Amenorrhea

Question 1

What counts as oligomenorrhea?

Answer 1

Less than 9 periods a year

Question 2

What 5 tests should all patients presenting with ameonorrhea have?

Answer 2

LH
FSH
Oestradiol
Thyroid function
Prolactin

Question 3

What blood test should you perform if a patient has hirsutism?

Answer 3

Androgen levels

Question 4

What test should you perform if a patient has a low oestrogen a low serum FSH and is having problems with vision.

Answer 4

Pituitary MRI

Question 5

What hormone is low in female hypogonadism?

Answer 5

Oestrogen

Question 6

High LH/FSH and low oestrogen.

Answer 6

Primary hypogonadism (hypergonadotrophic hypogonadism)

Question 7

Low LH/FSH and low oestrogen

Answer 7

Secondary hypogonadism (hypogonadotrophic hypogonadism)

Question 8

What genetic syndrome is associated with premature ovarian failure?

Answer 8

Turners

Question 9

A female patient presents with ameonorrhea. What should her FSH measurements be to confirm a diagnosis of premature ovarian failure?

Answer 9

FSH of above 430 on 2 separate occasions 1 month apart

Question 10

What genetic conditions causes a hypothalamic secondary hypogonadism?

Answer 10

Kallmans

Question 11

No GnRH secretion + anosmia

Answer 11

Kallmans syndrome

Question 12

What is the rotterdam criteria for PCOS?

Answer 12

2 out of:

1. Menstrual irregularity
2. Hyperandrogenism
3. Polycystic ovaries

Question 13

Give two reasons why you get androgen excess at the hair follicle in PCOS?

Answer 13

Excess circulating androgen

Increased peripheral conversion at the hair follicle

Question 14

What is the most likely enzyme that is deficient in CAH?

Answer 14

21α-hydroxylase

Question 15

Is CAH dominant or recessive?

Answer 15

Revessive

Question 16

A lady presents with amenorrhea for the last 3 months. She has signs of virilisation and a serum testosterone level of 7nmol.

Answer 16

Androgen secreting tumour

Question 17

What is the treatment for PCOS?

Answer 17

OCP
Cyproterone acetate (often combined with OCP as dianette)

Question 18

Name a local anti androgen cream

Answer 18

Efflornithine

Question 19

What is the karotype in turners?

Answer 19

XO

Question 20

What is testicular feminisation?

Answer 20

Androgen insensitivity syndrome. Genetically XY but phenotypically female.

Question 21

A surge in what hormone causes ovulation?

Answer 21

LH

Question 22

At which point in the menstrual cycle are oestrodial levels highest?

Answer 22

Before ovulation

Question 23

At which point in the menstrual cycle are progesterone levels highest?

Answer 23

After ovulation

Question 24

When should you measure progesterone levels?

Answer 24

Day 21 (Mid luteal)

Question 25

When should you check levels of FSH, LH, estradiol, Prolactin, TSH and free androgens.

Answer 25

Day 2 - 5 (Early follicular phase)

Question 26

Explain the progesterone challenge test.

Answer 26

5 - 7 days of progesterone given. When this is stopped there should be a bleed. If there is a bleed: Oestrogen levels fine but no ovulation occurring. If no bleed: Problem with the uterus itself or oestrogen levels are very low.

Question 27

What is the free androgen index?

Answer 27

Serum testosterone/SHBG

Question 28

Explain the WHO classification of amenorrhea?

Answer 28

Group 1: Hypothalamic pituitary failure Group 2: Hypothhalamic pituitary dysfunction Group 3: Ovarian problems

Question 29

What are the management options for hypothalamic anovulation?

Answer 29

Pulsatile GnRH (SC or OV) FSH and LH daily injections Both need ultrasound tracking and monitoring of response

Question 30

What are the biochemical test results in hypothalamic pituitary dysfunction?

Answer 30

Normal gonadotrophins Normal oestrogen Anovulation

Question 31

How does insulin resistance lead to hyperandrogenism?

Answer 31

Insulin lowers SHBG levels and so increases free testosterone.

Question 32

Name three theraputic options for the induction of ovulation in PCOS

Answer 32

1. Clomifene citrate 2. Daily FSH and LH injections 3. Laproscopic ovarian dithermy

Question 33

What is the first line treatment for induction of ovulation in PCOS?

Answer 33

Clomifene citrate

Question 34

Name two dopamine agonists

Answer 34

Cabergoline | Bromocriptine

Question 35

A patient who was being treated with dopamine agonists for a prolactinoma falls pregnant. What do you do?

Answer 35

Stop dopamine agonist.