USMLE Step 1 Web Prep Male Reproductive System

153075 >>> 0:00:00

SLIDE 1 of 8

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# -su!units- the same$ They differ in -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- 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

153080 >>> 0:08:04

SLIDE & of 8

%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, "ote( +oth $S% a)d Leydi- cell testostero)e are re.uired for )ormal spermato-e)esis

Leydig cells has receptors for LH. testosterone form Leydig cell- into the general circ lation and some goes to the !ertoli cell "spermatogenesis# testosterone- 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)- protei) - $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 ,!H% ,!H acti'ated these receptors% it-s also re+ ired for

spermatogenesis. !o $oth testostero)e from Leydig and $S% from anterior pit itary are re+ ired for spermato-e)esis. Sertoli secret inhi$in - negati'e feed$ac. for ,!H% and has aromatase acti'ity% they can con'ert androgen to the estrogen. /ndrogen ---- estrogen "aromatase# in the !ertoli 0ales do synthesi&e estrogen 1 one so rce 1 !ertoli. 2n !ertoli cell t mor- aromatase acti'ity increases- high circ lating estrogen 3ther male tiss e- adipose tissue has aromatase acti'ity- secrete estrogen 2n many o+ese male- higher than normal le'el of estro-e)
153085 >>> 0:13:34

SLIDE 0 of 8

#a+le I1/10/1 se2 steroids 1.5rimary hypogonadism "no secretion of hormone# 6.5it itary hypogonadism "secondary#- no LH% no ,!H 3.5ostmenopa sal *omen "o'aries has no follicle# 4. 7/na$olic steroid therapy "male# -methotestoterone 5. 772nhi$in inf sion "male#!ertoli cell 4. 7778n9H inf sion "constant rate# 7. 8n9H inf sion "p lsatile# "estrogen# "testosterone# -"no change# L% "no negati'e feed$ac.# "no stim l s for Leydig# -"no change# $S% " #

4. decrease LH- remo'e stim l s for Leydig cell- Leydig cell atrophy- no local prod ction of testosterone "re+ ired for spermatogenesis# - decrease in spermatogenesis. :estosterone normally not feed$ac. for ,!H. ; t if the testosterone is 'ery high% it *ill s ppress ,!H% not as m ch as LH 5. inhi$in- possi$le male contracepti'e- not nomal feed$ac. for LH% $ t s ppress ,!H. $eca se $oth local testosterone and ,!H are re+ ired- spermatogeneissi also inhi$ited 4. 8n9H- constant- initial increase plasma LH and ,!H "receptor still present#% *ith time 1 do*nreg lation *ith receptors and LH and ,!H le'el decreased" $eca se 8n9h is constant#. 7. 8n9H -p lsatile- pre'ents do*nreg lation- chronically high le'el of $oth LH and ,!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- circ lating le'el of hormone =-a=is- life "from fetal to aging ad lt# fetal de'elopment: plasma testosterone- almost as high as in ad lt male- re+ ired for normal male de'elopment

after deli'ery: plasma testosterone decline dramatically along *ith LH $efore p $erty p $erty: first increase is in LH- restim late Leydig- testosterone. 9ise in LH precede rise in testosterone. /d lt- LH dri'e high testosterone /ging ad lt: Leydig cell decrease secretion of testosterone "significantly#% eliminate negati'e feed$ac.% and LH increase 1 not important for step

1530<5 >>> 0:63:06

SLIDE * of 8

$etal life >e'elopment of male and female str ct res depend on the fetal hormo)al en'ironment "not genetics# 2f there is no hormonal inp t "normal female fet s#- female internal and female e=ternal str ct res de'elop "regardless of genetic ma.e p# 3'ary not secrete hormone ?ormal male de'elopment re+ ires the presence of 3 hormones: 1. h@8 A LH Leydig cells testosterone 4olffia) d cts differentiate into the ma)ority of male i)ter)al str ct res *$ :estosterone A * reductase Dihydrotestostero)e differentiation of the e2ter)al str ct res and the prostate gland 3. !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- *ollfian d cts- regress "as in female# B-s: male fet s 1 no 5-a-red ctase- cannot synthesi&e dihydrotestosterone- no hormonal inp t- female e=ternal str ct res. /nd male internal str ct re- if has testosterone. !o phenotype- is female% gro* ndisco'ered ntil p $erty% *hen testosterone rise. Mulleria) d cts de'elop to female i)ter)al str ct re Bs- ad lt male- car accident- C9- laceration- s rgery- in a$domen- ter s- presence of ter s- d ring de'elopment- not secrete 02H- he has in addition to male secretion has female internal str ct re- li'e entire normal life span.
153100 >>> 0:31:08

SLIDE 5 of 8

see a$o'e
153105 >>> 0:33:66

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. androgens dri'es gro*th hormone% *hich dri'es 28,-

28,-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. :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- 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- 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

,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- arteriole in the penis "a parasympathetic response# 1only e=ception- 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#