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Year 2 > Ovulation disorders > Flashcards

Ovulation disorders Flashcards

1
Q

What is oligomenorrhea?

A

Reduction in frequency of periods to less than 9 a year

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2
Q

What is primary amenorrhea?

A

Failure of menarche after age 16

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3
Q

What is secondary amenorrhea?

A

Cessation of periods for over 6 months in an individual who has previously menstruated

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4
Q

What are the physiological causes of amenorrhea?

A

Pregnancy

Post menopause

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5
Q

What are the causes of primary amenorrhea?

A

Congenital conditions (e.g turner’s, kallman’s)

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6
Q

What are the ovarian causes of secondary amenorrhea?

A

Polycystic ovarian syndrome

Premature ovarian failure

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7
Q

What are the uterine causes of secondary amenorrhea?

A

Uterine adhesions

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8
Q

What are the Hypothalamic causes of secondary amenorrhea?

A

Weight loss
Exercise
Stress

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9
Q

What are the pituitary causes of secondary amenorrhea?

A

High prolactin

Hypopituitarism

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10
Q

What are the symptoms of low oesteogen?

A

Low libido
Flushing
Dyspareunia (pain on sex)

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11
Q

What are the symptoms of hypothalamic problems?

A

Weight loss
Exercise
Stress

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12
Q

What are the features of androgen excess/PCOS?

A

Hirtuism

Acne

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13
Q

What would amenorrhea and anosmia indicated?

A

Kallman’s syndrome

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14
Q

What are the symptoms of hypopituitarism/pituitary tumour?

A

Galactorrhea

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15
Q

Are drugs associated with hyperprolactinemia?

A

Yes certain drugs (antidepressants, antipsychotics)

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16
Q

What should you look for on examination when someone presents with amenorrhea?

A 
Body habitus (turners)
Visual field defects
Anosmia
Breast development
Hirsutism
Acne
Androgen excess
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17
Q

How should amenorrhea be investigated?

A

LH, FSH, oestradiol
Thyroid function
Prolactin

Ovarian USS +/- endometrial thickness
Testosterone (hirsutism)
Pituitary function tests 
Pituitary MRI
Karyotype (primary)
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18
Q

What is female hypogonadism?

A

Low levels of oestrogen

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19
Q

What is primary hypogonadism?

A

Problem with the ovaries where there is high LH and FSH but low oestrogen (hypergonadotrophic hypogonadism)

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20
Q

What is an example of primary hypogonadism?

A

Premature ovarian failure

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21
Q

What is secondary hypogonadism?

A

Problem with hypothalamus or pituitary where there is low LH and FSH and low oestrogen (hypogonadotrophic hypogonadism)

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22
Q

Give two examples of secondary hypogonadism

A

High prolactin

Hypopituitarism

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23
Q

How do you differentiate between primary and secondary hypogonadism?

A

Primary - low oestradiol and high LH/FSH

Secondary - low oestradiol and low LH/FSH

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24
Q

What is premature ovarian failure and how does it present?

A

Loss of ovarian function occurring before 40 years old

Amenorrhea, low oestrogen and high gonadotrophins

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25
Q

What is the diagnostic criteria for premature ovarian failure?

A

FSH 430+ on 2 separate occasions more than 1 month apart

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26
Q

What are the chromosomal causes of premature ovarian failure?

A

Turner’s

Fragile X

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27
Q

What genetic mutations cause premature ovarian failure?

A

FSH/LH receptor mutations

28
Q

What are the autoimmune conditions associated with premature ovarian failure?

A

Addison’s

Autoimmune thyroid disease

29
Q

What are the iatrogenic causes of premature ovarian failure?

A

Radiotherapy

Chemotherapy

30
Q

What are the hypothalamic causes of secondary hypogonadism?

A

Functional disorder
Kallman’s
Idiopathic hypogonadotrophic hypogonadism

31
Q

What are the miscellaneous causes of secondary hypogonadism?

A

Prader-willi syndrome

Haemochromotosis

32
Q

What are the causes of functional hypothalamic amenorrhea?

A 
Weight change
Stress
Exercise
Steroids
Systemic illness
Iatrogenic
Head trauma 
Granulamatous disorders (sarcoid)
33
Q

What is the biochemical picture of functional hypothalamic amenorrhea?

A

Low gonadotrophin releasing hormone
Low LH/FSH
Low estradiol

34
Q

What other biochemical pathways are interrupted due to functional hypothalamic amenorrhea?

A

Low TSH
Low leptin
Increased corticosteroids –> increased cortisol
High ghrelin

35
Q

What is Kallman’s syndrome?

A

Genetic disorder where there is a loss of GnRH with/without anosmia

36
Q

Is Kallman’s syndrome more common in males or females?

A

Males

37
Q

What is pituitary function and MRI appearance in Kallman’s syndrome?

A

Normal apart from LH/FSH

Missing olfactory bulbs

38
Q

Is there typically a family history of Kallman’s disease?

A

Yes

39
Q

What is the biochemical picture of pituitary dysfunction?

A

Low LH/FSH

Low oestradiol

40
Q

What are the pituitary causes of hypogonadism?

A 
Non-functioning adenoma
Infarction
Hyperprolactinemia (prolactinoma, dopamine antagonists)
41
Q

What is the diagnostic criteria for polycystic ovarian syndrome?

A

2/3 of:
Menstrual irregularity
Hyperandrogenism
Polycystic ovaries

42
Q

Is congenital adrenal hyperplasia sometimes associated with amenorrhea?

A

Yes

43
Q

What is the oestrogen level like in PCOS?

A

Normal

44
Q

What is the gonadotrophin level like in premature ovarian failure?

A

High

45
Q

What are the androgen levels like in PCOS?

A

High

46
Q

What is hirsutism?

A

Excess hair distributed in the male pattern

47
Q

What are the causes of hirsutism?

A

PCOS
Congenital adrenal hyperplasia
Familial
Idiopathic

Ovarian tumour
Adrenal tumour

48
Q

How do the non-tumour causes of hirsutism present?

A

Long history
Elevated testosterone
No signs of virilisation

49
Q

How do the tumour causes of hirsutism present?

A

Short history
Very high testosterone
Signs of virilisation (clitomegaly, deep voice)

50
Q

What is congenital adrenal hyperplasia?

A

Group of inherited genetic conditions characterised by a deficiency in one of the enzymes needed for cortisol synthesis

51
Q

What is the most common enzyme deficiency in congenital adrenal hyperplasia?

A

21 alpha hydroxylase

52
Q

Is congenital adrenal hyperplasia dominant or recessive?

A

Recessive

53
Q

When does classic congenital adrenal hyperplasia present?

A

In infancy

54
Q

When does non-classic congenital adrenal hyperplasia present?

A

In adolescence
Hirsutism
Menstrual irregularity
Infertility due to anovulation

55
Q

How should hirsutism with a suspected tumour cause be investigated?

A

MRI adrenals and ovaries

56
Q

How is PCOS treated?

A

Oral contraceptive
Anti-androgens (cyproterone acetate)
Local anti-androgens (efflornithine cream)
Cosmesis (electrolysis, laser)

57
Q

How is low onset CAH treated?

A

Low dose glucocorticoid

58
Q

What is the chromosomal abnormality of Turner’s syndrome?

A

Only one X chromosome

59
Q

Which sex does turner’s syndrome affect?

A

Females

60
Q

How does turner’s syndrome present?

A 
Short stature
Webbed neck
Shield chest with wide spaced nipples
Cubitus valgus
Normal adrenarche
With/without breast development
Some pubertal development
61
Q

How does Turner’s syndrome present in adults?

A

Primary or secondary amenorrhea
Infertility
Habitus

62
Q

What are the CVS signs of turner’s syndrome?

A

Coarctation of the aorta
Bicuspid aortic valve
Hypoplastic left heart

63
Q

What are the GI signs of turner’s syndrome?

A

Vascular malformation –> bleed

Increased incidence of UC/crohns

64
Q

What are the mis symptoms of turner’s syndrome?

A 
Lymphoedema
Autoimmune hypothyroidism
Osteoporosis
Scoliosis
Otitis media
Renal abnormalities
65
Q

What is XX gonadal dysgenesis?

A

Absent ovaries with no chromosomal abnormalities

66
Q

What is testicular feminisation?

A

Androgen insensitivity syndrome (genetically XY but phenotypically female)

Year 2 (72 decks)

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