Endocrine System

The Endocrine System

Controls many body functions

exerts control by releasing special chemical

substances into the blood called hormones
Hormones affect other endocrine glands or
body systems

Endocrine System

Hormone
A substance that is released in one tissue and
travels through the circulation (usually) to the
target tissue.

Hormones reach all parts of the body, but only

target cells are equipped to respond

Hormones are secreted in small amounts and

often in bursts (pulsatile secretion)

Endocrine Functions

Maintain Internal Homeostasis

Support Cell Growth

Facilitate Responses to External Stimuli

Coordinate Development

Coordinate Reproduction , fertility, sexual

function

4 Classes of Hormones
1.

Peptide/ Protein (Range from 3 amino

acids to hundreds of amino acids in size. ) eg

insulin and glucagon

2.
3.

Steroid:eostrogen and testosterone

Amine (Thyroid hormones and
Catecholamines)eg parathyroid and thyroxine

4.

Eicosanoid (Fatty acid derivatives )

The hormones fall into two general classes

based on their solubility in water.
The water soluble { amine (epinephrine) and
peptide/protein hormones} are secreted by
exocytosis, travel freely in the bloodstream,
and bind to cell-surface receptors.
The lipid soluble hormones { thyroid
hormone, steroid hormones and Vitamin D3}.
diffuse across cell membranes, travel in the
bloodstream bound to transport proteins,
and diffuse through the membrane of target
cells .

Fat-soluble
hormone

Watersoluble
hormone

Signal receptor

Transport
protein

TARGET
CELL

(a)

Signal
receptor

NUCLEUS

(b)

Location of receptors
On cell surface
Peptides and proteins
- In cytoplasm
Steroids
- In nucleus
Thyroid hormones
-

Hypothalamic &
Pituitary Hormones

Cerebrum
Pineal
gland

Thalamus

Cerebellum

Pituitary
gland

Hypothalamus

Spinal cord

Hypothalamus
Posterior
pituitary
Anterior
pituitary

Hypothalamus and Pituitary

The output of the hypothalamus-pituitary unit

regulates the function of the thyroid, adrenal and
reproductive glands and also controls somatic growth,
lactation, milk secretion and water metabolism.

Hypothalamic Hs can have effect of stimulating or

inhibiting the release of ant. Pit. Hs. Called RELEASING
HORMONES RH or INHIBITING HORMONES IH

reflecting their influence on ant. Pit. Hs.

respectively,

The Pituitary Gland

The Pituitary Gland is divided into 2 areas, with separate types of

hormone production.

The anterior pituitary makes and releases H under

regulation of the hypothalamus
Growth Hormone (GH)
Thyroid-stimulating Hormone (TSH)
Adrenocorticotropin (ACTH)
Follicle-stimulating Hormone (FSH) ),
Leutinizing Hormone (LH),
Prolactin
The posterior pituitary stores and secretes H that
are made in the hypothalamus: oxytocin and

antidiuretic hormone (ADH)

Hypothalumus
Growth hormonereleasing
hormone(GHRH) +

Ant. pituitary

Growth Hormone (GH),

Growth hormonereleasing inhibiting

hormone (GHRIH)_
Somatostatin
Thyrotropin-releasing
hormone (TRH)+

Thyroid Stimulating
Hormone (TSH),

Corticotropin-releasing
hormone (CRH)+

Adrenocorticotropic
Hormone (ACTH),

Gonadotropin-releasing
hormone (GnRH)+

Follicle-stimulating
Hormone (FSH),
Luteinizing Hormone(LH).

Dopamine _

Prolactin,

Post. Pituitary

Antidiuretic
Hormone

Oxytocin

Hypothalamic hormones:
1- Growth Hormone- Releasing Hormone(GHRH):
Together with somatostatin controls release of the GH
from the ant. pit.

It is released from hypothalamus in a pulsatile

fashion, with 5-9 major pulses detected per
day.
GHRH release is enhanced by 2-adrenergic
agonists (e.g. clonidine) and opioids.

GHRH release is increased by vigorous exercise.

Diagnostic Uses of GHRH (Sermorelin)

To test pituitary function in patients with GH
deficiency.

GH deficiency could reflect either a hypothalamic or a pit. defect.

If the primary defect is hypothalamic, as is most

common, GHRH will elicit an increase in GH release.
If the defect is at the level of the pituitary, there will be
no increase in GH following GHRH administration.
Therapeutic Uses of GHRH to enhance GH secretion

Pulsatile subcutaneous delivery of GHRH,

mimicking the normal endogenous patterns
(e.g. ~ every 3 hours) has been used to
stimulate GH release in patients with GH
deficiency that is not of pituitary origin.
IV, SC, intranasal

2- Somatostatin (Growth hormone-

releasing inhibiting hormone (GHRIH):

Inhibits GH release and TSH from the ant. pituitary .

Inhibits release of most GI hormones, reduces gastric acids and pancreatic
secretion. (glucagon , insulin & gastrin),

Therapeutic Uses Somatostatin

Somatostatin is of no clinical value because of it's short half-life (<3 min)
Octreotide ,a synthetic somatostatin analogue with a longer duration of action

Lanreotide is much longer acting, and is administered only twice a month .

used to treat: Acromegaly, Gastrinoma ,Glucagonoma & Other Endocrine
Tumors , and esophageal varices bleeding. (Inhibits Mesenteric vasodilatation
induced by glucagon)

A/E: GI disturb. postprandial hyperglycemia.

Gall stones often form as a result of decreased biliary flow and gall bladder
contraction.

3- Thyrotropin-Releasing
Hormone(TRH):
Stimulates release of thyrotropin (TSH) from the ant pit.
Is used in diagnostic testing of thyroid dysfunction
Protirelin: IV

4- Corticotropin Releasing Hormone(CRH)

It stimulates secretion of both ACTH & beta endorphin (a
closely related peptide ) from the ant. pituitary .
CRH can be used in the diagnoses of abnormalities of ACTH
secretion .

5- Gonadotropin-Releasing Hormone:
(GnRH):

Stimulate the gonadotroph cell to produce and release LH and

FSH,
Gonadorelin, Buserelin, Nafarelin
GnRH agonists, SC infusion in pulses mimic physiological
GnRH, stimulates ovulation.
In contrast, steady dosing inhibits gonadotropin release by
causing down regulation (desensitization) of GnRH receptors
in pituitary cells that normally release gonadotropins .
GnRH is used in the diagnosis & treatment (by pulsatile
administration) of hypogonadal states in females & males .
Continuous GnRH agonists are used in sex H-dependent
conditions: prostate & breast cancers, uterine fibroids,
endometriosis or precocious puberty .

Dopamine is the physiologic inhibitor of prolactin

release

Because of its peripheral effects & the need for

administration, dopamine is not useful in
6- parenteral
Prolactin-Inhibiting
Hormone
the control of hyperprolactinemia, but bromocrptine
(PIH,dopamine):
& other orally active ergot derivatives (eg .
Cabergoline, pergoline) are effective in reducing
prolactin secretion from the normal glands as well as
from prolactinomas .

Also used in treatment of acromegaly

A/E: orthostatic hypotension, Psychiatric manifestations

Pituitary Hormones

Anterior pituitary
Hormones

Growth Hormone

Derived from the somatotroph cells

Its secretion is controlled by GHRH and

somatostatin;

GH secretion is high in newborn, deceasing at 4 yr

to an intermediate level, which is then maintained
until puberty, when there is further decline.

Insulin-like growth factor 1 (IGF-1) released from

the liver inhibits GH secretion by stimulating
somatostatin secretion from the hypothalamus,

Growth Hormone Activity

1.

Increases plasma free fatty acids (source of energy for

muscle tissue)

2.

Increases hepatic glucose output

3.

Decreases insulin sensitivity in muscle

4.

Is protein anabolic hormone

Growth Hormone Deficiency

Can have a genetic basis or can be acquired as a result
of damage to the pituitary or hypothalamus by a
tumor, infection, surgery, or radiation therapy.
In childhood: short stature and adiposity, hypoglycemia.
Adults : generalized obesity, reduced muscle mass.

GROWTH HORMONE EXCESS

Mainly benign pituitary tumor

In adults causes acromegaly,

If this occurred before the long bone epiphyses
close, it leads to the rare condition, gigantism.

Treatment of excess GH disorders:

- Synthetic Somatostatin (Octreotide)
- DA agonists (Bromocriptine)
- Surgical removal / Radiotherapy of the tumor
- GH Antagonists (Pegvisomant)

An excess of GH
can cause
gigantism, while a
lack of GH can
cause dwarfism

Clinical uses of GH
Somatotropin

GH deficiency in children & adults.

Children with short stature that is due to
factors other than GH deficiency:

Idiopathicshort stature, Turner syndrome, Chronic

renal failure
A/E:

Hypothyroidism, Pancreatitis, Gynecomastia,

Possibilities of abuse have also arisen, e.g.
creation of super sports people.

Thyroid-stimulating Hormone
(TSH)
Also

called thyrotrophin
Stimulates secretion of thyroid
hormone & growth of thyroid gland.
Diagnostic Uses of TSH
In patients who have been treated
surgically for thyroid carcinoma, to
test for recurrence

Adrenocorticotropin (ACTH)
Stimulates cortisol secretion by the adrenal
cortex & promotes growth of adrenal cortex

Diagnostic use: as a test of the capacity of

the adrenal cortex to produce cortisol;

Follicle stimulating hormone

(FSH)

Females: stimulates growth & development of ovarian

follicles, promotes secretion of estrogen by ovaries.

Males: required for sperm production

3 preparations are available for clinical use:

Urofollitropin ,purified from of the urine of post menopausal

women,

2 recombinant forms, follitropin alpha & follitropin beta.

These products are used in combination with other drugs to

treat infertility in women & men.

Leutinizing hormone (LH)

Females: responsible for ovulation, formation of corpus luteum

in the ovary, and regulation of ovarian secretion of female sex
hormones.
Males: stimulates cell in the testes to secrete testosterone

Lutropin alfa, approved for use in combination with

follitropin alfa for stimulation of follicular development in

infertile women with profound LH deficiency.

Prolactin

Secreted by lactotroph cells of the ant. Pit., which increase

in number during pregnancy.

Its secretion is stimulated by estrogen

Females: stimulates breast development and milk

production.

Males: involved in testicular function

No preparation of prolactin is available for use in prolactindeficient patients.

For patients with symptomatic hyperprolactinemia,

inhibition of prolactin secretion can be achieved with
dopamine agonists, which act in the pituitary to inhibit
prolactin release.

Posterior pituitary
Hormones

Oxytocin

It is synthesized in the hypothalamus &

transported to the post. Pit.

It is an effective stimulant of uterine

contractions & is used intravenously to induce
or reinforce labor .

Induces the release of milk

Suckling sends a message to the hypothalamus

via the nervous system to release oxytocin,
which further stimulates the milk glands

Clinical uses of oxyticin

IV, IM
Induction of labor
Control of postpartum bleeding

A/E :
fetal distress, placental abruption, or
uterine rupture
excessive fluid retention

Vasopressin (antidiuretic hormone

ADH)

It is synthesized in the hypothalamus & transported to

the post. Pit.

The function of ADH is to increase water conservation

by the kidney.

If there is a high level of ADH secretion, the kidneys

reabsorb water.
If there is a low level of ADH secretion, the kidneys
release water in dilute urine.
ADH release increases if blood pressure falls or blood
becomes too salty.
ADH causes peripheral blood vessel constriction to help
elevate blood pressure .

Clinical uses
Diabetes

insipidus,
Nocturnal enuresis (by decreasing
nocturnal urine production)
A/E: hyponatremia and seizures
Synthetic ADH drugs
Vasopressin: IV, IM
Desmopressin: IV, IM. PO, intranasal

Adrenal Gland

Paired endocrine
organs consisting
of both cortex and
medulla
2 distinct organs
that happen to
come together
during
development

CORTEX

The primordial cortex

arises from the coelomic
mesodermal tissue near
the cephalic end of the
mesonephros during the
4th and 5th wk of
gestation
7th wk can detect activity
Cell mass dominates
during the 4th month
Steriodgenesis reaches
its maximum during 3rd
trimester

MEDULLA

Arises from ectodermal

tissues of the
embryonal neural crest
Develops in parallel
with the sympathetic
ns in the 5th to 6th wk
The cells will migrate
ventrally to assume a
para-aortic position
near the developing
adrenal cortex where
they develop into
chromaffin cells

Vasculature:

Arterial supply is
diffuse/ venous
drainage is solitary
Arterial supply:
superior adrenal
from inferior inferior
phrenic
Small middle
adrenal from aorta
Inferior adrenal
arteries from renal
art

Adrenal vein
L side 2cm long
and drains into L
renal vein after
joining inf phrenic
art
R vein drains into
IVC

Glomerulosa

Produces
mineralcorticoids
aldosterone
Hyperadrenal
syndrome
hyperaldosteronis
m

Mineralcorticoids

Unlike glucorticoids which are exclusively

under neuroendocrine regulation
Release of aldosterone is regulated by
angiotensin II and the blood K level, and to a
lesser extent ACTH
The major stimulus for aldosterone is a
decrease in the intravascular blood volume..
Decrease renal perfusion sensed by JG
apparatus triggers the release of renin
Regulates circulating fluid and electrolyte
balance by promoting Na and Cl retention
Hypokalemia reduces aldosterone release
by suppressing renin secretion and acting
directly at the zona glomerulosa

Fasiculata

Glucocorticoids
cortisol,
corticosterone,
Hyperadrenal
syndrome Cushings syndrome

Glucocorticoids

Release of corticotropin releasing factor (CRF) into the

hypothalamic-pituitary portal system- results in the
secretion of ACTH by the anterior pituitary

Secretion of ACTH is pulsatile; stimulation of cortisol release

occurs within 15 min of the surge in ACTH

This will stimulate glucocorticoid secretion

Create a catabolic state- net effect of increasing blood
glucose concentrations
Hepatic glucose output is elevated by up-regulation of
gluconeogenesis and net glycogen deposition occurs
Glucose uptake by peripheral tissues is directly inhibited
Stim free fatty acids release from adipose tissue and AA
release from body proteins
supply the cell energy and substrate required for
response to stress and repair from injury
Cortisol inhibits the biosyntheisis and secretion of CRH and
ACTH negative feedback (HPA axis)

HPA axis

HPA axis
Major

function is to maintain
metabolic homeostasis and to
mediate the neuroendocrine stress
response

Male reproductive
system

Adolescence

Puberty
Burst of hormones activate maturation of
the gonads: testes
Begins: 9 14 yrs of age
Abnormally early = precocious puberty
Delayed = eunuchoidism

General Physical Changes

Enlargement of the external and
internal genitalia
Voice changes
Hair growth
Mental changes
Changes in body conformation and
skin
Sebaceous gland secretions
thicken/increase acne

External Genitalia
Gonads

= testes

undescended by birth= cryptorchidsim

Scrotum
Penis

Testes

Each testis is an oval structure about 5 cm long

and 3 cm in diameter
Covered by: tunica albuginea
Located in the scrotum
There are about 250 lobules in each testis. Each
contains 1 to 4 -seminiferous tubules that
converge to form a single straight tubule, which
leads into the rete testis.
Short efferent ducts exit the testes.
Interstitial cells (cells of Leydig), which produce
male sex hormones, are located between the
seminiferous tubules within a lobule.

scrotum
consists of skin and subcutaneous tissue
A vertical septum, of subcutaneous tissue in the center
divides it into two parts, each containing one testis.
Smooth muscle fibers, called the dartos muscle, in the
subcutaneous tissue contract to give the scrotum its
wrinkled appearance. When these fibers are relaxed, the
scrotum is smooth.
the cremaster muscle, consists of skeletal muscle fibers
and controls the position of the scrotum and testes.
When it is cold or a man is sexually aroused, this muscle
contracts to pull the testes closer to the body for
warmth.

Epididymis
a long tube (about 6 meters) located along
the superior and posterior margins of the
testes.
Sperm that leave the testes are immature
and incapable of fertilizing ova. They
complete their maturation process and
become fertile as they move through the
epididymis. Mature sperm are stored in the
lower portion, or tail, of the epididymis

spermatic cord
contains

the proximal ductus

deferens, testicular artery and veins,
lymph vessels, testicular nerve,
cremaster muscle and a connective
tissue covering.

Duct System
Sperm

cells pass through a series of

ducts to reach the outside of the
body. After they leave the testes, the
sperm passes through the
epididymis, ductus deferens,
ejaculatory duct, and urethra.

Ductus Deferens [vas

deferens]

a fibromuscular tube that is continuous with the

epididymis.
enters the abdominopelvic cavity through the
inguinal canal and passes along the lateral pelvic
wall, behind bladder & toward the prostate gland.
Just before it reaches the prostate gland, each
ductus deferens enlarges to form an ampulla.
Sperm are stored in the proximal portion of the
ductus deferens, near the epididymis

Ejaculatory Duct
Each

ductus deferens, at the ampulla

, joins the duct from the adjacent
seminal vesicle (one of the accessory
glands) to form a short ejaculatory
duct.
Each ejaculatory duct passes
through the prostate gland and
empties into the urethra.

Urethra
extends from the urinary bladder to the
external urethral orifice at the tip of the penis.
It is a passageway for sperm and fluids from
the reproductive system and urine from the
urinary system.
divided into three regions: The prostatic
urethra, the membranous urethra & the penile
urethra (also called spongy urethra or
cavernous urethra)

accessory glands
are

the seminal vesicles, prostate

gland, and the bulbourethral glands.
These glands secrete fluids that
enter the urethra.

Seminal Vesicles
glands posterior to the urinary
bladder.
Each has a short duct that joins with
the ductus deferens at the ampulla to
form an ejaculatory duct, which then
empties into the urethra.
The fluid is viscous and contains
fructose, prostaglandins and proteins.

Prostate
a firm, dense structure about the size of a
walnut that is located just inferior to the
urinary bladder.
encircles the urethra as it leaves the urinary
bladder.
Numerous short ducts from the prostate
gland empty into the prostatic urethra. The
secretions of the prostate are thin, milky
colored, and alkaline. They function to
enhance the motility of the sperm.

Bulbourethral Glands
small,

(Cowper's)

about the size of a pea, and

located near the base of the penis. A
short duct from each enters the
proximal end of the penile urethra.
In response to sexual stimulation, the
bulbourethral glands secrete an
alkaline mucus-like fluid

Seminal Fluid or Semen

a slightly alkaline mixture of sperm cells and

secretions from the accessory glands.
Secretions from the seminal vesicles make up
about 60 percent of the volume of the semen,
with most of the remainder coming from the
prostate gland. The sperm and secretions from
the bulbourethral gland contribute only a small
volume.
The volume of semen in a single ejaculation may
vary from 1.5 to 6.0 ml. There are between 50 to
150 million sperm per milliliter of semen. Sperm
counts below 10 to 20 million per milliliter usually
present fertility problems.

penis
is a cylindrical pendant organ located anterior
to the scrotum and functions to transfer
sperm to the vagina.
consists of three columns of erectile tissue
that are wrapped in connective tissue and
covered with skin. The two dorsal columns are
the corpora cavernosa. The single, midline
ventral column surrounds the urethra and is
called the corpus spongiosum.

penis

3 parts: a root, body (shaft), and glans penis.

The root of the penis attaches it to the pubic arch
the body is the visible, pendant portion.
The corpus spongiosum expands at the distal end
to form the glans penis.
The urethra, which extends throughout the length
of the corpus spongiosum, opens through the
external urethral orifice at the tip of the glans
penis. A loose fold of skin, called the prepuce, or
foreskin, covers the glans penis.

Erection
Involves

increase in length, width &

firmness
Changes in blood supply: arterioles
dilate, veins constrict
The spongy erectile tissue fills with
blood
Erectile Dysfunction [ED] also known
as impotence

Spermatogenesis: formation of sperm & occur in the

seminiferous tubules during active sexual life due to
stimulation by AP-GnRHs, begin at age of 13 years
,continue throughout life & decrease in old age.

Sertoli cells: large with overflowing cytoplasmic

envelopes that surround the developing
spermatogonia around the central lumen of the
seminiferous tubules.

Leydig cell: lie with interstices between the

seminiferous tubules.
They are non-existent in the testis during childhood
when the testis secrete almost no testosterone,
- numerous in the newborn male infants for the first few
months of life
- active at puberty & throughout adult life & secrete
testosterone.

Formation of sperm:
Spermatids when they formed, similar to
epitheliod cells
- then differentiate and elongate into
spermatozoa. Sperm formed of head and tail,
-the head contains nucleus, cytoplasm and cell
membrane
- outside the anterior 2/3 of the head is a thick
cap called acrosome that is formed mainly from
Golgi apparatus which contains enzymes
including hyaluronidase and powerful
proteolytic enzymes (which can digest
proteins).
- The tail of the sperm contain a collection of
mitochondria which synthesized ATP which is
important for sperm motility.

Maturation of sperm in the

epididymis:
-After formation in the seminiferous tubules,
the sperm require several days to pass
through the epididymis (still non-motile).
- After the sperm have been in the epididymis
for some 18 to 24 hour, they develop the
capability of motility (some inhibitory
proteins in the epididymal fluid prevent
final motility until after ejaculation).

Storage of sperm:
The 2 testis of adult human formed up to 120 million
sperm each day.
-Small amount stored in the epididymis
the majority stored in the vas deferens, maintaining
their fertility for at least a month. The sperm are
kept inactive state by multiple inhibitory substances
in the secretion of the ducts.

After ejaculation, the sperm become motile &

capable of fertilizing the ovum called maturation.

- The sertoli cells and epithelium of the epididymis
secrete nutrient fluid which contains (testosterone &
estrogens), enzymes & nutrients essential for sperm
maturation.

Physiology of mature sperm:

Mature sperm are motile & capable of fertilizing the ovum & their
activity is enhanced in a neutral & slightly alkaline medium &
depressed in mildly acidic medium. The life expectancy of
ejaculated sperm in the female genital tract is only 1 to 2 days.

Function of the seminal vesicles:

- secrete mucoid material containing fructose, citric acid &
nutrient substances & large quantities of prostaglandins &
fibrinogen. The prostaglandins are important help in
fertilization:
1- by reacting with the female cervical mucus making it more
receptive to sperm movement.
2- by causing backward reverse peristaltic contractions of the
uterus & fallopian tubes to move the ejaculated sperm toward
the ovaries.

Function of the prostate gland:

The prostate gland secretes thin milky fluid contains Ca2+
ion, citrate ion, phosphate ion, a clotting enzyme &
profibrinolysin. The alkaline prostatic fluid is important
for successful fertilization of the ovum.

Alkaline prostate fluid function :

1-successful fertilization of the ovum
2-help to neutralize the slightly acidic fluid of the vas
deferens (due to the presence of citric acid and
metabolic & product of the sperm inhibit sperm fertility).
3-helps to neutralize the acidity of other seminal fluids
during ejaculation & enhances motility & fertility of
sperm

Semen:

- Ejaculated semen during sexual act is composed of the fluid & sperm from
the vas deferens (~10%)+fluid from the prostate gland (~30%),+fluid from
the seminal vesicles (~60%) + small amounts from the mucous glands the
bulbourethral glands.
- The average pH is about 7.5, the alkaline prostatic fluid help to neutralize
the mild acidity of other portions of the semen.
& gives the semen a milky appearance
-fluid from the seminal vesicles & mucous glands give the semen mucoid
consistency.

Effect of sperm count on fertility:

The quantity of ejaculated semen during coitus about 3-5 ml, each milliter
contains about 120 million sperm (normal male count vary between 35
million to 200 million sperm). Sperm count below 20 million leads to
infertility.

Effect of sperm morphology and motility on

fertility:

Sometimes sperm count is normal but still infertile when about one half of the
sperm having abnormal shape.
-Sometimes the shape of the sperm is normal but they either relatively nonmotile or entirely non-motile which causes infertility.

Capacitation of the spermatozoa :

Making it possible for them to penetrate the ovum :

- Sperm in the epididymis is kept inactive by multiple inhibitory factors

secreted by the genital duct epithelia & they activated in female

genital tract, for the processes of fertilization. These activation
changes are called capacitation of the spermatozoa (require 1 to 10
hrs).

- Uterine & fallopian fluids wash away the inhibitory factors which
suppress the sperm activity in the male genital ducts.
- While the spermatozoa remain in the fluid of the genital ducts, they
exposed to many floating vesicles from the seminiferous tubules
containing large amount of cholesterol. This cholesterol is added to
the cellular membrane covering the acrosome making it more rough
& prevent the release of its enzyme. After ejaculation the sperm
removed from the cholesterol vesicles & this makes the membrane of
the sperm & head becomes weaker.
- The sperm membrane becomes more permeable to Ca2+ ion which
increase their movements & help to release the proteolytic enzymes
from acrosome which aid in penetrating the ovum.

Acrosome enzymes, the Acrosome Reaction

and penetration of the ovum:
The acrosome of the sperm stored large quantities of
hyaluronidase and proteolytic enzymes. Hyaluronidase
depolarizes hyaluronic acid polymers in the intracellular
cement that hold the ovarian granulose cells together. Also
the proteolytic enzymes digest the proteins.

Hormonal factors that stimulate spermatogenesis:

1-Testosterone: secreted by the leydig cells which located in the
interstitium of the testis, is essential for the growth and division
of the testicular germinal cells.
2-Luteinizing hormone (LH) secreted by the anterior pituitary
gland, stimulates the leydig cells to secrete testosterone.
3-Follicle stimulating hormone: FSH also secreted by the
anterior pituitary gland, stimulates the sertoli cells, stimulate the
conversion of spermatids to sperm (also important for
spermatogenesis).
4-Estrogen: formed from testosterone by the sertoli cell under FSH
stimulation also essential for spermatogenesis.
5-Growth hormone (also other body hormones) is necessary for
controlling metabolic functions of the testis. GH promotes early
division of spermatogonias in its absence (pituitary dwarfs), the
spermatogenesis is severely deficient or absent infertility.

Control of male sexual functions by

hormones from the hypothalamus
and anterior pituitary gland:
- GnRH and its effect in increasing the secretion of LH
and FSH: GnRH peptide secreted by the arcuate
nuclei of the hypothalamus through the
hypothalamic-hypophysial portal system to the
anterior pituitary gland and stimulates the release of
gonadotropins (LH and FSH).
- GnRH is secrete intermittently for few minutes every 1
to 3 hrs. The secretion of LH by the anterior pituitary
is also cyclical flowing the pulsatile release of GnRH.

Testosterone regulation of its production by

LH:
Testosterone is secreted by leydig cells, in the interstitium of
the testis, by LH stimulation from the AP or its release is
directly proportional to the amount of LH. Mature leydig
cells are found in a childs testis few weeks after birth &
then disappear until puberty when it appear again.

Inhibition of anterior pituitary secretion of LH

and FSH by testosterone negative
feedback control of testosterone secretion:
Testosterone secreted by the testis in response to LH
stimulation and has reciprocal effect of inhibiting the AP
secretion of LH. Most of the inhibitory effect result from a
direct effect of testosterone in the hypothalamus to
decrease secretion of GnRH which causes decrease
secretion of both LH & FSH.

Regulation of spermatogenesis by FSH and

testosterone:
- FSH binds with specific FSH receptors attached to the sertoli cell in
the seminiferous tubules, which causes these cells to grow &
secrete spermatogenic substances. Also testosterone &
dihydrotestosterone diffuses into the seminiferous tubules from
the leydig cells affect the spermatogenesis, so both FSH &
testosterone are necessary to initiate spermatogenesis.

Negative feedback control of seminiferous tubule

activity role of the hormone inhibition:
- When the seminiferous tubules fail to produce sperm secretion of
FSH from the AP increases. Conversely, when spermatogenesis
proceeds rapidly pituitary secretion of FSH diminishes. This is due
to the secretion of inhibin hormone from the sertoli cells which
strongly inhibit the AP- FSH and slight inhibitory effect on the
hypothalamus to inhibit GnRH secretion.

Male sexual act.

Stages of male sexual act:
1-Penile erection. Erection is caused by parasympathetic

impulses that pass from the sacral portion of the spinal cord
through the pelvic nerves to the penis.

2-Lubrication, Parasympathetic impulses cause the urethral

glands &bulbourethral glands to secrete mucous.

3-Emission and ejaculation. Function of the sympathetic

nerves. Emission begins by contraction of the vas deferens &

ampulla to cause expulsion of the sperm in the internal urethra.
Contraction of the prostate &seminal vesicles to expel their fluid in
the urethra. All these fluid mix in the internal urethra with the
mucous secreted by the bulbourethral glands to form the semen.
This process at this point is called emission.

- Filling of the internal urethra with semen causes sensory impulses

through pudendal nerves to the sacral region of the cord. Fullness
of the internal urethra causes rhythmical contractions of the
internal genital organs which increases their pressure to ejaculate
the semen to the outside called ejaculation.

Testosterone and other male sex chromosomes: secretion,

metabolism and chemistry of the male sex hormone:
Secretion of testosterone by the interstitial cell of leydig in the testis.
The testis secrete several male sex hormone called androgens
including testosterone, dihydrotestosterone and androstenedione.
Testosterone is the more abundant form while dihydrotestosterone
is more active and testosterone converted into
dihydrotestosterone in the target cells.
Secretion & chemistry of androgens in the body:
- From the adrenal glands & synthesized either from cholesterol or

directly from acetylcoenzyme A.

Metabolism of testosterone:
Testosterone bound with beta globulin and circulate in the blood for
30 minutes to several hours and converted to estrogen in the liver
and excreted either into the gut through liver bile or into the urine
through the kidneys.

Functions of testosterone:
It is responsible for the characteristic
masculine body. During fetal life the testis
are stimulated by placenta chorionic
gonodotropin to produce testosterone
throughout fetal life & the 10 weeks after
birth then no more testosterone production
during childhood & at puberty under the
anterior pituitary gonadotropic hormones
stimulation throughout life & then decline
beyond 80 years to 50%.

Function of testosterone during

fetal development:

Testosterone secreted by the genital widges &

later by the fetal testis is responsible for
development of the male body
characteristics including the formation of
penis & scrotum. & prostate gland, seminal
vesicles & male genital ducts & suppressing
the formation of female genital organs.

Effect of testosterone to cause

descent of the testis:
The testis descend into the scrotum during the
last 2 to 3 months of gestation when the
testis begin secreting reasonable quantities
of testosterone.

-Effect pf testosterone on development of adult

primary and secondary sexual characteristics:
1-After puberty, the increasing amounts of testosterone
cause enlargement of the penis, scrotum & testis &
secondary sexual characteristics.
2- Effect on the distribution of body hair:
Testosterone causes growth of hair: 1) over the pubis, 2)
upward along the linea alba of the abdomen to the
umbilicus; 3) on the face; 4) on the chest; 5) less often on
other regions such as the back.
3-Baldness:
Testosterone decreases the growth of hair on the top of the
head (two factors 1) genetic background; 2) large
quantities of androgenic hormones.
4-Effect on voice:
It causes hypertrophy of the laryngeal mucosa, enlargement
of the larynx (typical adult masculine voice)

5-Testosterone increases thickness of the skin and can

contribute to development of acne:
Testosterone increases the thickness of skin over the body &
subcutaneous tissues. Also it increases the secretion of the
sebaceous glands & sebaceous glands of the face causing acne.
6-Testosterone increased protein formation and muscle development :
Increase muscular development after puberty by 50% in muscle mass
over that in female. Also increase in protein in non-muscle parts of
the body. These effect due to the anabolic effect of testosterone.

7- Testosterone increases bone matrix and causes Ca2+

retention:
Bones grown thicker & deposit additional Ca2+. Thus it increases the
total quantity of bone matrix & causes Ca2+ retention (anabolic
effect). Testosterone has specific effect on the pelvis 1) narrow the
pelvic outlet; 2) lengthen it; 3) cause the funnel-like shape instead
of the broad ovoid shape of the female pelvis. It causes the
epiphyses of the long bones to unite with the shafts of the bones &
early closure of the epiphyses.

8-Testosterone increases basal metabolism:

It increases the basal metabolic rate by about 15% (indirectly
as a result of the anabolic effect).
9-Effect on red blood cells:

It increases red blood cells/ml (due to increase metabolic

rate).
10-Effect on electrolyte and water balance:
It increase the reabsorption of Na+ in the distal tubules of
the kidneys.
The basic intracellular mechanism of action of testosterone:
It increases the rate of protein synthesis in target cells.
Testosterone converted by the intracellular enzyme 5
reductase to dihydrotestosterone, then it binds with
cytoplasmic receptor protein. This combination moves
to the nucleus where it binds a nuclear protein and induces
protein formation.

Common Disorders Of
The Male
Reproductive System
By Joan Meade
October 2006

Testicular Trauma

Occurs when testicles are struck, hit,

kicked or crushed
Symptoms are severe pain, bruising,
swelling

Torsion of Testicles

Testicular torsion is
the twisting of the
spermatic cord,
which cuts off the
blood supply to the
testicle and
surrounding
structures within
the scrotum

Torsion of Testicles
Some

men may be predisposed to

testicular torsion as a result of
inadequate connective tissue within
the scrotum. However, the condition
can result from trauma to the
scrotum, particularly if significant
swelling occurs. It may also occur
after strenuous exercise or may not
have an obvious cause.

Torsion of Testicles
Symptoms

Sudden onset of severe pain in one

testicle, with or without a previous
predisposing event
Swelling within one side of the scrotum
Nausea or vomiting
Light headedness
Testicle lump
Blood in Semen

Torsion of Testicles

Surgery is usually required and should be

performed as soon as possible after
symptoms begin. If surgery is performed
within 6 hours, most testicles can be
saved.
During surgery, the testicle on the other
(non-affected) side is usually also
anchored as a preventive measure. This is
because the non-affected testicle is at risk
of testicular torsion in the future.

Undescended Testicles
Undescended

testicle occurs when

one or both testicles fail to move into
the scrotum prior to birth.
Surgery (orchiopexy) is the definitive
therapy. The trend in literature
favours earlier surgery to prevent
irreversible damage to the testis,
which may cause infertility.

Orchitis
Orchitis

is an inflammation of one or
both of the testicles, often caused by
infection
Caused by numerous bacterial and
viral organisms. The most common
viral cause is mumps.

Orchitis

Symptoms
Scrotal swelling
Tender, swollen, heavy feeling in the testicle
Tender, swollen groin area on affected side
Fever
Discharge from penis
Pain with urination (dysuria)
Pain with intercourse or ejaculation
Groin pain
Testicle pain aggravated by bowel movement or
straining
Blood in the semen

Orchitis

Treatment
Medications to treat infection are prescribed if the
causative agent is bacterial.

Pain medications and anti-inflammatory medications

are also commonly prescribed. In the case of
gonorrhea or chlamydia, sexual partners must also
be treated.

When orchitis is caused by viral agents, only

analgesics (pain relievers) are prescribed. Bed rest,
with elevation of the scrotum and ice packs applied
to the area, is recommended.

Micropenis

is an unusually smallpenis. A common criterion is

a that it must be smaller than about 7cm (2
inches) for an adult when compared to an
average erection of 12.5cm (5 inches).

Hydrocoele

A hydrocoele is a fluidfilled sack along the

spermatic cord within
the scrotum
Hydrocoeles can be
easily demonstrated by
shining a flashlight
through the enlarged
portion of the scrotum.
If the scrotum is full of
clear fluid, as in a
hydrocoele, the scrotum
will light up (
transillumination ).

Hydrocoele
During

normal development, the testicles

descend down a tract (tube) from the
abdomen into the scrotum. Hydrocoeles
result when this tube fails to close.
Hydrocoeles may also be caused by
inflammation or trauma of the testicle or
epididymis, or by fluid or blood
obstruction within the spermatic cord.
This type of hydrocoele is more common
in older men.

Hydrocoele

Treatment

Drainage
Surgery

Inguinal Hernia

An inguinal hernia
occurs in the groin
area, when an
organ, usually a part
of the intestine,
protrudes through
the abdominal wall
into the inguinal
canal. The inguinal
canal carries the
spermatic cord in
men.

Inguinal Hernia

Symptoms:
None until the doctor discovers it during a routine
medical exam.
Bulge created by the protruding intestine when
you stand upright, especially if you cough or
strain.
Other signs and symptoms:
Pain or discomfort in your groin, especially when
bending over, coughing or lifting
A heavy or dragging sensation in your groin
Pain and swelling in the scrotum around the testicles
when the protruding intestine descends into the scrotum

Phimosis

Tightening of the
foreskin which may
cause it not to be
able to retract and
may interfere with
urination

Treatment is
usually
circumcision

Paraphimosis

Entrapment of the
foreskin behind the
head of the penis
Can be congenital or
acquired
Acquired due to poor
hygiene or forceful
retraction of foreskin
Vigorous sexual
activity may also
cause paraphimosis

Paraphimosis
Symptoms

Pain and swelling

Pain with erection
Treatment

Manual reduction of the foreskin

Slitting the foreskin to free the constriction
Circumcision

Hypospadias & Epispadias

The urethral
opening appears
either on the
underside or upper
side of the penis
but not at the tip

Treatment
reconstructive
surgery

Varicocoele

Varicose vein in the

spermatic cord
Cause - the valve that
regulates blood flow
from the vein into the
main circulatory
system becomes
damaged or defective.
Inefficient blood flow
causes enlargement
(dilation) of the vein.

Varicocoele

Signs and Symptoms

Most men who have a varicocoele have no
symptoms. Signs and symptoms may include
the following:
Ache in the testicle
Feeling of heaviness in the testicle(s)
Infertility
Shrinkage (atrophy) of the testicle(s)
Visible or palpable (able to be felt) enlarged
vein

Varicocoele

Treatment
If the patient is asymptomatic or the symptoms are
mild and infertility is not an issue, the condition
can be managed by wearing an athletic supporter
or snug-fitting underwear to provide the scrotum
with support.
Surgery
If the varicocoele causes pain or atrophy, if it
damages the testicle(s), or if the condition is
causing infertility, surgery may be recommended.
Most varicoceles can be corrected through a
surgical procedure called varicocoelectomy (i.e.,
surgically "tying off" the affected spermatic veins).

Prostatitis
Prostatitis

- inflammation the
prostate gland
Cause - bacterial infection, but
evidence of infection is not always
found
Symptoms - painful urination and
ejaculation

Prostatitis
Diagnosis

Digital rectal exam to determine if the

prostate gland is tender or swollen
Urinalysis determines the presence of
white blood cells (leukocytes) in the
urine
Urine culture to identify bacteria
Treatment

analgesics

is antibiotics and

Prostate Cancer

Prostate cancer
commonly occurs
in men over age 50
Twice as common
in black men as it
is in whites.
The likelihood of
developing
prostate cancer
doubles if there is a
family history.

Prostate Cancer
Symptoms

include hesitant, frequent

or painful urination, blood in the
urine, sexual dysfunction, swollen
lymph nodes in the groin, and pain in
the pelvis, hips, back, or ribs.
Treatment may include surgery,
radiation therapy, hormone therapy,
chemotherapy, or a combination of
two or more of these approaches.