内分泌生殖系统教学课件：女性生殖系统.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Chapter 9.Hormonal Control of Reproduction Part II,Female Reproductive System,Contents,Part 1.Structure of Ovary,Part 2.Ovarian Hormones,Part 3.The Menstrual Cycle,Part 4.The Endocrinology of Pregnancy,STRUCTURE OF OVARY,Part 1,4,Structure of Ovary,Fibrous capsule,-,tunica,albuginea,Outer cortex houses developing,gametes,the,oocytes,（卵母细胞）,within,follicles,（滤泡）,Inner medulla is loose connective tissue with largest vessels and nerves,5,Follicular phase,1,st,approx 14 days but variable,Egg develops in a follicle,Stimulated by,FSH,Estrogen produced,Ovulation,Egg released from follicle(,LH,surge),Egg in abdominal cavity,Picked up by fimbria(,伞部）,of fallopian tube,Ovarian Cycle,Ovarian Cycle(cont.),Luteal phase,Postovulatory phase 14 days(more constant),Corpus luteum develops from exploded follicle,Produces progesterone as well as estrogen,Progesterone stimulates uterus to be ready for baby,If no pregnancy,corpus luteum degenerates into corpus albicans,Stages of Follicular Development in the Ovary,Oogenesis,Generation of eggs,Starts in fetal period,No more,oocytes,made after about 7th month,Developed only to early stage of meiosis I by birth and stops(called,primary oocyte),6-12 primordial oocytes each cycle selected to develop for ovulation(most die),Only then is meiosis I completed,Secondary oocyte,is then arrested in meiosis II,Meiosis II not completed(now an,ovum,)unless sperm penetrates its plasma membrane,Of the 4 daughter cells,only one becomes ovum(needs a lot of cytoplasm),The other 3 become,“polar bodies”,Primordial Follicle,（原始卵泡）,The primordial follicle can be identified by its single layer of follicular cells(red arrow).To the right are two atretic follicles,（闭锁卵泡）,(blue arrows).Notice the wavy stroma,（基质）,.Bar=50 Microns,Primary Follicle,（初级卵泡）,At least two layers of follicular cells identify the primary follicle(red arrow).A primordial follicle(in another plane and therefore slightly out of focus)lies alongside(blue arrow).Bar=50 Microns,Primary Follicle,secondary follicle,The secondary follicle shows the beginning of a fluid-filled space known as the antrum(A).Notice that the oocyte proper(arrow)is embedded within the follicular cells.Bar=50 Microns,Graafian(vesicular)Follicle,卵丘,卵母细胞,透明带,内膜层,外膜层,14,Nearly mature follicle,Oocyte develops the,zona pellucida,（透明带）,Glycoprotein coat,Protective shell(egg shell),Sperm must penetrate to fertilize the oocyte,Thecal cells stimulated by LH to secrete,androgens,Granulosa cells,(with FSH influence)convert androgens to estrogen(follicular cells called granulosa cells now),Clear liquid gathers to form fluid-filled antrum:now a secondary follicle,Surrounding coat of granulosa cells:,corona radiata,（放射冠）,Fully mature,ready to ovulate,called:,”Graafian follicle”,15,Ovulation,Signal for ovulation is LH surge,Ovarian wall ruptures and egg released,surrounded by its corona radiata,corpus luteum,Progesterone from the corpus luteum maintains the uterus for implantation.Notice the fullness of the granulosa luteal cells(GL)and positioning of the theca luteal cells(TL).Bar=50 Microns,corpus luteum,Corpus albicans,（白体）,19,Fallopian(uterine)tubes,Fimbriae(fingers)pick up egg,Beating cilia and muscular peristalsis propel egg to uterus,Empties into superior part of uterus*,_Fallopian tubes_,Fimbriae,*,Cross section through entire tube,Enlargement of mucosa layer showing ciliated columnar epithelium,PID,Part 2 Hormones Secreted from Ovary,Cases:Imbalanced Sex Steroids,Joanna Jones,24 years old woman,presented with,Increased facial and body hair,acne,Skin greasy,Irregular periods,Began at the age of 11 years,Always unpreditcable,Miss one or two periods every 3 months since 15 years,Planning marriage in the next 12 months and hoped to start a family,Physical Examination,Weighted 85 kg,height 163 cm,body mass index 32kg/cm,2,Hirsutism,Skin:greasy and marked by acne,Fundoscopy,visual fields and eye movement were normal,Imbalanced Sex Steroids,Questions,What is the differential diagnosis?,Which tests should be performed to confirm the diagnosis?,How will her symptoms and tests guide treatment?,Will the couple be infertile?,Secretion of Progesterone and Estrogen by Ovary,Hypothalamus Pituitary Ovary Axis,29,Pituitary hormones,FSH:follicle stimulating hormone,LH:luteinizing hormone,Ovarian hormones,Estrogen,Progesterone,Time:one cycle(approx 28 d.),*,ovulation,Follicular phase,Luteal phase,Intracellular Signalling Pathways Activated by Progesterone and Estrogens,Biological Actions of Estrogens and Progesterone,Target Organ,Estrogen,Progesterone,Uterus,Endometrial thickening,Make cervical mucus thinner and more alkaline,Increasing vascularization of the endometrium during the luteal phase,Make cervical mucus more viscous,Vagina,More comified vaginal epithelium,Induce synthesis of pheromones in vaginal secretion,Induces thick mucus secretions from the vaginal epithelium,Causes epithelium to thicken and become infiltrated with leukocytes,Breast,Promote growth and proliferation of mammary ducts,Enlarge breasts at puberty,Antagonize milk-producing effect of prolactin,Increases growth of breast lobules and alveoli,Induces differentiation of ductal tissue,Biological Actions of Estrogens and Progesterone(conti.),Target Organ,Estrogen,Progesterone,Central Nervous System,Inhibits FSH,secretion,Brief exposure of the pituitary to estrogens decreases its sensitivity to GnRH,Prolonged exposure of the pituitary to oestrogens increases its sensitivity to GnRH,4.Increase libido possible by direct effect on hypothalamic neurons,induce dendrite proliferation in neurons,Inhibits secretion of LH,Cause a rise in body temperature,and is probably responsible for the slight increase in body temperature at time of ovulation,Stimulates ventilation and thereby lowers alveolar pCO2 in both the luteal phase of the monthly cycle and in pregnancy,Biological Actions of Estrogens and Progesterone(conti.),Target Organ,Estrogen,Progesterone,Metabolism,Exert protein anabolic effect by increasing androgen output from the adrenals,-,Bone and Cartilage,Cause epiphysial closure,-,Other,Partly responsible for female secondary sex characteristics,Renal retention of salt and water,Inhibit atherogenesis by lowering plasma cholesterol,inhibiting vascular smooth muscle proliferation,and increasing NO synthesis,Can promote thrombosis at high levels,Hormonal Regulation of Ovarian Function,FSH,Stimulates the growth of the developing follicle,Promote the conversion from androgen to oestrogen(through aromatase),LH,stimulates steroid production by the corpus luteum and the developing follicle,stimulate ovulation(LH surge),Imbalanced Sex Steroids,Differential diagnosisImbalanced sex steroids,During puberty of the women,breast development-Requires estrogen,pubic hair development-Requires androgens,Joannas symptoms suggest a disruption of the sex steroid:,excess male hormone,Polycystic ovary syndrome,Androgen secreting ovarian or adrenal tumours,Genetic condition congenital adrenal hyperplasia,Reduced female hormones,Disease of pituitary/hypothalamus,Ovarian failure,Which test should be performed to confirm the diagnosis,Section 3.Hormonal Control of the Menstrual Cycle,39,The Uterine Wall,*,Three basic layers,Perimetrium,:outer serous membrane,Myometrium,:middle muscle,Endometrium,:inner mucosal lining,*,40,Endometrium,(inner mucosal lining of uterine cavity),Simple columnar epithelium containing secretory and ciliated cells,Lamina propria of connective tissue,2 main layers(Strata),Functionalis(functional zone),Basalis(basal zone),(not shed),(shed if no implantation of baby),Note:,Uterine glands,Uterine arteries,Endometrium,Functional zone,layer,closest to the cavity,contains,majority of,glands,undergoes,changes with monthly cycle,Basal zone,layer just under,myometrium,attaches,functional layer to myometrial,tissue,has,terminal ends of,glands,Remains,constant,The Menstrual Cycle,：,Menstruation,Loss of egg and uterine tissue via vagina if fertilization does not occur,The Menstrual,Cycle,：,Proliferative Phase,lasts,10,days,FSH,&LH levels,increase,egg matures,follicle,secretes estrogen to prepare uterus,The Menstrual Cycle:Ovulation,High level of estrogen detected by hypothalamus,increased LH,decreased FSH,follicle bursts egg released,Estrogens,The Menstrual Cycle:Luteal Phase,LH converts follicle to corpus luteum,secretes estrogen&progesterone.,Progesterone prepares uterus,Increased progesterone keeps LH&FSH low,子宫内膜周期性变化,Amenorrhoea,Primary amenorrhoea,：,Menarche,（初潮）,nerve occurred,Absence of menses by age 16 with normal secondary sexual characteristics.,Absence of menses by age 14 without secondary sexual development.,Secondary amenorrhoea,Failure of three or more menstrual periods in succession in a woman,Cause:,Pregnancy,Ovarian failure,Pituitary failure,Hypothalamus failure,Hypothalamic Amenorrhea,Disorder of GnRH secretion,and subsequent failure of FSH and LH secretion,1/3 of non-pregnant amenorrhea,Causes,Psychological stress,Anorexia nervosa(,厌食症）,weight loss,Increased exercise levels,drug-induced amenorrhea,Space-occupying lesion of CNS,Pituitary Amenorrhea,tumor,Hyperprolactinaemia,Empty sella syndrome(,空鞍综合征）,Sheehan syndrome(,席汉氏综合征,),Ovarian Amenorrhea,Premature ovarian failure,Ovarian failure occurs before 40 years,Caused by:,Turner syndrome:absence of one X chromosome,Autoimmune destruction of the ovary,Polycystic ovarian syndrome,Enlarged ovaries containing numerous cysts,Excessive androgen secretion,Polycystic Ovarian Syndrome,Questions,What is the differential diagnosis?,Which tests should be performed to confirm the diagnosis?,How will her symptoms and tests guide treatment?,Will the couple be infertile?,Section 4 Pregnancy,I.Fertilization and Implantation,58,Fertilization,Hormones Changes during Pregnance,Human Chorionic Gonadotropin(HCG),Progesterone and Estrogen,Human Chorionic Somatommotropin(HCS),Relaxin,Aldosterone,Parathyroid hormone,(PTH),Human Chorionic Gonadotropin(HCG),Glycoprotein with a molecular weight of 39,000,Secreted by the syncytial trophoblast cells,can be measured in the blood 8 to 9 days after ovulation,Function:,identical to LH in its effect,maintain the corpus letum,Progesterone and Estrogen,Secreted by,corpus luteum before 5-6 weeks of pregancy and by placenta later,maintain the endometrium and prevent menstruation,Estrogen:cause enlargement of uterus,breasts and mothers female external genitalia,Progesterone:decrease the contractility of pregnant uterus,inhibit release of FSH and LH from anterior pituitary gland(preventing ovulation),Progesterone and Estrogen,Human Chorionic Somatommotropin(HCS),Also called human placental Lactogen(hPL),Protein with molecular weight of 38,000,Begins to be secreted by the placenta at the 5th week of pregnancy,Secretion in direct proportion to the weight of placenta.,Function,stimulates growth of fetus,regulates metabolism of carbohydrate,fat and protein in both the fetus and the mother,Stimulate mammary gland,31-,64,Relaxin,（松弛素）,From placenta,chorion,and decidua.,Inhibits uterine contractions and relaxes ligaments of pelvis,promote cervical ripening,Aldosterone,From adrenal gland,Increases sodium and water retention,Parathyroid hormone,(PTH),Helps maintain high calcium levels in the blood,Hormonal Changes during Pregnancy(cont.),妊娠期间血中激素,66,Childbirth,Dilation of cervis;head enters true pelvis,Late dilation with head rotation to AP position,Expulsion:head first safest as is largest part,Delivery of the placenta,Hormones Involved in Labor,Labor Initiation:,Increasing CRH at the end of the gestation,the resulting secretion of prostaglandin,Decline of progesterone,Relaxin,promote cervical ripening,