Hormonal Causes of Infertility

Question 1

define oligomenorrhea

Answer 1

less than 9 periods per yr

Question 2

describe difference between primary and secondary amenorrhea

Answer 2

primary - failure of menarche by 16 yearhs

secondary- cessation of periods for more than 6 months in person who has previously menstruated

Question 3

physiological causes of amenorrhea

Answer 3

pregnancy

postmenopausal

Question 4

causes of primary amenorrhea

Answer 4

turners

kallmans

Question 5

causes of secondary amenorrhea

Answer 5

PCOS
POF
uterine adhesions
weightloss, over exercise, stress
high prolactin, hypopituitrism

Question 6

define primary hypogonadism and give example

Answer 6

problem with the ovaries such as POF

Question 7

define secondary hypogonadism

Answer 7

problem with hypothalamus/pituitary eg high prolactin, hypopituitarism

Question 8

define premature ovarian failure

Answer 8

amenorrhea, oestrogen deficiency and elevated gonadotrophins occurring at less than 40 years of age, as a result of loss of ovarian function

Question 9

what measurements must be taken to diagnose POF

Answer 9

FSH more than 30 on 2 separate occasions more than 1 month apart

Question 10

give causes of POF

Answer 10

turners, fragile x
gene mutations (FSH/LH receptors)
autoimmune disease eg addisons
iatrogenic (chemotherapy)

Question 11

give causes of secondary hypogonadism

Answer 11

kallmans
IHH
pituitary problem
prader willi
haemochromatosis

Question 12

what can cause functional hypothalamic amenorrhea

Answer 12

weight change
stress
exercise
anabolic steroids
systemic illness
surgery
recreational drugs
head trauma
sarcoidosis

Question 13

key features of kallmans

Answer 13

loss of GNRH secreation +/- anosmia
50-75 percent have anosmia
normal pituitary function

Question 14

what gender is kallmans more common in

Answer 14

men

4:1

Question 15

what percentage of IHH cases are kallmans

Answer 15

60 percent

Question 16

what proportion of kallmans is inheritied

Answer 16

one third

Question 17

what mutations results in x linked inheritance of kallmans

Answer 17

KAL 1 gene

Question 18

give causes of pituitary dysfunction

Answer 18

piturary macroadenoma
empty sella
pituitary infarct
hyperprolactinaemia
micro/macro-prolactinoma
drugs (dopamine antagonists)

Question 19

give the diagnostic criteria for PCOS

Answer 19

2 of three of:
menstrual irregularity
hyperandrogenism
polycystic ovaries

Question 20

what is turners syndrome

Answer 20

45X0

Question 21

clinical features of turners syndrome

Answer 21

short stature
webbed nicek
shield chest with wide spaced nipples
cubitus algus
no menstruation 
rudimentary ovaries

Question 22

what other conditions are associated with turners

Answer 22

cardiovascular problems - coartication of aorta
gi problems
lymphaedema
hypthyroidisms
osteoporosis
scoliosis
otitis media
renal anomalies

Question 23

what is hirsuitism

Answer 23

excess hairs im a male pattern

Question 24

what causes hirsuitism

Answer 24

androgen excess at the hair follicle

• due to excess circulating androgen
• due to increased peripheral conversion at the hair follicle

Question 25

what is congenital adrenal hyperplasia

Answer 25

inherited group of disorders characterised by deficiency in one of the enzymes required for cortisol synthesis
usually 21 alpha hydroxylase

Question 26

how Is cah inherited

Answer 26

autosomal recessive
If classic - will present in childhood
if non classic and only partial deficiency may present in adulthood

Question 27

list causes of hyperandrogenism

Answer 27

PCOS
CAH
cushings
acromegaly
androgen secreting tumour

Question 28

causes of male primary hypogonadism

Answer 28

klinefelters
cryptochidims
testicular trauma torsion 
orchiditis
chemotherapy
varicocoele

Question 29

causes of secondary hypogonadism in males

Answer 29

same as female-kallmans, prader willi

hyperprolactinaemia

Question 30

causes of gynaecomastia

Answer 30

physiological
drugs eg spironolactone
hypogonadism
tumours
endocrine- cushings
systemic illness
hereditary disorders