Color Atlas of Physiology 2003 thieme

Hormonal Control of the Menstrual

Cycle

(!A2). In the mid-follicular phase, estrogens

restrict FSH and LH secretion (via negative feedback control and with the aid of inhibin; !A2) but later stimulate LH receptor production in granulosa cells. These cells now also start to produce progesterone (start of luteinization), which is absorbed by the theca cells (!A3) and used as precursor for further increase in androgen synthesis (!p. 295 A, steps f and l).

Inhibin and estrogens secreted by the dominant follicle increasingly inhibit FSH secretion, thereby decreasing the estrogen production in other follicles. This leads to an androgen build-up in and apoptosis of the unselected follicles.

Increasing quantities of LH and FSH are released in the late follicular phase (!A3), causing a sharp rise in their plasma concentrations. The FSH peak occurring around day 13 of the cycle induces the first meiotic division of the ovum. Estrogens increase the LH secretion (mainly via the hypothalamus), resulting in the increased production of androgens and estrogens (positive feedback) and a rapid rise in the LH conc. (LH surge). The LH peak occurs around day 14 (! A2). The follicle ruptures and discharges its ovum about 10 hours later (ovulation). Ovulation does not take place if the LH surge does not occur or is too slow. Pregnancy is not possible in the absence of ovulation.

Luteal phase (!A4). LH, FSH and estrogens transform the ovarian follicle into a corpus luteum. It actively secretes large quantities of progesterone (progestational hormone), marking the beginning of the luteal phase (!A). Estrogens and progesterone now inhibit the secretion of FSH and LH directly and indirectly (e.g., through inhibition of Gn-RH; see above), causing a rapid drop in their plasma conc. This negative feedback leads to a marked drop in the plasma conc. of estrogens and progesterone towards the end of the menstrual cycle (approx. day 26), thereby triggering the menses (!p. 299, A2). FSH secretion starts to rise just before the start of menstruation (!A4).

Combined administration of estrogens and gestagens during the first half of the menstrual cycle prevents ovulation. Since ovulation does not occur, pregnancy cannot take place. Most contraceptives work according to this principle.

11 Hormones and Reproduction

302

cholesterol via pregnenolone (!p. 295). It is produced in the corpus luteum, ovarian follicles and placenta (!p. 304) of the female, and in the adrenal cortex of males and females. Like cortisol, most circulating progesterone is bound to cortisol-binding globulin (CBG = transcortin). Like estradiol (E2), most progesterone is broken down during its first pass through the liver, so oral doses of progesterone are almost completely ineffective. Pregnanediol is the most important degradation product of progesterone.

Actions of progesterone. The main functions of progesterone are to prepare the female genital tract for implantation and maturation of the fertilized ovum and to sustain pregnancy (!see table). Progesterone counteracts many of the effects induced by estrogens, but various effects of progesterone depend on the preparatory activity or simultaneous action of estrogens. During the follicular phase, for example, estrogens increases the density of progesterone receptors, while simultaneous estrogen activity is needed to induce mammary growth (see below).

The uterus is the chief target organ of progesterone. Once estrogen induces endometrial thickening, progesterone stimulates growth of the uterine muscle (myometrium), restructures the endometrial glands (! p. 298), alters the blood supply to the endometrium, and changes the glycogen content. This represents the transformation from a proliferative endometrium to a secretory endometrium, with a peak occurring around day 22 of the cycle. Progesterone later plays an important role in the potential implantation (nidation) of the fertilized ovum because it reduces myometrial activity (important during pregnancy), narrows the cervical os, and changes the consistency of the cervical mucous plug so that it becomes virtually impregnable to sperm.

Progesterone inhibits the release of LH during the luteal phase. The administration of gestagens like progesterone during the follicular phase inhibits ovulation. Together with its effects on the cervix (see above) and its inhibitory effect on capacitation (!p. 302), progesterone can therefore have a contraceptive effect (“mini pill”).

High levels of progesterone have an anesthetic effect on the central nervous system. Progesterone also increases the susceptibility

to epileptic fits and exerts thermogenic action, i.e., it raises the basal body temperature (!p. 298). In addition, a decrease in the progesterone concentration is also believed to be responsible for the mood changes and depression observed before menstruation (premenstrual syndrome, PMS) and after pregnancy (postpartum depression).

In the kidneys, progesterone slightly inhibits the effects aldosterone, thereby inducing increased NaCl excretion.

Prolactin and Oxytocin

The secretion of prolactin (PRL) is inhibited by prolactin-inhibiting hormone (PIH = dopamine) and stimulated by thyroliberin (TRH) (!p. 270). Prolactin increases the hypothalamic secretion of PIH in both men and women (negative feedback control). Conversely, estradiol (E2) and progesterone inhibit PIH secretion (indirectly via transmitters, as observed with Gn-RH; see above). Consequently, prolactin secretion rises significantly during the second half of the menstrual cycle and during pregnancy. Prolactin (together with estrogens, progesterone, glucocorticoids and insulin) stimulate breast enlargement during pregnancy and lactogenesis after parturition. In breast-feeding, stimulation of the nerve endings in the nipples by the suckling infant stimulates the secretion of prolactin (lactation reflex). This also increases release of oxytocin which triggers milk ejection and increases uterine contractions, thereby increasing lochia discharge after birth. When the mother stops breast-feeding, the prolactin levels drop, leading to the rapid stoppage of milk production.

Hyperprolactinemia. Stress and certain drugs inhibit the secretion of PIH, causing an increase in prolactin secretion. Hypothyroidism (!p. 288) can also lead to hyperprolactinemia, because the associated increase in TRH stimulates the release of prolactin. Hyperprolactinemia inhibits ovulation and leads to galactorrhea, i.e., the secretion of milk irrespective of pregnancy. Some women utilize the anti-ovulatory effect of nursing as a natural method of birth control, which is often but not always effective.

Estrogens

303

Hormonal Control of Pregnancy and

Birth

In contrast to other endocrine organs, the placenta has to receive the appropriate precursors (cholesterol or androgens, !p. 294) from the maternal and fetal adrenal cortex, respectively, before it can synthesize progesterone and estrogen (!A2). The fetal adrenal cortex (FAC) is sometimes larger than the kidneys and consists of a fetal zone and an adult zone. The

304placenta takes up cholesterol and pregnenolone and uses them to synthesize pro-

gesterone. It is transported to the fetal zone of

the FAC, where it is converted to dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S). DHEA and DHEA-S pass to the placenta, where they are used for estrogen synthesis. Progesterone is converted to testosterone in the testes of the male fetus.

Human placental lactogen (hPL = human chorionic somatomammotropin, HCS) levels rise steadily during pregnancy. Like prolactin (!p. 303), hPL stimulates mammary enlargement and lactogenesis in particular and, like GH (!p. 280), stimulates physical growth and development in general. hPL also seems to increase maternal plasma glucose conc.

Corticotropin-releasing hormone (CRH) secreted by the placenta seems to play a key role in the hormonal regulation of birth. The plasma levels of maternal CRH increase exponentially from the 12th week of gestation on. This rise is more rapid in premature births and slower in post-term births. In other words, the rate at which the CRH concentration rises seems to determine the duration of the pregnancy. Placental CRH stimulates the release of ACTH by the fetal pituitary, resulting in increased cortisol production in the adult zone of FAC; this again stimulates the release of CRH (positive feedback). CRH also stimulates lung development and the production of DHEA and DHEA-S in the fetal zone of FAC.

The maternal estrogen conc. rises sharply towards the end of the pregnancy, thereby counteracting the actions of progesterone, including its pregnancy-sustaining effect. Estrogens induce oxytocin receptors (!p. 303), α1- adrenoceptors (!p. 84ff.), and gap junctions in the uterine musculature (!p. 16ff.), and uterine cells are depolarized. All these effects increase the responsiveness of the uterine musculature. The simultaneous increase in progesterone synthesis triggers the production of collagenases that soften the taut cervix. Stretch receptors in the uterus respond to the increase in size and movement of the fetus. Nerve fibers relay these signals to the hypothalamus, which responds by secreting larger quantities of oxytocin which, in turn, increases uterine contractions (positive feedback). The gap junctions conduct the spontaneous impulses from individual pacemaker cells in the fundus across the entire myometrium at a rate of approximately 2 cm/s (!p. 70).

A.Hormone synthesis in placenta, mother and fetus: fetoplacental unit

1Early pregnancy:

Proteohormone synthesis in placenta 2 Later pregnancy:

Steroid hormone synthesis in placenta

Steroid hormones:

P = progesterone; DHEA(-S) = dehydroepiandrosterone (sulfate); E = estrogens

Plate 11.19 Hormonal Control of Pregnancy and Birth

Androgens and Testicular Function

the functions of the genitalia, prostate and seminal vesicle (see below), testosterone also induces the secondary sex characteristics that occur in males around the time of puberty, i.e., body hair distribution, physique, laryngeal size (voice change), acne, etc. In addition, testosterone is necessary for normal sex drive (libido), procreative capacity (fertility) and coital capacity (potentia coeundi) in the male. Testosterone also stimulates hematopoiesis and has anabolic properties, leading to increased muscle mass in males. It also has central nervous effects and can influence behavior— e.g., cause aggressiveness.

Sexual development and differentiation. The genetic sex (!B) determines the development of the sex-specific gonads (gamete-producing glands). The germ cells (spermatogonia; see below) then migrate into the gonads. The somatic sex is female when the subsequent somatic sex development and sex differentiation occurs in the absence of testosterone (!C). Male development requires the presence of testosterone in both steps (!C) with or without the aid of additional factors (e.g., calcitonin gene-related peptide, CGRP?) in certain stages of development (e.g., descent of testes into scrotum). High conc. of testosterone, either natural or synthetic (anabolic steroids), lead to masculinization (virilization) of the female (!C).

Testicular function. Spermatogenesis occurs in several stages in the testes (target organ of testosterone) and produces sperm (spermatozoa) (! A3). Sperm are produced in the seminiferous tubules (total length, ca. 300 m), the epithelium of which consists of germ cells and Sertoli cells that support and nourish the spermatogenic cells. The seminiferous tubules are strictly separated from other testicular tissues by a blood–testis barrier. The testosterone required for sperm maturation and semen production (!p. 308) must be bound to andro- gen-binding protein (ABP) to cross the barrier.

Spermatogonia (!B) are primitive sex cells. At puberty, a spermatogonium divides mitotically to form two daughter cells. One of these is kept as a lifetime stem cell reservoir (in contrast to oogonia in the female; !p. 298). The other undergoes several divisions to form a primary spermatocyte. It undergoes a first meiotic division (MD1) to produce two secondary spermatocytes, each of which undergoes a second meiotic division (MD2), producing a total of four spermatids, which ultimately differentiate into spermatozoa. After MD1, the spermatocytes have a single (haploid) set of chromosomes.

A.Control and transport of androgenic hormones; effects of testosterone on the testes

Seminiferous

tubule

Plate 11.20 Androgens and Testicular Function

307

11 Hormones and Reproduction

308

Sexual Response, Intercourse and

Fertilization

Sexual response in the male (!A1). Impulses from tactile receptors on the skin in the genital region (especially the glans penis) and other parts of the body (erogenous areas) are transmitted to the erection center in the sacral spinal cord (S2–S4), which conducts them to parasympathetic neurons of the pelvic splanchnic nerves, thereby triggering sexual arousal. Sexual arousal is decisively influenced by stimulatory or inhibitory impulses from the brain triggered by sensual perceptions, imagination and other factors. Via nitric oxide (! p. 278), efferent impulses lead to dilatation of deep penile artery branches (helicine arteries) in the erectile body (corpus cavernosum), while the veins are compressed to restrict the drainage of blood. The resulting high pressure (!1000 mmHg) in the erectile body causes the penis to stiffen and rise (erection). The ejaculatory center in the spinal cord (L2 –L3) is activated when arousal reaches a certain threshold (!A2). Immediately prior to ejaculation, efferent sympathetic impulses trigger the partial evacuation of the prostate gland and the emission of semen from the vas deferens to the posterior part of the urethra. This triggers the ejaculation reflex and is accompanied by orgasm, the apex of sexual excitement. The effects of orgasm can be felt throughout the entire body, which is reflected by perspiration and an increase in respiratory rate, heart rate, blood pressure, and skeletal muscle tone. During ejaculation, the internal sphincter muscle closes off the urinary bladder while the vas deferens, seminal vesicles and bulbocavernous and ischiocavernous muscles contract rhythmically to propel the semen out of the urethra.

Semen. The fluid expelled during ejaculation (2–6 mL) contains 35–200 million sperm in a nutrient fluid (seminal plasma) composed of various substances, such as prostaglandins (from the prostate) that stimulate uterine contraction. Once semen enters the vagina during intercourse, the alkaline seminal plasma increase the vaginal pH to increase sperm motility. At least one sperm cell must reach the ovum for fertilization to occur.

Sexual response in the female (!A2). Due to impulses similar to those in the male, the erectile tissues of the clitoris and vestibule of the vagina engorge with blood during the erection phase. Sexual arousal triggers the release of secretions from glands in the labia minora and transudates from the vaginal wall, both of which lubricate the vagina, and the nipples become erect. On continued stimulation, afferent impulses are transmitted to the lumbar spinal cord, where sympathetic impulses trigger orgasm (climax). The vaginal walls contract rhythmically (orgasmic cuff), the vagina lengthens and widens, and the uterus becomes erect, thereby creating a space for the semen. The cervical os also widens and remains open for about a half an hour after orgasm. Uterine contractions begin shortly after orgasm (and are probably induced locally by oxytocin). Although the accompanying physical reactions are similar to those in the male (see above), there is a wide range of variation in the orgasmic phase of the female. Erection and orgasm are not essential for conception.

Fertilization. The fusion of sperm and egg usually occurs in the ampulla of the fallopian tube. Only a small percentage of the sperm expelled during ejaculation (1000–10 000 out of 107 to 108 sperm) reach the fallopian tubes (sperm ascension). To do so, the sperm must penetrate the mucous plug sealing the cervix, which also acts as a sperm reservoir for a few days. In the time required for them to reach the ampullary portion of the fallopian tube (about 5 hours), the sperm must undergo certain changes to be able to fertilize an ovum; this is referred to as capacitation (!p. 302).

After ovulation (!p. 298ff.) the ovum enters the tube to the uterus (oviduct) via the abdominal cavity. When a sperm makes contact with the egg (via chemotaxis), species-specific sperm-binding receptors on the ovum are exposed and the proteolytic enzyme acrosin is thereby activated (acrosomal reaction). Acrosin allows the sperm to penetrate the cells surrounding the egg (corona radiata). The sperm bind to receptors on the envelope surrounding the ovum (zona pellucida) and enters the egg. The membranes of both cells then fuse. The ovum now undergoes a second meiotic division, which concludes the act of fertilization. Rapid proteolytic changes in the receptors on the ovum (zona pellucida reaction) prevent other sperm from entering the egg. Fertilization usually takes place on the first day after intercourse and is only possible within 24 hours after ovulation.