Sample Answer for NUR-631 Topic 15 DQ 1 Included After Question
Select two of the following questions for your discussion response. Indicate which questions you have chosen using the format displayed in the “Discussion Forum Sample.”
Review the hypothalamus, pituitary, and ovarian axis, and explain the pathophysiology of PCOS. Explain the role of hormones in the development of this disorder. How does PCOS contribute to infertility?
Explain the role of genetics and oncogenes in the development of reproductive cancers. In addition, examine if genetically linked reproductive cancers are only seen in women or are they also in men?
Jones, a 60-year-old male, was seen for his yearly physical. Upon review of his lab results, a high PSA level was seen. Having heard about the PSA test and correlation to prostate cancer, he is worried about a diagnosis of cancer. What would you tell Mr. Jones in your discussion about the lab results?
A Sample Answer For the Assignment: NUR-631 Topic 15 DQ 1
Title: NUR-631 Topic 15 DQ 1
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MA
Review the hypothalamus, pituitary, and ovarian axis, and explain the pathophysiology of PCOS. Explain the role of hormones in the development of this disorder. How does PCOS contribute to infertility?
The pathophysiology of PCOS is associated with different factors, including ovulatory dysfunction, abnormal gonadotropin secretion insulin resistance, hyperandrogenism, and aberrant gonadotropin‐releasing hormone (GnRH) pulsation, which interact of exacerbate each other (Harada, 2022). Ovarian dysfunction encompasses androgens’ hypersecretion, which is attributed to abnormal follicular growth and ovulatory dysfunction, resulting in polycystic ovarian morphology. High concentration of anti‐Müllerian hormone, released by antral follicles which accumulate in polycystic ovary syndrome ovaries, additionally intensify the ovarian dysfunction through alteration of the follicular micro-environment and gonadotropin‐releasing hormone pulsation (Harada, 2022). Hyperandrogenism results in dysregulation of the pulsatile secretion of gonadotropin‐releasing hormone, leading to the aberrant release of gonadotropins along with excess secretion of luteinizing hormone. Higher concentrations of luteinizing hormone alongside the resulting imbalance in the luteinizing hormone/follicle‐stimulating hormone ratio play a significant role in exacerbating the dysregulation of follicular growth and causes androgens hypersecretion. The excess androgen production is associated with several characteristic features of polycystic ovary syndrome, such as excessive hair growth, acne, and irregular menstrual cycles.
The elevated androgens inhibit the delicate balance of the hypothalamic-pituitary-ovarian axis, a complex feedback loop, which play a critical role in regulating the female reproductive system. This results in an imbalance in the ratio of follicle‐stimulating hormone to luteinizing hormone. Elevated luteinizing hormone levels, relative to follicle‐stimulating hormone, causes the arrested development of ovarian follicles, making the ovaries to develop numerous small cyst-like structures, called follicles. The follicles usually fail to mature and release eggs, resulting in anovulation and the typical irregular or absent menstrual cycles observed in polycystic ovary syndrome.
Infertility is one of the commonest consequences of polycystic ovary syndrome because of the combination of factors resulting from hormonal imbalances. The absent or irregular ovulation upsets the regular release of eggs from the ovaries, significantly limiting the likelihoods of conception. Additionally, the hormonal environment in polycystic ovary syndrome can result in the development of a thickened and less receptive endometrial lining, which is important for implantation of a fertilized egg. This further decreases the probability of successful pregnancy. Furthermore, the excess androgens adversely affect the production of quality eggs and interfere with the maturation process, possibly impacting the capacity of fertilization.
Explain the role of genetics and oncogenes in the development of reproductive cancers. In addition, examine if genetically linked reproductive cancers are only seen in women or are they also in men?
Genetics highly contribute to a person’s vulnerability to reproductive cancers. Inherited mutations in particular genes often predispose people to the malignancies. For example, mutations in the BRCA1 and BRCA2 genes are significantly linked to increased risk of breast as well as ovarian cancer in women. The above genes repair damaged DNA and maintain the genome’s stability. Mutations in the genes play a critical role in impairing the ability to repair DNA damages, increasing the possibility of cancer development (Shen, Shi & Wang, 2018). Although the mutations are more generally linked to ovarian and breast cancers among the females, they can as well increase the risk of prostate cancers. For example, in men mutations in genes like HOXB13 and BRCA2 is linked to an elevated risk of prostate cancer. Men with BRCA2 mutations have increased risk of developing aggressive prostate cancer at a younger age compared to the general population.
Similarly, oncogenes are specific genes that, when abnormally activated or mutated, facilitate uncontrolled cell growth and division, resulting in cancer. Some oncogenes are implicated in reproductive cancers. For example, human papillomavirus (HPV) infection is one of the main risk factors for cervical cancer. Human papillomavirus oncogenes E6 and E7 play a significant role in interfering with the normal regulatory mechanisms of the cell cycle, promoting uncontrolled growth and resulting in the development of cervical cancer (Cosper et al., 2021). Besides these genetic and molecular factors, it is vital to note that reproductive cancers are not entirely limited to women. Although some types like ovarian and cervical cancers, largely affect the female gender because of the nature of the reproductive organs involved, other types can affect both men and women. For instance, testicular cancer mostly occurs in men, arising from the cells in the testes. Prostate cancer, on the other hand, affects the prostate gland in men. Genetic predisposition can also influence the likelihood of these cancers in men. Mutations in genes like BRCA2 can increase the risk of breast and prostate cancers in males.
References
Cosper, P. F., Bradley, S., Luo, Q., & Kimple, R. J. (2021, October). Biology of HPV mediated carcinogenesis and tumor progression. In Seminars in Radiation Oncology (Vol. 31, No. 4, pp. 265-273). WB Saunders.
Harada, M. (2022). Pathophysiology of polycystic ovary syndrome revisited: Current understanding and perspectives regarding future research. Reproductive Medicine and Biology, 21(1), e12487.
Shen, L., Shi, Q., & Wang, W. (2018). Double agents: genes with both oncogenic and tumor-suppressor functions. Oncogenesis, 7(3), 25.
REPLY
DS
Hello Mariam,
You did a great job explaining polycystic ovarian syndrome (PCOS) including how it is diagnosed, the pathophysiology behind it, and its risks such as infertility and hormonal imbalance. I would also like to add to your discussion the other complications that are related to PCOS including insulin resistance, diabetes mellitus type 2, metabolic syndrome, increased risk of cardiovascular dysfunction, depression, anxiety, and excess androgens. Women with PCOS suffer from symptoms such as bloating, irregular periods, anovulation, cystic acne, and excessive hair growth (hirsutism) due to an imbalance of hormones and excess androgens (Sadeghi et.al, 2022). PCOS is a growing issue in the United States and there are currently no FDA-approved medications to directly treat the diagnosis. Treatment depends on certain medications such as anti-diabetics, oral contraceptives, ovulation inducers, antiandrogen agents, and HMG-CoA reductase inhibitors such as statins (Sadeghi et.al, 2022). While medication treatment options are limited, it is recommended that patients with PCOS follow a diet and exercise plan to decrease insulin resistance. Implementing regular exercise and following a fat-free and sugar-free diet can drastically decrease the risk of developing complications related to PCOS.
Reference:
Sadeghi, H. M., Adeli, I., Calina, D., Docea, A. O., Mousavi, T., Daniali, M., Nikfar, S., Tsatsakis, A., & Abdollahi, M. (2022). Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. International journal of molecular sciences, 23(2), 583. https://doi.org/10.3390/ijms23020583
REPLY
TG
The most common genes associated with the development of breast and ovarian cancer are the BRCA1 and BRCA2 (Yoshida, 2021). Hereditary breast and ovarian cancer is a term used to describe an inherited increased risk for breast and ovarian cancer. Clinicians should consider the family history and other risk factors to determine if referral for genetic testing is appropriate. If found to display these genes, preventative surgeries can be performed. These include mastectomy and salpingo-oopherectomy.
References
Yoshida R. (2021). Hereditary breast and ovarian cancer (HBOC): review of its molecular characteristics, screening, treatment, and prognosis. Breast cancer (Tokyo, Japan), 28(6), 1167–1180. https://doi.org/10.1007/s12282-020-01148-2
REPLY
MD
The HPO axis, which includes the hypothalamus, pituitary gland, and ovaries, functions as a unit to regulate the cyclical release of gonadotropic and steroid hormones, allowing for reproduction. In order to prime the endometrium for implantation, this cycle is highly controlled to choose a dominant follicle for ovulation. The steroid hormones required for follicular growth and oocyte maturation are produced mostly by the ovary. It controls the hormonal environment necessary for oocyte development and fertilization and contains the fixed quantity of oocytes a woman will have throughout her reproductive lifetime. Disruptions to this intricate control may occur at any node along the HPO axis (Mikhael, S. et al. 2019).
PCOS, also known as polycystic ovary syndrome, is the hormonal condition that affects reproductive-aged women more often than any other condition. It is characterized by hyperandrogenism, polycystic ovaries, and irregular menstrual cycles (Rasquin et al., 2022). Polycystic ovary syndrome (PCOS) is a physical form of the illness, whereas hyperandrogenemia is mostly biochemical. Anovulation, menstrual abnormalities, and follicular development suppression are all possible outcomes of the hyperandrogenism that is characteristic with PCOS. The most prevalent endocrine condition in women of childbearing age is polycystic ovary syndrome (PCOS). Symptoms include cyclical or no menstrual bleeding, increased testosterone levels, and polycystic ovaries. Primary abnormalities in the hypothalamic-pituitary axis, in insulin production and action, and in ovarian function all contribute to the pathophysiology of polycystic ovary syndrome. PCOS has been related to insulin resistance and obesity, although its exact etiology is still unclear. Ovarian function is regulated in part by insulin, and the ovaries react to elevated insulin levels by increasing androgen production, which may cause anovulation. Stopping at an immature follicle stage is a telltale symptom of ovarian dysfunction. Signs of polycystic ovary syndrome (PCOS) include increased levels of luteinizing hormone (LH) and gonadotropin-releasing hormone (GnRH) and decreased or stable levels of follicular-stimulating hormone (FSH). More androgens are produced when an increase in GnRH stimulates the ovarian thecal cells. Increasing endogenous FSH levels or administering exogenous FSH may reverse follicular arrest. There is evidence from genetic research to show that PCOS is a major abnormality in females just starting puberty. Roughly a quarter of PCOS patients also have high prolactin levels ( Ndefo, et.al. 2013).
2. Jones, a 60-year-old male, was seen for his yearly physical. Upon review of his lab results, a high PSA level was seen. Having heard about the PSA test and correlation to prostate cancer, he is worried about a diagnosis of cancer. What would you tell Mr. Jones in your discussion about the lab results?
PSA stands for prostate-specific antigen and is a kind of protein that is produced by the cells that make up the prostate gland. Because higher PSA levels are linked with a larger probability of prostate cancer, measuring the levels of PSA in the blood may be used to diagnose early prostate cancer, which is often asymptomatic in its first stages. A higher PSA test, like in the instance of Mr. Jones, is not always a reliable diagnostic process to diagnose prostate cancer. According to David MK and Leslie SW. (2022), the serum prostate-specific antigen test is still considered to be a somewhat contentious screening exam for healthy guys who are asymptomatic. This is due to the fact that high blood PSA is observed in a wide variety of benign prostatic diseases. Infection, trauma, inflammation, and benign prostatic hyperplasia (BPH) are all conditions that may cause an increase in serum PSA levels. This decreases the biomarker’s specificity when it comes to its utility in predicting prostate cancer. According to the findings of certain studies, up to 86 percent of people who have BPH may have an abnormally high blood PSA level. Other diagnostic tests can be performed, such as a digital rectal examination (DRE) and transrectal prostatic ultrasonography (TRUS), for the purpose of detecting early prostate cancer and referring the patient to a urologist, despite the fact that the patient is asymptomatic and the PSA level is elevated. This is done to avoid performing unnecessary biopsies or making an incorrect diagnosis.
References:
David MK, Leslie SW. (2022). Prostate Specific Antigen. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557495/
Mikhael, S., Punjala-Patel, A., & Gavrilova-Jordan, L. (2019). Hypothalamic-Pituitary-Ovarian Axis Disorders Impacting Female Fertility. Biomedicines, 7(1), 5. https://doi.org/10.3390/biomedicines7010005
Ndefo, U. A., Eaton, A., & Green, M. R. (2013). Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P & T : a peer-reviewed journal for formulary management, 38(6), 336–355.
Rasquin Leon LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease.( 2022). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/
