MEDICAL PHYSIOLOGY
                       Endocrine Conference Quiz 8A
                               March 13, 2002

1. Adipose contains the aromatase enzyme which is important for the
conversion of testosterone to estradiol.



2. List two endocrine factors that can regulate the levels of sex hormone
binding globulin in serum and whether they increase or decrease SHBG
levels.

          Increased by estrogens and thyroid hormones.
          Decreased by androgens and insulin.

3. What are two common characteristics that define a PCOS patient?

          Anovulatory, oligomenorrheic, ovaries with thick, smooth capsule,
          small cystic follicles and no CL. (hirsute, obese)

4. What could lead to fluid loss from a patient's nipples (if observed) and
how would that impact her ability to become pregnant?

          Hypreprolactinemia, can lead to many of the characteristics
          observed in this patient (anovulatory, oligomenorrheic).

5. What do the levels of LH, FSH, and androgens tell us about the
hypothalamic-pituitary axis in our patient?

          The normal feedback (negative) is not functioning properly. The
          high levels of free androgens should be suppressing gonadotropin
          secretion.







                            MEDICAL PHYSIOLOGY
                       Endocrine Conference Quiz 8B
                               March 14, 2002

1. Adipose contains the aromatase enzyme which is important for the
conversions of androgens to estrogens.



2. What relative levels of SHBG would you expect to observe in a
post-menopausal woman receiving estrogen therapy as compared to a similar
woman not receiving estrogen?

          Post-menopausal woman + estrogen > Post-menopausal woman -
          estrogen

3. What are two characteristic morphologic features of the ovary in a PCOS
patient?

          Ovaries with thick, smooth capsule, small cystic follicles and no
          CL.

4. Why did the physician ask whether the patient had fluid escaping from
her nipples?

          To determine whether the patients infertility may be due to
          hyperprolactinemia.

5. What possible role(s) did insulin resistance and elevated levels of
insulin play in the development of PCOS in our patient?

          Contributed to the low SHBG levels and elevated free androgen
          levels. In association with LH, led to increased androgen
          production by the ovary. [The elevated androgens were converted
          to estrogens by the adipose and this altered steroid feedback to
          the HPG axis (and the response to steroid feedback).]