USMLE Step 1 Web Prep — Male Reproductive System

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Chapter 10: Male Reproductive System
O ER!LL CO"#ROL O$ %ORMO"!L SECRE#IO" GnRH- preoptic region, secrete in pulses, goes to ant pituitary, and produce LH and FSH Pulsatile release prevent down regulation of receptors LH and FSH, TSH, and human chorionic gonadotropin glycoproteins - water- solu!le "very long half-life# α-su!units- the same$ They differ in β-su!units- provide specificity and activity$ LH- has only one target tissue- Leydig cell " Lh- Leydig# Leydig cells% testosterone re&uired for normal Sertoli cell function, to normal spermatogenesis 'n peripheral tissue testosterone converted to dihydrotestosteron "more active form# !y 5-α reductase (nder normal adult male, circulating testosterone is a negative feed!ac) loop for LH, !ut under normal conditions testosterone is not for FSH$ FSH- has only one target cell in adult male - Sertoli cell and support spermatogenesis$ Sertoli cell must secrete compound "INHIBIN#- negative feed!ac) loop for FSH Testosterone (Leydig) - LH Inhibin (Sertoli) - FSH

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"ote( +oth $S% a)d Leydi.!H acti'ated these receptors% it-s also re+ ired for .%ORMO"!L CO"#ROL O$ #ES#IC'L!R $'"C#IO" "ormally( the co)ce)tratio) of testostero)e i) the testes is *0 times that of the +lood.uired for )ormal spermato-e)esis Leydig cells has receptors for LH.lipid-sol $le% and n cle s of the !ertoli has receptors for testosterone Sertoli cells synthesi&e and secrete into the l men of the seminefero s t $ les an a)dro-e)/+i)di).into the general circ lation and some goes to the !ertoli cell "spermatogenesis# testosterone. testosterone form Leydig cell.$ind locally prod ced testosterone and maintain 'ery high local concentration of testosterone "concentration in the testes 50 times that of $lood# (o can ne'er in)ect eno gh testosterone to get local concentration high eno gh in testis *itho t prod ction of the Leydig cells "so testosterone of Leydig cell re+ ired for spermatogenesis# !ertoli has receptors for .cell testostero)e are re.protei) .!H% .

7/na$olic steroid therapy "male# -methotestoterone 5.# ↓ ↑ ↓ "no stim l s for Leydig# -"no change# ↓ ↑ $S% ↑ ↓ ↑ "↓ # ↓ ↓ ↑ 4.remo'e stim l s for Leydig cell. 7778n9H inf sion "constant rate# 7.higher than normal le'el of estro-e) 153085 >>> 0:13:34 SLIDE 0 of 8 #a+le I1/10/1 se2 steroids 1. 772nhi$in inf sion "male#!ertoli cell 4.!H% not as m ch as LH 5.Leydig cell atrophy. !o $oth testostero)e from Leydig and $S% from anterior pit itary are re+ ired for spermato-e)esis. :estosterone normally not feed$ac.!H% and has aromatase acti'ity% they can con'ert androgen to the estrogen. /ndrogen ---.5it itary hypogonadism "secondary#.!H le'el decreased" $eca se 8n9h is constant#.possi$le male contracepti'e.!H.not nomal feed$ac.decrease in spermatogenesis. 8n9H.!H are re+ ired.circ lating le'el of hormone =-a=is. inhi$in.pre'ents do*nreg lation. .estrogen "aromatase# in the !ertoli 0ales do synthesi&e estrogen 1 one so rce 1 !ertoli.no local prod ction of testosterone "re+ ired for spermatogenesis# . for .spermatogeneissi also inhi$ited 4. Sertoli secret inhi$in . decrease LH.almost as high as in ad lt male. 8n9H inf sion "p lsatile# ↓ ↓ ↓ "estrogen# ↑ "testosterone# -"no change# ↓ ↑ L% ↑ "no negati'e feed$ac.!H.adipose tissue has aromatase acti'ity.aromatase acti'ity increases. for .!H "receptor still present#% *ith time 1 do*nreg lation *ith receptors and LH and . t if the testosterone is 'ery high% it *ill s ppress .5ostmenopa sal *omen "o'aries has no follicle# 4. 7.negati'e feed$ac.!H 1530<0 >>> 0:61:44 SLIDE 3 of 8 CO'RSE O$ L% !"D #ES#OS#ERO"E SECRE#IO" I" #%E "ORM!L M!LE y-a=is. 8n9H -p lsatile.re+ ired for normal male de'elopment .5rimary hypogonadism "no secretion of hormone# 6.initial increase plasma LH and . for LH% $ t s ppress .chronically high le'el of $oth LH and .constant.life "from fetal to aging ad lt# fetal de'elopment: plasma testosterone.no LH% no . $eca se $oth local testosterone and . 2n !ertoli cell t mor.!H 3.high circ lating estrogen 3ther male tiss e.secrete estrogen 2n many o+ese male.spermatogenesis.

153100 >>> 0:31:08 SLIDE 5 of 8 see a$o'e 153105 >>> 0:33:66 .car accident.testosterone.li'e entire normal life span.female internal and female e=ternal str ct res de'elop "regardless of genetic ma.LH dri'e high testosterone /ging ad lt: Leydig cell decrease secretion of testosterone "significantly#% eliminate negati'e feed$ac.not secrete 02H.ter s.C9.*ollfian d cts. Mulleria) d cts de'elop to female i)ter)al str ct re Bs.regress "as in female# B-s: male fet s 1 no 5-a-red ctase. /d lt.restim late Leydig.d ring de'elopment.if has testosterone. !o phenotype. /nd male internal str ct re.laceration.he has in addition to male secretion has female internal str ct re.female e=ternal str ct res.cannot synthesi&e dihydrotestosterone.no hormonal inp t.is female% gro* ndisco'ered ntil p $erty% *hen testosterone rise.presence of ter s.ad lt male. 9ise in LH precede rise in testosterone. !ertoli cells 0 llerian inhi$iting factor "02H# 02H pre'ents the de'elopment of the 0 llerian d cts "present in $oth se=# B-s: in the fet s no testosterone. h@8 A LH Leydig cells testosterone 4olffia) d cts differentiate into the ma)ority of male i)ter)al str ct res *$ :estosterone A * α reductase Dihydrotestostero)e differentiation of the e2ter)al str ct res and the prostate gland 3.s rgery.e p# 3'ary not secrete hormone ?ormal male de'elopment re+ ires the presence of 3 hormones: 1.% and LH increase 1 not important for step 1530<5 >>> 0:63:06 SLIDE * of 8 $etal life >e'elopment of male and female str ct res depend on the fetal hormo)al en'ironment "not genetics# 2f there is no hormonal inp t "normal female fet s#.after deli'ery: plasma testosterone decline dramatically along *ith LH $efore p $erty p $erty: first increase is in LH.in a$domen.

gi'e him testosterone "terminate gro*th# 153110 >>> 0:37:0< SLIDE 8 of 8 DE8E"DE"CE O$ S8ERM!#O7E"ESIS O" LO4ER #EM8ER!#'RES O$ #%E SCRO#'M . androgens dri'es gro*th hormone% *hich dri'es 28.recei'e methotestosterone 1to increase athletic performance: he *ill $e shorter than normal "androgen initiates and terminate gro*th of $one#% not taller 2f yo ng man too tall. :h s androgens stim late the gro*th of long $ones "indirect# ?ear the end of p $erty% androgens promote the minerali&ation of the epiphyseal plate of long $ones "terminate indi'id al gro*th# /ndrogen initiates gro*th and terminate gro*th "male# Cstrogen can also ca se plate clos re% e'en in men B-s: (o ng male.or n.no*n reasons% spermatogenesis ceases at temperat res typical of the a$dominal ca'ity "on 37D@# ?ormally% the scrot m pro'ides an en'ironment that is 4D@ cooler than the a$dominal ca'ity EREC#IO"( EMISSIO"( !"D E:!C'L!#IO" Crection is ca sed $y dilatation of the $lood 'essels.SLIDE 6 of 8 E1#R!/7O"!D!L 8RO8ER#IES: #%E !"!9OLIC !C#IO"S O$ !"DRO7E"S > ring p $erty% androgens promote the secretion of the follo*ing ana$olic se+ ence: /t p $erty% if :4 is normal% 1.arteriole in the penis "a parasympathetic response# 1only e=ception.-1 is the ma)or stim l s for cell di'ision of the cartila-e-synthesi&ing cells located in the epiphyseal plates of long $ones.E25 or ?3 Cmission is a mo'ement mediated $y sympathetic "thoracol m$ar# adrenergic transmitters C)ac lation re+ ires the somatic ner'o s system "Asympathetic# .- 28.