Updated: 12/15/2018

Female Hormones

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Overview
 

Introduction
  • Female hormones
    • in follicular phase of menstrual cycle, follicle synthesizes estrogens
      • major product is 17β-estradiol
    • in luteal phase of menstrual cycle, corpus luteum synthesizes progesterone and estrogen
      • major product is progesterone
Estrogen
 

estrogen production

  • Sources of estrogens
    • ovary (17β-estradiol)
    • placenta (estriol)
    • blood (aromatization)
  • Estrogens biosynthesis
    • two-cell, two-gonadotropin model
      • 17β-estradiol synthesis requires granulosa cells and theca cells
        • theca cells do not express aromatase
          • aromatase catalyzes conversion of androstenedione to 17β-estradiol
      • biosynthetic pathway
        • LH acts on theca cells
          • increases activity of cholesterol desmolase
            • increases synthesis/secretion of androstenedione
            • androstenedione freely diffuses from theca cells to granulosa cells
        •  FSH acts on granulosa cells
          • increases activity of aromatase
            • increases synthesis/secretion of 17β-estradiol
  • Estrogens potency
    • 17β-estradiol > estrone > estriol
  • Estrogen receptor
    • estrogen receptor (ER) functions as a homodimer and resides in cell cytoplasm
    • estrogen-ER complex translocates to cell nucleus, interacts with steroid response elements on chromatin, and rapidly induces transcription of target genes
  • Function of estrogens
    • at puberty, functions in development of female sex characteristics
      • genitalia, breasts, and female fat distribution
    • functions in proliferation and development of ovarian granulosa cells of follicles
    • functions in maturation and maintenance of uterus
      • proliferates endometrium of uterus
      • lowers uterine threshold to contractile stimuli
        • increases myometrial excitability
    • upregulates estrogen, progesterone, and LH receptors
    • negatively feeds back on anterior pituitary in follicular phase of menstrual cycle 
      • ↓ FSH and ↓ LH
    • positively feeds back on anterior pituitary at midcycle in response to LH surge
      • ↑ FSH and ↑ LH
    • stimulates prolactin secretion
      • blocks action of prolactin on breasts
    • upregulates transport proteins
      • in blood plasma, estrogens are mostly bound to carrier proteins
        • e.g., albumin and sex hormone-binding globulin (SHBG)
    • upregulates HDL cholesterol and downregulates LDL cholesterol
  • Notes
    • pregnancy
      • 50-fold ↑ in 17β-estradiol and estrone
      • 1,000-fold ↑ in estriol
        • increase in estriol levels is an indicator of well-being of fetus
Progesterone
  • Sources of progesterone
    • corpus luteum, placenta, adrenal cortex, and testes
  • Function of progesterone
    • stimulates endometrial glandular secretions
    • stimulates development of spiral arteries
    • maintains pregnancy
    • raises uterine threshold to contractile stimuli during pregnancy
      • decreases myometrial excitability
    • relaxes uterine smooth muscle
      • prevents contractions
    • produces thick cervical mucus that inhibits sperm entry into uterus
    • increases basal body temperature
      • increases hypothalamic temperature set-point
    • negatively feeds back on anterior pituitary in luteal phase of menstrual cycle
      • ↓ FSH and ↓ LH
    • downregulates estrogen receptors
  • Notes
    • increase in biosynthesis of progesterone is characteristic of mid cycle or ovulation
    • "PROGESTerone is PRO-GESTation"
Estrogen and Progesterone in Pregnancy
  • Overview
    • estriol is major estrogen in pregnancy
  • Maternal-placental-fetal unit
    • elevated levels of estrogens and progesterone are necessary for maintaining pregnancy
    • corpus luteum is not adequate to generate very high hormone levels
    • placenta emerges as major source of estrogens and progesterone
    • placenta is an imperfect endocrine organ
      • placenta cannot synthesize sufficient cholesterol
        • cholesterol is a precursor for hormone synthesis
      • placenta lacks necessary enzymes for estrogen synthesis
    • maternal-placental-fetal unit overcomes shortcomings of placenta to very high hormones levels
  • Progesterone synthesis
    • mother provides cholesterol (LDL particles) to placenta
    • placenta converts cholesterol to pregnenolone then to progesterone
    • placenta provides high progesterone levels to mother
  • Estriol synthesis
    • mother provides cholesterol (LDL particles) to placenta
    • placenta converts cholesterol to pregnenolone to progesterone
    • placenta provides high progesterone levels to fetus
    • fetal adrenal cortex converts progesterone to DHEA-sulfate
    • fetal liver hydroxylates DHEA-sulfate to 16-OH DHEA-sulfate
    • fetus provides high levels of 16-OH DHEA-sulfate to placenta
    • placenta converts 16-OH DHEA-sulfate to estriol
    • placenta provides high estriol levels to mother
 

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Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M1.RP.3) A 19-year-old female complains of abnormal facial hair growth. This has been very stressful for her, especially in the setting of not being happy with her weight. Upon further questioning you learn she has a history of type 2 diabetes mellitus. Her height is 61 inches, and weight is 185 pounds (84 kg). Physical examination is notable for facial hair above her superior lip and velvety, greyish thickened hyperpigmented skin in the posterior neck. Patient is started on a hormonal oral contraceptive. Which of the following is a property of the endometrial protective hormone found in this oral contraceptive? Review Topic

QID: 100503
1

Increases thyroid binding globulin

15%

(5/34)

2

Thickens cervical mucus

47%

(16/34)

3

Enhances tubal motility

6%

(2/34)

4

Decreases LDL

9%

(3/34)

5

Decreases bone fractures

15%

(5/34)

M1

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