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BPT Endocrinology > Female Reproductive Endocrinology > Flashcards

Female Reproductive Endocrinology Flashcards

1
Q

What is the prevalence of PCOS?

A

5-10%

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2
Q

What are the reproductive features of PCOS?

A

delayed menarche, menstrual irregularity, infertility, miscarriage, pregnancy complications, delayed menopause

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3
Q

What are the metabolic features of PCOS?

A

obesity, insulin resistance, dyslipidaemia, cardiovascular disease

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4
Q

What are the key features in PCOS pathogenesis?

A

dysregulation of ovarian steroidogenesis leading to hyperandrogenism
insulin resistant hyperinsulinaemia

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5
Q

What is required for diagnosis of PCOS?

A

chronic anovulation
clinical or biochemical hyperandrogenism
exclusion of other causes

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6
Q

What causes need to be excluded prior to a diagnosis of PCOS?

A

thyroid disorder, hyperprolactinaemia, cushing’s syndrome, non classic CAH, androgen secreting tumour

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7
Q

What are the clinical features of hyperandrogenism?

A

hirsutism, acne, male pattern hair loss

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8
Q

What is the management for PCOS?

A 
weight loss
COCP
androgen blockade
metformin 
ovulation induction
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9
Q

What can be used for infertility in PCOS?

A 
letrozole
clomiphene
metformin
gonadotrophin therapy
IVF
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10
Q

What is required for long term management for PCOS?

A 
check for diabetes every 2 years
check lipid profile every 2 years
measure blood pressure annually
assess for sleep apnoea
assess endometrial thickness
assess for depression/anxiety
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11
Q

What investigations should be ordered for ammenorrhoea?

A

beta HCG, FSH/LH, TSH, prolactin, oestradiol, androgen profile, karyotyping if indicated, pelvic US

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12
Q

What is the definition of primary amenorrhoea?

A

absence of menses by age 16 years or

absence of breast develop or menses by age 13 years

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13
Q

What is the definition of secondary amenorrhoea?

A

absence of menstruation for greater than 6 months in women with past menses

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14
Q

Where is GnRH released from?

A

the hypothalamus

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15
Q

Where is FSH and LH released from?

A

the pituitary

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16
Q

What are the hypothalamic causes of amenorrhoea?

A 
dysfunctional (exercise, weight loss, chronic illness)
neoplasm
gonadotrophin deficiency (kallmann syndrome)
17
Q

What are the pituitary causes of amenorrhoea?

A

neoplasm (prolactinoma, macroadenoma)
post treatment of pituitary lesion
sheehan’s syndrome

18
Q

What are the endocrine causes of amenorrhoea?

A

hypothyroidism

hyperprolactinaemia

19
Q

What are the ovarian causes of amenorrhoea?

A 
gonadal dysgenesis (Turner's syndrome)
ovarian failure (idiopathic or treatment related)
PCOS
20
Q

What are the outflow tract obstruction causes of amenorrhoea?

A

mullerian agenesis
vaginal atresia
imperforate hymen
asherman syndrome

21
Q

What is turner syndrome?

A

a genetic abnormality (45XO)

22
Q

What is the incidence of turner syndrome?

A

1 in 2500

23
Q

What are the clinical features of turner syndrome?

A

short stature, pubertal delay, primary or secondary amenorrhoea

24
Q

What cardiac comorbidities is turner syndrome associated with?

A 
coarctation of aorta
bicuspid aortic valve
mitral valve prolapse
hypertension
IHD
dissection
25
Q

What non cardiac cormorbidities is turner syndrome associated with/?

A

horshoe kidney, autoimmune hypothyrodism, hearing loss, metabolic syndrome, osteoporosis, liver dysfunction, coeliac disease, neurocognitive

26
Q

What is primary ovarian insufficiency?

A

development of hyperfonadroptic hypogonadism at age < 40 years

27
Q

What are the causes of primary ovarian insufficiency?

A

iatrogenic, autoimmune, genetic (fragile X), idiopathic

28
Q

What investigations are required for diagnosis of primary ovarian insufficiency?

A

2 x FSH > 40 at least one month apart with low oestradiol and amenorrhoea/menopausal symptoms

29
Q

What is the management for primary ovarian insufficiency?

A

hormone therapy until age of natural menopause

surveillance for autoimmune hypothyroidism

30
Q

What is the cause of amenorrhoea if FSH is high and oestradiol is low?

A

primary ovarian insufficiency

31
Q

What is the most likely cause of amenorrhoea if FSH is low and oestradiol is low?

A

functional hypothalamic (exercise, eating disorder, stress)

32
Q

What is the most likely cause of amenorrhoea if FSH is normal and oestradiol is low or normal?

A

outflow tract obstruction or hyperandrogenism

33
Q

What are the 4 most common causes of amenorrhoea?

A

PCOS, hypothalamic amenorrhoea, ovarian failure, hyperprolactinaemia

BPT Endocrinology (9 decks)

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