UNIT SIX  THE ENDOCRINE SYSTEM

21 Mechanisms of Hormonal Regulation

NAME THE HORMONES

Write the name of the gland and the major hormones it secretes beside each number.

2
1 3

(From Patton KT, Thibodeau GA: Anatomy & physiology, ed 8, St Louis, 2013, Mosby.)

1. Gland: _______________________________

One hormone: _______________________________________________________________________________________

2. Gland: _______________________________

Six hormones: _______________________________________________________________________________________

3. Gland: _______________________________

Seven hormones from anterior:_________________________________________________________________________

Two hormones from posterior: _________________________________________________________________________

4. Gland: _______________________________

Three hormones: _____________________________________________________________________________________

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Chapter 21 Mechanisms of Hormonal Regulation Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
 5. Gland: _______________________________

Three hormones from cortex: __________________________________________________________________________

Two hormones from medulla: __________________________________________________________________________

6. Gland: _______________________________

Four hormones: ______________________________________________________________________________________

7. Gland: _______________________________

One hormone: _______________________________________________________________________________________

MATCH THE FUNCTIONS

Match the altered function on the right with the hormone on the left.

A Significant Change in Secretion of This Hormone Alters the Regulation of This Variable
���� 8. Antidiuretic hormone (ADH) A. Plasma calcium concentration

���� 9. Parathyroid hormone (PTH) B. Blood glucose concentration

���� 10. Insulin C. Body fluid osmolality

���� 11. Gonadotropin-releasing hormone (GnRH) D. Extracellular fluid volume and plasma potassium
concentration
���� 12. Aldosterone
E. Menstrual cycle regulation

CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

13. The hypothalamus is connected to the posterior pituitary by (portal blood vessels, a nerve tract) and to the anterior
pituitary by (portal blood vessels, a nerve tract).

14. Water-soluble hormones generally have a (short, long) half-life and circulate in (bound, free) forms.

15. Low hormone concentrations usually cause cells to (down-regulate, up-regulate) receptors for that hormone, which
(increases, decreases) cellular sensitivity to that hormone.

16. Water-soluble hormones bind with (cell membrane, intracellular) receptors.

17. Hormone receptors are (proteins, steroids, either proteins or steroids).

18. (GH, ACTH) is an example of a somatotropic hormone.

19. (Water, Lipid)-soluble hormones alter gene expression when the hormone-receptor complex binds to the promoter
region of (RNA, DNA).

20. Secretion of cortisol increases when (ACTH, CRF) binds to receptors on cells in the adrenal (cortex, medulla).

21. Many of the actions of growth hormone are mediated through the effects of (insulin-like growth factors, incretins,
ghrelins), which also are known as (somatotropins, somatomedins, somatostatins).

22. Catecholamines are released from the adrenal (cortex, medulla).

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22 Alterations of Hormonal Regulation

CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

1. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by (high, low) levels of ADH in
the absence of normal control mechanisms.

2. An anterior pituitary adenoma usually causes (hyposecretion, hypersecretion) of hormones from the adenoma itself
and (hyposecretion, hypersecretion) of hormones from the surrounding pituitary cells.

3. Women who have gestational diabetes have (decreased, increased) risk for type 2 diabetes later in life.

4. An individual with type 1 diabetes who has the dawn phenomenon has a (lower, higher) blood glucose in the early
morning than in the middle of the night.

5. Cretinism is caused by untreated congenital (hypothyroidism, growth hormone deficiency).

6. In autoimmune diabetes, also called type (1A, 1B, 2) diabetes, pancreatic beta cells are destroyed by autoreactive
(cytotoxic T lymphocytes, natural killer cells).

7. Persons who have type 1 diabetes have a deficit of insulin and (glucagon, amylin) and a relative excess of (glucagon,
amylin).

8. In diabetes, microvascular disease refers to (accelerated atherosclerosis, destruction of capillaries), whereas macro-
vascular disease refers to (accelerated atherosclerosis, destruction of capillaries).

EXPLAIN THE PICTURE

Examine the picture and answer the questions about it.

9. The woman in this picture has _______________
disease.
Facial flush 10. What causes her round face and truncal obesity?

Moon face
Supraclavicular 11. This woman is worried that she has leukemia be-
fat pad cause she keeps bruising when she just bumps
Purple striae Hyperpigmentation herself a little. What does she need to know about
(in -dependent how her endocrine disorder causes this?
causes of cortisol
excess)
Pendulous
Trunk obesity 12. What hormone fits the blank line under the word
abdomen
“Hyperpigmentation”? _______________ How
does an excess of this hormone cause hyperpig-
Thin mentation?
extremities
Easy bruising

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DESCRIBE THE DIFFERENCE

Describe the difference between each pair of terms.

13. What is the difference between a primary and a secondary endocrine disorder?

14. What is the difference between thyrotoxicosis and thyrotoxic crisis?

15. What is the difference between neurogenic and nephrogenic diabetes insipidus?

16. What is the difference between acromegaly and gigantism?

MATCH THE CLINICAL MANIFESTATIONS

Match the clinical manifestation on the right with the disorder on the left.

���� 17. SIADH A. Hypertension, tachycardia, palpitations, severe headache, dia-

���� 18. Hypothyroidism
���� 19. Pheochromocytoma
���� 20. Adrenal adenoma causing hypersecre-
tion of androgens in a woman
���� 21. Diabetic ketoacidosis
���� 22. Hypoglycemia
���� 23. Primary hyperaldosteronism
���� 24. Type 1 diabetes mellitus
���� 25. Diabetes insipidus
���� 26. Addison disease
phoresis, heat intolerance, weight loss, constipation
B. Polydipsia, nocturia, polyuria, hypernatremia, increased plasma
osmolality, large volume of dilute urine
C. Polydipsia, nocturia, polyuria, increased appetite, weight loss,
hyperglycemia, glycosuria
D. Weakness, fatigue, hypotension, hyperkalemia, hypoglycemia,
elevated ACTH
E. Lethargy, cold intolerance, hoarseness, nonpitting boggy edema
around eyes, coarse hair, decreased body temperature
F. Lethargy, hyponatremia, perhaps seizure, decreased plasma
osmolality, concentrated urine
G. Tachycardia, diaphoresis, tremor, pallor, confusion, decreased
level of consciousness, perhaps seizure
H. Virilization: lack of breast development, hirsutism, increased
muscle bulk
I. Polyuria, decreased level of consciousness, Kussmaul breath-
ing, acetone smell to breath, hyperglycemia, decreased blood
pH, ketonuria, glycosuria
J. Hypertension, hypokalemia, increased blood pH, increased
urine potassium

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Chapter 22 Alterations of Hormonal Regulation Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
 UNIT SEVEN  THE REPRODUCTIVE SYSTEMS

Structure and Function of the

23 Reproductive Systems

MATCH THESE DEFINITIONS

Match the terms on the right with their definitions on the left.

���� 1. Maturation of the ovaries or testes A. Thelarche

���� 2. Onset of menstruation B. Gonadarche

���� 3. Onset of breast development C. Adrenarche

���� 4. Increased production of adrenal androgens before puberty D. Menarche

CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

5. Production of ova (occurs only during fetal life, begins at puberty); production of sperm (occurs only during fetal
life; begins at puberty).

6. Menopause is defined as cessation of menstrual flow for (3 months if not pregnant, 1 year).

7. The ability of the female perineum to stretch is most important during (sexual intercourse, childbirth).

8. A vaginal pH that is (low, high) protects against infection.

9. The most important estrogen is E2, also known as (estriol, estradiol).

10. Ovulation is triggered by a surge of (LH and FSH, ACTH) from the (posterior, anterior) pituitary, controlled by
(GnRH, CRF) from the hypothalamus.

11. Maintaining pregnancy is an important function of the hormone (estrogen, progesterone).

12. The characteristic hormone profile of menopause is (low, high) estrogen and progesterone levels, (low, high) FSH
and LH levels, and (low, high) secretion of inhibin.

ORDER THE STEPS

Sequence the events that occur during spermatogenesis.

1 3. Write the letters here in the correct order of the steps: _______________________________
A. Sperm cells migrate to the epididymis.
B. Spermatogonia divide by mitosis.
C. Spermatids attach to Sertoli cells and mature into sperm cells.
D. Primary and secondary spermatocytes divide by meiosis.
E. Sperm become motile when activated by biochemicals in semen.

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Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 23 Structure and Function of the Reproductive Systems
EXPLAIN THE PICTURES

Examine the pictures and answer the questions about them.

UNDIFFERENTIATED

Diaphragmatic
ligament

Paramesonephric
duct
(müllerian)
Mesonephric
tubule
Gonad

Mesonephric
duct
(wolffian)

Genital cord

Primordium of Urogenital sinus

prostate
or Skene ducts
*Primordium of
Cowper or Bartholin
glands

This picture shows embryonic reproductive structures that have not yet differentiated.

14. Expression of a gene on the _______________ chromosome creates testosterone-determining factor, which stimulates
the gonads to develop into _______________.

15. In the absence of a Y chromosome, expression of other genes causes the gonads to develop into _______________
and the regression of which of type of duct in the picture? _______________

16. What happens to the remaining ducts in the presence of estrogen and absence of appreciable amounts of
testosterone?

17. The primordium marked with an asterisk (*) in the picture will develop into Cowper glands in a _______________
and Bartholin glands in a _______________.

18. What analogous function do those glands serve in sexually mature adults?

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Chapter 23 Structure and Function of the Reproductive Systems Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
 Alterations of the Female Reproductive
24 System

MATCH THESE DEFINITIONS

Match the word on the right with its definition on the left.

���� 1. Development of the breasts in girls A. Hirsutism

���� 2. The process of sexual maturation B. Cystocele

���� 3. Menstrual cycles longer than 6 to 7 weeks C. Enterocele

���� 4. Abnormal hairiness D. Puberty

���� 5. Heavy or irregular bleeding in the absence of organic disease E. Thelarche

���� 6. Bulging of the rectum and posterior vaginal wall into the vaginal F. Leiomyoma
canal
G. Dysfunctional uterine bleeding
���� 7. Descent of a portion of the posterior bladder wall and trigone into
the vaginal canal H. Oligomenorrhea

���� 8. Herniation of the rectouterine pouch into the septum between the I. Rectocele
rectum and posterior vaginal wall

���� 9. Benign smooth muscle tumor in the uterine muscle

CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

10. Premenstrual syndrome and premenstrual dysphoric disorder occur during the (luteal, follicular) phase of the
menstrual cycle; the most prominent and distressing symptoms are (physical, emotional).

11. During the reproductive years, the (acid, alkaline) pH of the vagina protects against infection.

12. Vulvodynia is (chronic pain of, cyst formation in) the vulva; a Bartholin cyst occurs in the (duct, gland body) of the
Bartholin gland.

13. Risk factors for pelvic organ prolapse include (very low body weight, obesity), familial tendency, childbirth, and
(abdominal, pelvic) surgery or trauma.

14. Endometrial polyps are often related to (estrogen, progesterone) stimulation and are a common cause of (scanty,
excessive) menstrual bleeding.

15. HPV-associated carcinoma in situ is most likely to develop where the (squamous, columnar) epithelium of the
cervical lining meets the (squamous, columnar) epithelium of the outer cervix and vagina.

16. Most cervical cancers are (symptomatic; asymptomatic); the major symptom of invasive vaginal cancer is vaginal
(dryness, bleeding).

17. The major risk factor for endometrial cancer is prolonged exposure to (estrogen, progesterone) without the presence
of (estrogen, progesterone).
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 18. Ovulatory factors account for (4%, 40%) of female infertility; reproductive tract abnormalities account for
(4%, 40%) of female infertility.

19. Nonproliferative breast lesions generally (are, are not) associated with an increased risk for breast cancer; an
example of a nonproliferative breast lesion is (ductal hyperplasia, fibrocystic disease).

CATEGORIZE THESE DISORDERS

Write the type of disorder beside each example of sexual dysfunction. Possible choices include: disorder of desire, disorder
of orgasm, disorder of sexual pain.

�������������� 20. Anorgasmia

�������������� 21. Decreased libido

�������������� 22. Dyspareunia

�������������� 23. Hypoactive sexual desire

�������������� 24. Vaginismus

EXPLAIN THE PICTURES

Examine the pictures and answer the questions about them.

A Ductal carcinoma in situ B Advanced breast cancer

25. What is the difference between the disorders in Figure A and Figure B with regard to the basement membrane?

26. Will the DCIS in Figure A invariably progress to the cancer in Figure B? _______________

27. Which figure shows a lesion that might be detected clinically as a lump? _______________

28. Would that lump typically be painful or painless? _______________

29. The cancer in Figure B is most apt to metastasize to what location first? _______________

30. Is it likely that the cells in the cancer in Figure B are homogeneous? Explain your answer.

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Chapter 24 Alterations of the Female Reproductive System Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
 Alterations of the Male Reproductive
25 System

MATCH THESE DEFINITIONS

Match the term on the right with its definition on the left.
���� 1. Visible enlargement of breast tissue in a male A. Peyronie disease

���� 2. Foreskin of the penis B. Cryptorchidism

���� 3. Narrowing of the urethra due to scarring C. Balanitis

���� 4. Prolonged painful penile erection D. Orchitis

���� 5. Inflammation of the glans penis E. Spermatocele

��� 6. Fibrosis of the corpora cavernosa that causes penile curvature F. Posthitis
during erection
G. Varicocele
���� 7. Undescended testicle (or both testes)
H. Urethral stricture
���� 8. Inflammation of the testes
I. Prepuce
���� 9. Inflammation of the foreskin
J. Priapism
���� 10. Cyst in the epididymis
K. Gynecomastia
���� 11. Abnormally dilated vein within the spermatic cord

CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

12. Most breast cancers in men are (estrogen, androgen) positive.

13. Any factor that causes testicular temperature to (fall, rise) can impair sperm production.

14. Most penile cancer is (squamous cell carcinoma, adenocarcinoma), whereas most prostate cancer is (squamous cell
carcinoma, adenocarcinoma).

15. The most common cause of orchitis in postpubertal males is (gonorrhea, mumps).

16. Testicular torsion requires immediate treatment to prevent (ischemia and necrosis, epididymitis and sterility).

17. Benign prostatic hyperplasia (BPH) begins in the (inner layers, periphery) of the prostate; most prostate cancer begins
in the (inner layers, periphery) of the prostate.

18. In acute bacterial prostatitis, bacteria reach the prostate (through the blood, by ascending the urinary tract); the
clinical manifestations are similar to those of (pyelonephritis, prostate cancer).

19. Arterial diseases can cause sexual dysfunction by interfering with (erection, ejaculation).

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Chapter 25 Alterations of the Male Reproductive System Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
DESCRIBE THE DIFFERENCE

Describe the difference between each pair of terms.

20. What is the difference between phimosis and paraphimosis?

21. What is the difference between delayed puberty and precocious puberty in boys?

22. What is the difference between a varicocele and a hydrocele?

COMPLETE THESE SENTENCES

Write one word in each blank to complete these sentences.

23. Priapism needs emergency treatment to prevent development of _____________ _____________.

24. The most common type of testicular cancer is _____________, the least aggressive type.

25. Urine reflux into the epididymis causes _____________ _____________.

26. Studies on the association of high levels of the hormones testosterone and _____________ with prostate cancer are
incomplete and controversial.

27. The prostate and other tissues can use the enzyme aromatase to convert androgens to _____________.

28. Sexual dysfunction is impairment of any of these three processes (listed in the order that they normally occur):
_____________, _____________, _____________.

29. Gynecomastia usually involves imbalance of the _____________ ratio.

30. Central precocious puberty is caused by failure of central inhibition of the _____________ pulse generator.

TEACH THESE PEOPLE ABOUT PATHOPHYSIOLOGY

Write your response to each situation in the space provided.

31. Mr. Marcum has been diagnosed with BPH. He says, “Tell me why it takes so long for me to empty my bladder.”

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26 Sexually Transmitted Infections

CHOOSE THE CORRECT WORDS

Circle the correct word from the choices provided to complete these sentences.

1. The risk for developing gonorrhea from intercourse with an infected heterosexual partner is greater for (men, women).

2. In the United States, the prevalence of syphilis is highest among (men, women).

3. The rash of (primary, secondary) syphilis is unusual because it appears (on palms of hands and soles of feet, in lines
on the backs of hands and top of feet) as well as on the torso.

4. (Men, Women) who develop chancroid infection usually are asymptomatic; persons who are symptomatic develop
(painless, painful) genital ulcers and buboes.

5. HPV serotypes 16 and 18 are associated with (genital warts, anogenital cancer), and HPV serotypes 6 and 11 are as-
sociated with (genital warts, anogenital cancer).

6. Trichomoniasis is caused by a (bacterium, parasite) that (adheres to, invades) squamous epithelium.

7. Although Trichomonas infection may be asymptomatic in men or women, women who have symptoms usually report
pruritus and a (scant clear, copious frothy) discharge that smells (very unpleasant, like fish).

8. Genital warts are (not, highly) contagious and are caused by a (bacterium, virus).

9. Persons who have HSV infection can transmit the virus (only when having, whether or not they have) symptoms.

CHARACTERIZE THESE SEXUALLY TRANSMITTED INFECTIONS

Write one letter and one number by each sexually transmitted infection in the left column in order to indicate the organ-
ism that causes the infection and the type of organism.

Sexually Transmitted Choose the Organism that

Infection (STI) Causes the STI Choose the Description of the Organism
���� 10. Chlamydia A. Herpes simplex virus 1. Anaerobic spirochete

���� 11. Gonorrhea B. Treponema pallidum 2. Nonenveloped circular, double-stranded

DNA virus that has numerous strains
���� 12. Genital herpes C. Chlamydia trachomatis
3. Gram-negative diplococci
���� 13. Genital warts D. Neisseria gonorrhoeae
4. Gram-negative intracellular bacterium
���� 14. Syphilis E. Human papillomavirus
5. Enveloped linear, double-stranded DNA
virus that has latent stage in neurons

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ORDER THE STEPS

Sequence the events that occur when an individual becomes infected with T. pallidum and does not receive treatment.

1 5. Write the letters here in the correct order of the steps: ______________________________
A. Signs and symptoms disappear.
B. T. pallidum enters through a minor break in skin or mucous membrane.
C. Gummas, cardiac valve damage, and/or neurological damage may become apparent.
D. The infection becomes systemic, causing low-grade fever, malaise, and skin or mucous membrane lesions.
E. T. pallidum multiplies, and a chancre appears in that location.

EXPLAIN THE PICTURE

Examine the picture and answer the questions about it.

16. The picture shows the typical appearance of what condition?
___________________________________________________________

17. What type of organism causes this lesion? _______________________

18. Why do the lesions have this shape? ____________________________

19. What is the typical clinical manifestation at the location of these lesions?
___________________________________________________________

20. In addition to transmission during sexual contact, what other ways can
this condition be transmitted? ________________________________
_________________________________________________________

DESCRIBE THE DIFFERENCE

Describe the difference between each pair of terms.

21. What is the difference between a chancre and a bubo?

22. What is the difference between condylomata acuminata and condylomata lata?

23. What is the difference between “crabs” and scabies?

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Chapter 26 Sexually Transmitted Infections Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.