bleeding (EWB)
  • Progesterone breakthrough bleeding (PBB)
• Histologic changes in the endometrium during ovulatory cycle
  • Menstrual endometrium
  • Proliferative phase
  • Secretory phase
  • Preparation for implantation phase
  • Phase of endometrial breakdown
• Teleologic theory of endometrial cycle events
• Physiologic and pharmacologic endometrial responses to steroid hormones
  • Estrogen withdrawal bleeding
  • Estrogen breakthrough bleeding
  • Progesterone withdrawal bleeding
  • Prsgestin breakthrough bleeding
  • Estrogen and progestin withdrawal bleeding
  • Uncontrolled, excessive anovulatory bleeding
• Treatment program for anovulatory bleeding
• Summary of key points in therapy of anovulatory bleeding

Lecture L: Hirsutism - 30 slides

• Clinical presentation
• Biology of human hair growth
  • Embryology
  • Structure and Growth
  • Hair growth patterns
  • Hair pattern and hormonal control
  • Hair cycle and hormonal control
• Evaluation of hirsutism
  • Pathogenesis
    • Origin, metabolism, excretion of androgens in womn
  • Etiology of hirsutism and/or virilization
  • Differential diagnosis
  • The diagnostic workup
    • The testosterone level
  • Problems in workup
    • Androgen-producing tumors
    • End-organ hypersensitivity (idiopathic hirsutism)
    • Mixed adrenal gland and ovarian disease
    • Patients requiring hospitalization for evaluation
• Treatment of hirsutism
  • Suppression of androgen production
  • Alteration in androgen transport and metabolism
  • Receptor inhibition
  • Target organ elimination

Lecture M: The Breast - 29 slides

• Growth and development
  • Puberty
  • Abnormal shapes and sizes
  • Pregnancy
• Pregnancy and milk secretion
  • Milk ejection
  • Prolactin inhibiting factor (PIF)
  • Prolactin releasing factor (PRF)
  • Cessation of lactation
  • Contraceptive effect of lactation
• Inappropriate lactation: galactorrhea syndromes
  • Differential diagnosis
  • Clinical problem of galactorrhea
  • Methods of differential diagnosis
  • Treatment of galactorrhea
• Cancer of the breast
  • Scope of the problem
  • Risk factors
  • Specific endocrine factors
  • Treatment of breast cancer

Lecture N: Obesity - 24 slides

• Physiology of adipose tissue
  • Fate of ingested fat
  • Lipogenesis
  • Lipolysis
• Clinical obesity
  • Diagnosis
  • Pathogenesis
  • Treatment

Lecture O: Steroid Contraception - 30 slides

• Pharmacology of the birth control pill
  • The estrogen components of the pill
  • The progestin components of the pill
• Mechanism of action for the combination pill
• Side effects of combined steroid contraception
  • Thrombosis and the pill
  • Neurovascular accidents
  • Myocardial infarction
  • Carbohydrate metabolism
  • Liver adenomas
  • Gallbladder disease
  • Hypertension
  • Steroid contraception and cancer
  • Postpill amenorrhea
• Patient management
  • Absolute contraindications to the use of the pill
  • Relative contraindications
  • When to start the pill after a pregnancy
  • Monitoring the patient
  • Problems associated with the low dose pill
  • Tailor-making the pill to the patient
  • Prescribing the pill to women over 40
• Other forms of steroid contraception
  • The minipill
  • Postcoital contraception

Lecture P: Evaluation of the Infertile Couple - 29 slides

• Mechanisms in fertilization
  • Sperm transport
  • Sperm capacitation
  • Egg transport and fertilization
• Clinical evaluation
  • Postcoital test
  • Tests of tubal patency
  • Disorders of ovulation
    • Endometrial biopsy
    • Inadequate luteal phase
  • Infection
  • Sperm allergy
  • Laparoscopy
• Summary

Lecture Q: The Infertile Male - 24 slides

• General principles
  • Basic anatomy and function
  • Histology
  • Spermatogenesis
  • Hypothalamic-pituitary-testicular axis
  • The androgen-binding protein
• Clinical evaluation and management
  • The semen analysis
  • Features of patient history
  • Urology
  • Varicocele
  • Endocrine factors
  • Artificial insemination, homologous (AIH)
  • Artificial insemination, donor (AID)

Lecture R: Endometriosis - 26 slides

• Definition
• Incidence
• Distribution
• Classification
• Pathogenesis
• Pathophysiology
• Symptoms and findings
  • Dysmenorrhea
  • Pelvic pain
  • Dyspareunia
  • Menstrual irregularity
  • Infertility
  • Pelvic findings
• Diagnosis
• Treatment

Lecture S: Tubal Surgery - 24 slides

• Tubal disease and infertility
  • Selection of patients for tubal surgery
• Surgical techniques
  • Lysis of adhesions
  • Reduction of postoperative adhesions
  • Salpingostomy or fimbrioplasty
    • Procedure
    • Postoperative management
  • Tubal reimplantation
  • Tubal end to end anastomosis
    • Procedure
    • Alternate procedure
• Follow-up post surgery
  • Ectopic pregnancies
• Estes procedure

Lecture T: Clinical Assays - 32 slides

• General Principles
  • Bioassay
  • Radioimmunoassay
    • Antibody characteristics
    • Antibody development
    • Problems in protein binding assays
  • Protein binding assays
  • Immunochemical assays
• Clinical applications
  • Measurement of pituitary gonadotropins
  • Measurement of prolactin
  • Measurement of gonadal steroids in plasma
  • Plasma levels of gonadal steroids
  • Plasma gonadal steroids in pregnancy
  • Urinary levels of gonadal steroids during the menstrual cycle and pregnancy
  • Measurement of human chorionic gonadotropin
  • Measurement of human placental lactogen
  • Measurement of estriol in pregnancy
  • The lecithin/sphingomyelin (L/s) ratio
• Adrenal corticosteroids
  • Measurement of urinary 17-ketosteroids
  • Measurement of urinary 17-ketogenic steroids and 17-hydroxycorticosteroids