Hypogonadism- Female

Question 1

Define:

Answer 1

Characterised as impairment of ovarian function

Question 2

Aetiology/risk factors for primary hypogonadism:

Answer 2

Pregnancy = the most common cause of ammenorrhea

o Gonadal dysgenesis (due to chromosomal abnormalities e.g. Turner’s syndrome)
o Gonadal damage (e.g. autoimmune, chemotherapy, radiotherapy)
o Premature ovarian failure: premature pregnancy
o Androgen excess: gonadal or adrenal tumour

Question 3

Aetiology/risk factors of secondary hypogonadism:

Answer 3

o	Functional (e.g. stress, weight loss, excessive exercise, eating disorders)
o	Pituitary/Hypothalamic Tumours and Infiltrative Lesions (e.g. pituitary adenomas, haemochromatosis) 
o	Hyperprolactinaemia (e.g. due to prolactinoma)
o	Congenital GnRH deficiency: Kallmann's syndrome, idiopathic
o	Post pill amenorrhoea: using contraceptive pill for a long time can downregulate the hypothalamus and pituitary even once pill stopped

Question 4

Epidemiology:

Answer 4

Secondary is more common than primary

Turner’s occurs in 1.5% of pregnancies

Question 5

Symptoms:

Answer 5

Hot flushes

Vaginal dryness

Oligo/ammenorrhea

Decreased libido

Infertility

Night sweats

Dyspareunia

Turner’s - shorter stature, cubitus valgu and poor breast development

Question 6

Signs of hypogonadism:

Answer 6

Pre-pubertal:

• Delayed puberty
• Eunuchoid (long legs, arm span greater than height)

Post-pubertal:

• Regression of secondary sexual characteristics (e.g. loss of secondary sexual hair, breast atrophy)
• Perioral and periorbital fine facial wrinkles

Signs of underlying cause
• Hypothalamic/Pituitary disease - visual field defects
• Kallmann’s syndrome - anosmia

If autoimmune then will have other autoimmune conditions

Question 7

Signs of Turner’s syndrome:

Answer 7

o	Short statue 
o	Low posterior hair line 
o	High arched palate 
o	Widely spaced nipples 
o	Wide carrying angle 
o	Short fourth and fifth metacarpals 
o	Congenital lymphoedema

Question 8

General Investigations:

Answer 8

•	Pregnancy test
•	Low serum oestradiol 
•	Serum FSH/LH
o	Primary hypogonadism = HIGH 
o	Secondary hypogonadism = LOW 
•	Prolactin 
•	TFTs – can affect menstruation 

o Turner’s Syndrome - periodic echocardiography, renal US, chromosomal analysis
o Autoimmune Oophoritis - check autoimmune adrenal insufficiency

Question 9

Primary hypogonadism investigations:

Answer 9

o	Karyotype (look for chromosomal abnormalities) 
o	Pelvic imaging (US or MRI) - performed in primary amenorrhoea to check for structural defects (e.g. androgen insensitivity) 
•	Screen for FMR1 gene in patients with unexplained pre-mature ovarian failure

Question 10

Secondary hypogonadism investigations:

Answer 10

o Pituitary function tests (e.g. 9 am cortisol, TFTs, prolactin)
o Visual field testing
o Hypothalamic-pituitary MRI
o Smell tests for anosmia
o Serum transferrin saturation (check for haemochromatosis)