Week I8 IFinal IExam IStudy IGuide
Reproductive:
endometrial Icycle Iand Ithe Ioccurrence Iof Iovulation IOvulation Iis Ithe Irelease Iof Ian Iovum Ifrom Ia
Imature Ifollicle Iand Imarks Ithe Ibeginning Iof Ithe Iluteal/secretory Iphase Iof Ithe
menstrual Icycle. IHCG Ican Ibe Idetected Iin Imaternal Iblood Iand Iurine I8 Ito I10 Idays Iafter Iovulation.
IOvulatory Icycles Iappear Ito Ihave Ia Iminimum Ilength Iof I24 Ito I26.5 Idays. IOnce Iovulation Ioccurs
Iand Iserum Iprogesterone Ilevels Iincrease, Ithe Iendometrial Itissue Idevelops Isecretory Icharacteristics
I(secretory Iphase). IIf Iimplantation Iof Ia Ifertilized Iovum Idoes Inot Itake Iplace, Iendometrial Itissue
Ibegins Ito Ibreak Idown Iapproximately I11 Idays Iafter Iovulation I(ischemic Iphase Iof Imenstruation)
IDetermines Iwhether Iovulation Ihas Ioccurred Iby Iobtaining Iendometrial Itissue Ion Iday I26 Iof I28-day
Imenstrual Icycle I(or Ipostovulatory Iday I12). INormal Imenstrual Icycle I27-30 Idays. IOvulatory
Iphase:Iestrogen Ilevels Idip; Iprogesterone Ilevels Ibegin Ito Irise, ICorpus Iluteum Ibegins Ito Idevelop;
Iendometrium Ienters Isecretory Iphase. IShift Iin Itemperature Iis Irelated Ito Iovulation.
uterine Iprolapse Iis Idescent Iof Ithe Icervix Ior Ientire Iuterus Iinto Ithe Ivaginal Icanal. ILoss Iof Isupport
Iby Ipelvic Imuscles. IUterine Iprolapse Idescent Ior Iherniation Iof Ithe Iuterus Iinto Ior Ibeyond Ithe Ivagina
Ibecause Iof Iweakness Iof Ithe Ipelvic Imusculature, Iligaments, Iand Ifascia Ior Iobstetric Itrauma Iand
Ilacerations Isustained Iduring Ilabor Iand Idelivery.
polycystic Iovarian Isyndrome I(PCOS) IStrong Igenetic Ifactor I-A Ihyperandrogenic Istate Iis Ia
Icardinal Ifeature Iin Ithe Ipathogenesis Iof IPCOS. IGlucose Iintolerance/insulin Iresistance I(IR) Iand
Ihyperinsulinemia Ioften Irun Iparallel Ito Iand Imarkedly Iaggravate Ithe Ihyperandrogenic Istate. ISigns
Iand Isymptoms Iof Iwomen Iwith IPCOS Imay Ichange Iover Itime, Iwith Imetabolic Isyndrome Ibecoming
Imore Iprominent Iwith Iage. IIn Iaddition, Ipolycystic Iovaries Imay Ibe Iassociated Iwith ICushing
Isyndrome, Iacromegaly, Ipremature Iovarian Ifailure, Isimple Iobesity, Icongenital Iadrenal Ihyperplasia,
Ithyroid Idisease, Iandrogen-producing Iadrenal Itumors Ior Iovarian Itumors. IAnovulation Iresults Ifrom
Imetabolic Iabnormalities Icontributing Ito Iobesity Iinclude ICushing Isyndrome, ICushing Idisease,
Ipolycystic Iovary Isyndrome.
testicular Icancer Iand Iconditions Ithat Iincrease Irisk: IPainless Itesticular Ienlargement Iis Ithe Ifirst
Isign Iof Itesticular Icancer. ISigns Iof Itesticular Icancer Iinclude Iabnormal Iconsistency, Iinduration,
Inodularity, Ior Iirregularity Iof Ithe Itestis I A Ifirm, Inontender Itesticular Imass Ior Idiffuse Ienlargement Iis
Ifound Iin Ithe Imajority Iof Icases. IRisk Ifactor Ifor Imen Iwith Iundescended Itesticles, Ia Ifactor Iin Isome
Istudies Icorrelated Iwith IDES Iexposure. IThe Irisk Iof Itesticular Icancer Iis I35 Ito I50 Itimes Igreater Ifor
Imen Iwith Icryptorchidism. IIn Imen Ibetween Ithe Iages Iof I15-35 Iy/o. IGerm Icell Itumors Iconstitute
I90% Iof Itesticular Icancer. IRisk Ifactors Iinclude Ihistory Iof Icryptorchidism, Iabnormal Itesticular
Idevelopment, IHIV, Iand IAIDS, IKlinefelter Isyndrome, Iand Ihx Iof Itesticular Icancer. IScrotal Iincisions
Imay Iincrease Irisk Ior Irecurrence. ISome Iaffected Imen Ihave Ipersistent Iparesthesia, IRaynaud
Iphenomenon, Ior Iinfertility. ICryptorchidism I(one Iof Ithe Itestes Ifails Ito Idescend Iinto Ithe Iscrotum)
Isignificantly Iincreases Ithe Irisk Iof Itesticular Icancer
symptoms Ithat Irequire Ievaluation Ifor Ibreast Icancer Iwoman Iwho Icarries Ia Imutation Iin Ithe
IBRCA1 Ior IBRCA2 Igenes. IFirst Isign Iof Ibreast Icancer Iis Ia Ipainless Ilump. IOther Ipresenting Isigns
Iinclude Ipalpable Inodes Iin Ithe Iaxilla, Iretraction Iof Itissue I(dimpling) I(Fig. I25.49), Ior Ibone Ipain
Icaused Iby Imetastasis Ito Ithe Ivertebrae. IBenign Ibreast Idisease I(BBD) Imost Icommon Isymptoms
Ireported Iare Ipain, Ipalpable Imass, Inipple Idischarge. IStrong Ilink Ibetween Istress Iand Ibreast Icancer
,progression. Ishift-work Iand Iits Idisruptive Ieffects Ion Icircadian Irhythms Iand Isleep Ideprivation Iat
Inight Ihave Ibeen Isuggested Ias Ia Irisk Ifactor Ifor Ibreast Icancer.
Clinical Imanifestation Iof Ibreast ICa:
Chest Ipain nipple Idischarge
I Dilated Iblood Ivessel nipple Iretraction
I Dimpling Iof Iskin pitting Iof Ithe Iskin
Edema reddened Iskin, Ilocal Itenderness, Iwarmth
Hemorrhage
I skin Iretraction
Local Ipain ulceration
Nipple/areolar Ieczema
I
signs Iof Ipremenstrual Idysphoric Idisorder ICyclic Irecurrence I(in Ithe Iluteal Iphase Iof Ithe
Imenstrual Icycle) Iof Idistressing Iphysical, Ipsychologic, Ior Ibehavioral Ichanges Ithat Iimpair
Iinterpersonal Irelationships Ior Iinterfere Iwith Iusual Iactivities Iand Iresolve Iafter
Imenstruation.IIt Iis Ilinked Ito Ihormonal Ichanges Iemotional Isymptoms Iof Idepression, Ianger,
Iirritability, Iaggression, Ifatigue, Iand Iimpulse Icontrol. IPhysical Isymptoms Is/s Ibreast
Itenderness, Iabdominal Ibloating, Iheadache, Iand Iswelling Iof Iextremities, Iwater Iretention,
Ibloating, Iweight Igain.
Box I25.5
D i a g n o s t i c I C r i t e r i a I for I P r e m e n s t r u a l I D y sp h o r i c I D i s o rd e r
• A. I≥5 Isymptoms Ibelow: Ioccur Iin Imost Icycles Iduring Ithe Iweek Ibefore Imenses Ionset,
Iimprove Iwithin Ia Ifew Idays Iafter Imenses Ionset, Iand Idiminish Iin Ithe Iweek Ipostmenses
• B. IOne I(or Imore) Iof Ithe Ifollowing Isymptoms Imust Ibe Ipresent:
o a. IMarked Iaffective Ilability
o b. IMarked Iirritability Ior Ianger Ior Iincreased Iinterpersonal Iconflicts
o c. IMarked Ianxiety, Itension
• C. IOne I(or Imore) Iof Ithe Ifollowing Isymptoms Imust Ialso Ibe Ipresent:
o a. IDecreased Iinterest
o b. IDifficulty Iconcentrating
o c. IEasy Ifatigability, Ilow Ienergy
o d. IIncrease Ior Idecrease Iin Isleep
o e. I Feelings I of I being I overwhelmed
o f. IPhysical Isymptoms Isuch Ias Ibreast Itenderness, Imuscle Ior Ijoint Iaches,
I“ bloating” Ior Iweight Igain
NOTE: ICriteria IA–C Imust Ibe Ipresent Ifor Imost Imenstrual Icycles Iin Ithe Ipreceding Iyear
• D. ISymptoms Iare Iassociated Iwith Isignificant Idistress Ior Iinterferences Iwith Iwork, Ischool,
Ir elationships
• E. IThe Idisturbance Iis Inot Imerely Ian Iexacerbation Iof Ianother Idisorder Isuch Ias Imajor
Idepression, Ipanic Idisorder, Ipersistent Idepressive Idisorder, Ior Ia Ipersonality
Idisorder
• F. ICriterion IA Ishould Ibe Iconfirmed Iby Iprospective Idaily Iratings Iin Iat Ileast Itwo
Isymptomatic Icycles
• G. IThe Isymptoms Iare Inot Idue Ito Iphysiological Ieffects Iof Ia Isubstance Ior Ianother Imedical
Icondition
, dysfunctional Iuterine Ibleeding I(DUB) IHeavy Ior Iirregular Ibleeding Iin Ithe Iabsence Iof Iorganic
Idisease, Isuch Ias Isubmucous Ifibroids, Iendometrial Ipolyps, Iblood Idyscrasias, Ipregnancy, Iinfection,
Ior Isystemic Idisease. IIncreased Iendometrial Ibleeding Iis Icorrelated Iwith Ia Ichange Ifrom Iovulatory
Ito Ianovulatory Icycles Idue Ito Ihigh Iestrogen Ilevels. IHeavy I& Iunpredictable Iflow Ibleeding I(clot I&
Iflooding)
pathophysiology Iof Iprostate Icancer IMore Ithan I95% Iof Iprostatic Ineoplasms Iare Ihistologically
Isimilar Ito Iadenocarcinomas Iand Irely Ion Iandrogen-dependent Isignaling Ifor Itheir Idevelopment
IandIprogression.108-110 IMost Iof Ithese Ineoplasms Ioccur Iin Ithe Iperiphery Iof Ithe Iprostate.
Heterogenous Igroup Iof Itumors. ITesticular Itestosterone Iprovides Ithe Imain Isource Iof
I androgens Iin Ithe I prostate I and Iis Ithe I major Icirculating Iandrogen, Iwhereas IDHT
I predominates I in I prostate I tissue I and I binds I to I the I AR I (androgen I receptors) I with I greater
Iaffinity Ithan Idoes IT I(hormone Itestosterone). IAndrogen Iproduction Ioutside Iof Ithe Itestes, Ior
Iextra I testicular I sources. ITestosterone I is I converted I to I dihydrotestosterone. I DHT I is I the I most
Ipotent Iintraprostatic Iandrogen
HPV Iand Ithe Idevelopment Iof Icervical Icancer IVirtually Iall Icervical Icancer Iis Icaused Iby
Iinfection I with Ispecific Itypes I of I HPV, Iwhich Iinfects Ibasal I skin I cells Iand I commonly I causes
warts. IHPV-16, I-18, I-31, Iand I-45) Iare Iassociated Iwith Ithe Ihighest Irisk Ifor Ideveloping
I
Icervical. I viral I DNA Ibecomes Iintegrated I into Ithe I genomic I DNA I of Ithe I infected I basal I cell
Iof Ithe Icervix I and Idirects Ithe Ipersistent I production Iof I viral I oncogenes. IHPV Iis Imainly
Itransmitted Ithrough Isexual Icontact. IPersistence Iof Iinfection Iwith Ihigh-risk IHPV Iis Ia
Iprerequisite Ifor Ithe Idevelopment Iof Icervical Iintraepithelial Ineoplasia I(CIN) I(see IFig.
25.19), I lesions, I and I invasive I cervical I cancers
Endocrine:
body’s Iprocess Ifor Iadapting Ito Ihigh Ihormone Ilevels IHormones Ioperate Iwithin Ifeedback
systems, Ieither Ipositive Ior Inegative, Ito Imaintain Ian Ioptimal Iinternal Ienvironment.
I
Feedback Isystems Iprovide Iprecise Imonitoring Iand Icontrol I of Ithe Icellular Ienvironment.
IBoth I negative I and I positive I feedback I systems I are I important I for I maintaining I hormone
Ilevels I within I physiologic I ranges. I Negative I feedback I is I the I most I common I and I occurs
Iwhen I a I changing I chemical, I neural, I or I endocrine I response I decreases I the I subsequent
Isynthesis I and I secretion I of I a I hormone. I Positive I feedback I occurs I when I a I neural,
Ichemical, I or I endocrine I response I increases I the I synthesis I and I secretion I of I a I hormone.
IPositive I feedback I also I occurs I when I an I increased I hormone I level I further I increases I the
Isynthesis Iand Isecretion I of Ithat I same I hormone. I The Isensitivity I or I affinity I of Ithe I target
Icell Ito Ia Iparticular Ihormone Iis Irelated Ito Ithe Iconcentration Iof Ireceptors Iper Icell: Ithe
Imore Ireceptors, Ithe Ihigher Ithe Iaffinity Ior Ithe Imore Isensitive Ithe Icell Iis Ito Ithe Istimulating
Ieffects I of Ithe I hormone. I Thus Ithe I cell I can I adjust I its I sensitivity I to I the Iconcentration I of
Ithe I signaling I hormone. I hormone I is I distributed I throughout I the I body, I only I target I cells
Iwith Ispecific Ireceptors Ifor Ithat Ihormone Iare Iaffected. ITarget Icell Iresponse Idepends Ion
Iblood Ilevels Iof Ithe Ihormone, Ithe Iconcentration Iof Itarget Icell Ireceptors, Iand Iaffinity Iof
Ithe Ireceptor Ifor Ithe Ihormone. IHormone Ireceptors Iof Ithe Itarget Icell Ihave Itwo Imain
Ifunctions: I(1) Ito Irecognize I and I bind Iwith I high I affinity Ito Itheir Iparticular I hormones I and
I(2) Ito Iinitiate Ia Isignal Ito Iappropriate Iintracellular Ieffectors. ISee IChapter I1 Ifor Icell
Isignaling Ipathways, Iparticularly
Cushing’s ISyndrome IHyperfunction. IExcess Iendogenous Isecretion Iof IACTH I(corticotropin).
IOversecretion Iof Iadrenocorticotropic Ihormone I(ACTH) Ior Ialdosterone. IExcess IACTH Istimulates
Iexcess Iproduction Iof Icortisol. ITwo Iobservations Iapply Ito Iindividuals Iwith ICushing’s ISyndrome I1.
IThey Idon’t Ihave Idiurnal Ior Icircadian Isecretion Ipatterns Iof IACTH Iand Icortisol. I2. IThey Idon’t
Reproductive:
endometrial Icycle Iand Ithe Ioccurrence Iof Iovulation IOvulation Iis Ithe Irelease Iof Ian Iovum Ifrom Ia
Imature Ifollicle Iand Imarks Ithe Ibeginning Iof Ithe Iluteal/secretory Iphase Iof Ithe
menstrual Icycle. IHCG Ican Ibe Idetected Iin Imaternal Iblood Iand Iurine I8 Ito I10 Idays Iafter Iovulation.
IOvulatory Icycles Iappear Ito Ihave Ia Iminimum Ilength Iof I24 Ito I26.5 Idays. IOnce Iovulation Ioccurs
Iand Iserum Iprogesterone Ilevels Iincrease, Ithe Iendometrial Itissue Idevelops Isecretory Icharacteristics
I(secretory Iphase). IIf Iimplantation Iof Ia Ifertilized Iovum Idoes Inot Itake Iplace, Iendometrial Itissue
Ibegins Ito Ibreak Idown Iapproximately I11 Idays Iafter Iovulation I(ischemic Iphase Iof Imenstruation)
IDetermines Iwhether Iovulation Ihas Ioccurred Iby Iobtaining Iendometrial Itissue Ion Iday I26 Iof I28-day
Imenstrual Icycle I(or Ipostovulatory Iday I12). INormal Imenstrual Icycle I27-30 Idays. IOvulatory
Iphase:Iestrogen Ilevels Idip; Iprogesterone Ilevels Ibegin Ito Irise, ICorpus Iluteum Ibegins Ito Idevelop;
Iendometrium Ienters Isecretory Iphase. IShift Iin Itemperature Iis Irelated Ito Iovulation.
uterine Iprolapse Iis Idescent Iof Ithe Icervix Ior Ientire Iuterus Iinto Ithe Ivaginal Icanal. ILoss Iof Isupport
Iby Ipelvic Imuscles. IUterine Iprolapse Idescent Ior Iherniation Iof Ithe Iuterus Iinto Ior Ibeyond Ithe Ivagina
Ibecause Iof Iweakness Iof Ithe Ipelvic Imusculature, Iligaments, Iand Ifascia Ior Iobstetric Itrauma Iand
Ilacerations Isustained Iduring Ilabor Iand Idelivery.
polycystic Iovarian Isyndrome I(PCOS) IStrong Igenetic Ifactor I-A Ihyperandrogenic Istate Iis Ia
Icardinal Ifeature Iin Ithe Ipathogenesis Iof IPCOS. IGlucose Iintolerance/insulin Iresistance I(IR) Iand
Ihyperinsulinemia Ioften Irun Iparallel Ito Iand Imarkedly Iaggravate Ithe Ihyperandrogenic Istate. ISigns
Iand Isymptoms Iof Iwomen Iwith IPCOS Imay Ichange Iover Itime, Iwith Imetabolic Isyndrome Ibecoming
Imore Iprominent Iwith Iage. IIn Iaddition, Ipolycystic Iovaries Imay Ibe Iassociated Iwith ICushing
Isyndrome, Iacromegaly, Ipremature Iovarian Ifailure, Isimple Iobesity, Icongenital Iadrenal Ihyperplasia,
Ithyroid Idisease, Iandrogen-producing Iadrenal Itumors Ior Iovarian Itumors. IAnovulation Iresults Ifrom
Imetabolic Iabnormalities Icontributing Ito Iobesity Iinclude ICushing Isyndrome, ICushing Idisease,
Ipolycystic Iovary Isyndrome.
testicular Icancer Iand Iconditions Ithat Iincrease Irisk: IPainless Itesticular Ienlargement Iis Ithe Ifirst
Isign Iof Itesticular Icancer. ISigns Iof Itesticular Icancer Iinclude Iabnormal Iconsistency, Iinduration,
Inodularity, Ior Iirregularity Iof Ithe Itestis I A Ifirm, Inontender Itesticular Imass Ior Idiffuse Ienlargement Iis
Ifound Iin Ithe Imajority Iof Icases. IRisk Ifactor Ifor Imen Iwith Iundescended Itesticles, Ia Ifactor Iin Isome
Istudies Icorrelated Iwith IDES Iexposure. IThe Irisk Iof Itesticular Icancer Iis I35 Ito I50 Itimes Igreater Ifor
Imen Iwith Icryptorchidism. IIn Imen Ibetween Ithe Iages Iof I15-35 Iy/o. IGerm Icell Itumors Iconstitute
I90% Iof Itesticular Icancer. IRisk Ifactors Iinclude Ihistory Iof Icryptorchidism, Iabnormal Itesticular
Idevelopment, IHIV, Iand IAIDS, IKlinefelter Isyndrome, Iand Ihx Iof Itesticular Icancer. IScrotal Iincisions
Imay Iincrease Irisk Ior Irecurrence. ISome Iaffected Imen Ihave Ipersistent Iparesthesia, IRaynaud
Iphenomenon, Ior Iinfertility. ICryptorchidism I(one Iof Ithe Itestes Ifails Ito Idescend Iinto Ithe Iscrotum)
Isignificantly Iincreases Ithe Irisk Iof Itesticular Icancer
symptoms Ithat Irequire Ievaluation Ifor Ibreast Icancer Iwoman Iwho Icarries Ia Imutation Iin Ithe
IBRCA1 Ior IBRCA2 Igenes. IFirst Isign Iof Ibreast Icancer Iis Ia Ipainless Ilump. IOther Ipresenting Isigns
Iinclude Ipalpable Inodes Iin Ithe Iaxilla, Iretraction Iof Itissue I(dimpling) I(Fig. I25.49), Ior Ibone Ipain
Icaused Iby Imetastasis Ito Ithe Ivertebrae. IBenign Ibreast Idisease I(BBD) Imost Icommon Isymptoms
Ireported Iare Ipain, Ipalpable Imass, Inipple Idischarge. IStrong Ilink Ibetween Istress Iand Ibreast Icancer
,progression. Ishift-work Iand Iits Idisruptive Ieffects Ion Icircadian Irhythms Iand Isleep Ideprivation Iat
Inight Ihave Ibeen Isuggested Ias Ia Irisk Ifactor Ifor Ibreast Icancer.
Clinical Imanifestation Iof Ibreast ICa:
Chest Ipain nipple Idischarge
I Dilated Iblood Ivessel nipple Iretraction
I Dimpling Iof Iskin pitting Iof Ithe Iskin
Edema reddened Iskin, Ilocal Itenderness, Iwarmth
Hemorrhage
I skin Iretraction
Local Ipain ulceration
Nipple/areolar Ieczema
I
signs Iof Ipremenstrual Idysphoric Idisorder ICyclic Irecurrence I(in Ithe Iluteal Iphase Iof Ithe
Imenstrual Icycle) Iof Idistressing Iphysical, Ipsychologic, Ior Ibehavioral Ichanges Ithat Iimpair
Iinterpersonal Irelationships Ior Iinterfere Iwith Iusual Iactivities Iand Iresolve Iafter
Imenstruation.IIt Iis Ilinked Ito Ihormonal Ichanges Iemotional Isymptoms Iof Idepression, Ianger,
Iirritability, Iaggression, Ifatigue, Iand Iimpulse Icontrol. IPhysical Isymptoms Is/s Ibreast
Itenderness, Iabdominal Ibloating, Iheadache, Iand Iswelling Iof Iextremities, Iwater Iretention,
Ibloating, Iweight Igain.
Box I25.5
D i a g n o s t i c I C r i t e r i a I for I P r e m e n s t r u a l I D y sp h o r i c I D i s o rd e r
• A. I≥5 Isymptoms Ibelow: Ioccur Iin Imost Icycles Iduring Ithe Iweek Ibefore Imenses Ionset,
Iimprove Iwithin Ia Ifew Idays Iafter Imenses Ionset, Iand Idiminish Iin Ithe Iweek Ipostmenses
• B. IOne I(or Imore) Iof Ithe Ifollowing Isymptoms Imust Ibe Ipresent:
o a. IMarked Iaffective Ilability
o b. IMarked Iirritability Ior Ianger Ior Iincreased Iinterpersonal Iconflicts
o c. IMarked Ianxiety, Itension
• C. IOne I(or Imore) Iof Ithe Ifollowing Isymptoms Imust Ialso Ibe Ipresent:
o a. IDecreased Iinterest
o b. IDifficulty Iconcentrating
o c. IEasy Ifatigability, Ilow Ienergy
o d. IIncrease Ior Idecrease Iin Isleep
o e. I Feelings I of I being I overwhelmed
o f. IPhysical Isymptoms Isuch Ias Ibreast Itenderness, Imuscle Ior Ijoint Iaches,
I“ bloating” Ior Iweight Igain
NOTE: ICriteria IA–C Imust Ibe Ipresent Ifor Imost Imenstrual Icycles Iin Ithe Ipreceding Iyear
• D. ISymptoms Iare Iassociated Iwith Isignificant Idistress Ior Iinterferences Iwith Iwork, Ischool,
Ir elationships
• E. IThe Idisturbance Iis Inot Imerely Ian Iexacerbation Iof Ianother Idisorder Isuch Ias Imajor
Idepression, Ipanic Idisorder, Ipersistent Idepressive Idisorder, Ior Ia Ipersonality
Idisorder
• F. ICriterion IA Ishould Ibe Iconfirmed Iby Iprospective Idaily Iratings Iin Iat Ileast Itwo
Isymptomatic Icycles
• G. IThe Isymptoms Iare Inot Idue Ito Iphysiological Ieffects Iof Ia Isubstance Ior Ianother Imedical
Icondition
, dysfunctional Iuterine Ibleeding I(DUB) IHeavy Ior Iirregular Ibleeding Iin Ithe Iabsence Iof Iorganic
Idisease, Isuch Ias Isubmucous Ifibroids, Iendometrial Ipolyps, Iblood Idyscrasias, Ipregnancy, Iinfection,
Ior Isystemic Idisease. IIncreased Iendometrial Ibleeding Iis Icorrelated Iwith Ia Ichange Ifrom Iovulatory
Ito Ianovulatory Icycles Idue Ito Ihigh Iestrogen Ilevels. IHeavy I& Iunpredictable Iflow Ibleeding I(clot I&
Iflooding)
pathophysiology Iof Iprostate Icancer IMore Ithan I95% Iof Iprostatic Ineoplasms Iare Ihistologically
Isimilar Ito Iadenocarcinomas Iand Irely Ion Iandrogen-dependent Isignaling Ifor Itheir Idevelopment
IandIprogression.108-110 IMost Iof Ithese Ineoplasms Ioccur Iin Ithe Iperiphery Iof Ithe Iprostate.
Heterogenous Igroup Iof Itumors. ITesticular Itestosterone Iprovides Ithe Imain Isource Iof
I androgens Iin Ithe I prostate I and Iis Ithe I major Icirculating Iandrogen, Iwhereas IDHT
I predominates I in I prostate I tissue I and I binds I to I the I AR I (androgen I receptors) I with I greater
Iaffinity Ithan Idoes IT I(hormone Itestosterone). IAndrogen Iproduction Ioutside Iof Ithe Itestes, Ior
Iextra I testicular I sources. ITestosterone I is I converted I to I dihydrotestosterone. I DHT I is I the I most
Ipotent Iintraprostatic Iandrogen
HPV Iand Ithe Idevelopment Iof Icervical Icancer IVirtually Iall Icervical Icancer Iis Icaused Iby
Iinfection I with Ispecific Itypes I of I HPV, Iwhich Iinfects Ibasal I skin I cells Iand I commonly I causes
warts. IHPV-16, I-18, I-31, Iand I-45) Iare Iassociated Iwith Ithe Ihighest Irisk Ifor Ideveloping
I
Icervical. I viral I DNA Ibecomes Iintegrated I into Ithe I genomic I DNA I of Ithe I infected I basal I cell
Iof Ithe Icervix I and Idirects Ithe Ipersistent I production Iof I viral I oncogenes. IHPV Iis Imainly
Itransmitted Ithrough Isexual Icontact. IPersistence Iof Iinfection Iwith Ihigh-risk IHPV Iis Ia
Iprerequisite Ifor Ithe Idevelopment Iof Icervical Iintraepithelial Ineoplasia I(CIN) I(see IFig.
25.19), I lesions, I and I invasive I cervical I cancers
Endocrine:
body’s Iprocess Ifor Iadapting Ito Ihigh Ihormone Ilevels IHormones Ioperate Iwithin Ifeedback
systems, Ieither Ipositive Ior Inegative, Ito Imaintain Ian Ioptimal Iinternal Ienvironment.
I
Feedback Isystems Iprovide Iprecise Imonitoring Iand Icontrol I of Ithe Icellular Ienvironment.
IBoth I negative I and I positive I feedback I systems I are I important I for I maintaining I hormone
Ilevels I within I physiologic I ranges. I Negative I feedback I is I the I most I common I and I occurs
Iwhen I a I changing I chemical, I neural, I or I endocrine I response I decreases I the I subsequent
Isynthesis I and I secretion I of I a I hormone. I Positive I feedback I occurs I when I a I neural,
Ichemical, I or I endocrine I response I increases I the I synthesis I and I secretion I of I a I hormone.
IPositive I feedback I also I occurs I when I an I increased I hormone I level I further I increases I the
Isynthesis Iand Isecretion I of Ithat I same I hormone. I The Isensitivity I or I affinity I of Ithe I target
Icell Ito Ia Iparticular Ihormone Iis Irelated Ito Ithe Iconcentration Iof Ireceptors Iper Icell: Ithe
Imore Ireceptors, Ithe Ihigher Ithe Iaffinity Ior Ithe Imore Isensitive Ithe Icell Iis Ito Ithe Istimulating
Ieffects I of Ithe I hormone. I Thus Ithe I cell I can I adjust I its I sensitivity I to I the Iconcentration I of
Ithe I signaling I hormone. I hormone I is I distributed I throughout I the I body, I only I target I cells
Iwith Ispecific Ireceptors Ifor Ithat Ihormone Iare Iaffected. ITarget Icell Iresponse Idepends Ion
Iblood Ilevels Iof Ithe Ihormone, Ithe Iconcentration Iof Itarget Icell Ireceptors, Iand Iaffinity Iof
Ithe Ireceptor Ifor Ithe Ihormone. IHormone Ireceptors Iof Ithe Itarget Icell Ihave Itwo Imain
Ifunctions: I(1) Ito Irecognize I and I bind Iwith I high I affinity Ito Itheir Iparticular I hormones I and
I(2) Ito Iinitiate Ia Isignal Ito Iappropriate Iintracellular Ieffectors. ISee IChapter I1 Ifor Icell
Isignaling Ipathways, Iparticularly
Cushing’s ISyndrome IHyperfunction. IExcess Iendogenous Isecretion Iof IACTH I(corticotropin).
IOversecretion Iof Iadrenocorticotropic Ihormone I(ACTH) Ior Ialdosterone. IExcess IACTH Istimulates
Iexcess Iproduction Iof Icortisol. ITwo Iobservations Iapply Ito Iindividuals Iwith ICushing’s ISyndrome I1.
IThey Idon’t Ihave Idiurnal Ior Icircadian Isecretion Ipatterns Iof IACTH Iand Icortisol. I2. IThey Idon’t
