Abnormalities of Secretion by the Ovaries
Hypogonadism. Less than normal secretion by
the ovariescan result from poorly formed ovaries, lack of ovaries, or
genetically abnormal ovaries that secrete the wrong hormones because of missing
enzymes in the secretory cells. When ovaries are absent from birth or when they
become nonfunctional before puberty, femaleeunuchism
occurs. In this condition, the usual secondarysexual characteristics do not
appear, and the sexual organs remain infantile. Especially characteristic of
this condition is prolonged growth of the long bones because the epiphyses do
not unite with the shafts as early as they do in a normal woman. Consequently,
the female eunuch is essentially as tall as or perhaps even slightly taller
than her male counterpart of similar genetic background.
When the ovaries of a fully developed woman are removed, the sexual
organs regress to some extent so that the uterus becomes almost infantile in
size, the vagina becomes smaller, and the vaginal epithelium becomes thin and
easily damaged. The breasts atrophy and become pendulous, and the pubic hair
becomes thinner. The same changes occur in women after menopause.
Irregularity of Menses, and Amenorrhea Caused by
Hypogonadism. As pointed out in the preceding dis-cussion of menopause, the
quantity of estrogens pro-duced by the ovaries must rise above a critical value
in order to cause rhythmical sexual cycles. Consequently, in hypogonadism or
when the gonads are secreting small quantities of estrogens as a result of
other factors, such as hypothyroidism,
the ovarian cycle often does not occur normally. Instead, several months may
elapse between menstrual periods, or menstruation may cease altogether
(amenorrhea). Prolonged ovarian cycles are frequently associated with failure
of ovulation, presum-ably because of insufficient secretion of LH at the time
of the preovulatory surge of LH, which is necessary for ovulation.
Hypersecretion by the Ovaries. Extreme hypersecretion
ofovarian hormones by the ovaries is a rare clinical entity, because excessive
secretion of estrogens automatically decreases the production of gonadotropins
by the pituitary, and this limits the production of ovarian hormones.
Consequently, hypersecretion of feminizing hormones is usually recognized
clinically only when a feminizing tumor develops.
A rare granulosa cell tumor
can develop in an ovary, occurring more often after menopause than before.
These tumors secrete large quantities of estrogens, which exert the usual
estrogenic effects, including hypertrophy of the uterine endometrium and
irregular bleeding from this endometrium. In fact, bleeding is often the first
and only indication that such a tumor exists.
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