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ENRP Exam I > Menstrual Disorder I & II (Moulton) > Flashcards

Menstrual Disorder I & II (Moulton) Flashcards

1
Q

Briefly explain the hypothalamic-pituitary axis as it relates to the menstrual cycle.

A

GnRH from the hypothalamus stimulates FSH and LH from the anterior pituitary, those then stimulate estrogen and progesterone from the ovarian follicle.

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2
Q

The pituitary gland is contained within what bony cavity?

A

sella turcica

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3
Q

What hormones are secreted from the anterior pituitary?

A

FLAT PiG
FSH, LH, ACTH, TSH, PrL, GnRH

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4
Q

What hormones are secreted from the posterior pituitary?

A

Vasopressin and Oxytocin

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5
Q

What are the two phases of the ovarian cycle?

A
  1. Follicular phase (onset of menstruation to pre-ovulatory surge)
  2. Luteal phase (onset of pre-ovulatory surge to first day of menses)
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6
Q

LH stimulates which cells within the ovary?

A

theca cells; produce androgens (androstenedione and testosterone)

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7
Q

What hormones are produced by theca cells?

A

androgens (androstenedione and testosterone); stimulated by LH

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8
Q

FSH stimulates which cells within the ovary?

A

granulose cells; convert androgens into estrogen (E1 and E2)

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9
Q

Granulosa cells serve what function in the ovary?

A

convert androgens (produced by theca cells) into estrogen (E1 and E2); stimulated by FSH

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10
Q

Decapeptide

A

responsible for the synthesis and release of LH and FSH; synthesized in the arcuate nucleus

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11
Q

During early follicular phase, estrogen levels are what?

A

low; until 1 week before ovulation

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12
Q

When does estrogen levels start to increase in the follicular phase of the ovarian cycle?

A

1 week before ovulation

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13
Q

Right after the LH surge what happens to estrogen levels?

A

marked and precipitous fall

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14
Q

The corpus luteum is replaced by what if pregnancy does not occur?

A

avascular scar called corpus albicans

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15
Q

What labs are used to diagnose menopause?

A

FSH; levels will be elevated

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16
Q

What are the two zones of the endometrium?

A

functionalis (sloughed off) and basalis (unchanged)

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17
Q

Functionalis layer of the endometrium

A

outer portion; undergoes cyclic changes; shedded during menstruation; spiral arteries

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18
Q

Basalis layer of the endometrium

A

inner portion; remains unchanged; provides stem cells; basal or straight arteries

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19
Q

What are the three stages of the endometrium?

A
  1. Menstrual phase
  2. Proliferative or estrogenic phase
  3. Secretory or progestational phase
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20
Q

What is the only portion of the endometrium cyclic cycle visualized externally?

A

Menstrual phase; shedding

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21
Q

The first day of menstruation is what day in the ovarian cycle?

A

Day 1

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22
Q

Proliferative phase of the endometrium

A

estrogenic stimulation; increase in spiral arteries

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23
Q

Secretory phase of the endometrium

A

progesterone stimulated; endometrial reaches maximal thickness; tortuous glands; edematous stroma

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24
Q

At which phase does the endometrial lining reach its maximal thickness?

A

secretory phase

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25
Q

The endometrium undergoes involution if conception does not occur by which day?

A

Day 23

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26
Q

Primary amenorrhea

A

no menstruation by 13 yrs w/o secondary sexual development OR by the age of 15 yrs w/ secondary sexual characteristics

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27
Q

What is the median age for menarche to occur?

A

12 yrs

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28
Q

What is the normal menstrual cycle range in the first gynecological year?

A

21 to 45 days

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29
Q

What is the normal menstrual cycle range for typical adults?

A

21 to 35 days (28 +/- 7 days)

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30
Q

What is the normal menstrual product use in the typical adult?

A

3 to 6 pads or tampons per day

31
Q

What is the typical age range for puberty to occur?

A

10-16 yrs (median is 12); earlier in obese children

32
Q

How many oocytes do female infants typically have during mid gestation (16-20 weeks)?

A

6 - 7 million

33
Q

What are the two functions of low levels of gonadotropins and sex steroids during the prepubertal period?

A
  1. gonadostat sensitivity to negative feedback of low circulating estradiol
  2. inhibition of GnRH secretion
34
Q

Thelarche

A

breast development; first physical sign of puberty; requires estrogen

35
Q

What is typically the first physical sign of puberty in young females?

A

thelarche (breast development)

36
Q

Pubarche

A

pubic hair development; requires androgens

37
Q

Adrenarche

A

axillary hair development; requires androgens

38
Q

Menarche

A

onset of menses; requires pulsatile GnRH, FSH, LH and estrogen and progesterone

39
Q

TAGME

A

stages for normal pubertal development;
T = Thelarche
A = Adrenarche
G = Growth/Height
ME = Menses

40
Q

What is the median age for African Americans females to experience thelarche/aderenarche?

A

9.5 yrs

41
Q

Tanner Staging in breast development

A

Stage 1: elevation of papilla only
Stage 2: breast and papilla enlargement around areolar region
Stage 3: further enlargement of breast and areolar
Stage 4: projection of areolar and papilla (secondary mound)
Stage 5: mature stage; projection of papilla only

42
Q

Tanner Staging in pubic hair development

A

Stage 1: absence of hair
Stage 2: sparse hair along labia
Stage 3: hair sparsed around triangle; darker and coarser
Stage 4: no spread to medial thigh
Stage 5: hair spread to medial thigh

43
Q

Precocious puberty

A

early puberty

44
Q

What are the two major subgroups of precocious puberty?

A
  1. Heterosexual precocious puberty
  2. Isosexual precocious puberty
45
Q

Heterosexual precocious puberty

A

development of secondary characteristics of the OPPOSITE sex; caused by virilizing neoplasms (Sertoli-Leydig cell origin), congenital adrenal hyperplasia (21- hydroxyls deficiency) or exposure to exogenous androgens

46
Q

Isosexual precocious puberty

A

development of secondary characteristics of the APPROPRIATE sex; two types:
1. True isosexual precocity - premature activation of normal HPO axis
2. Pseudoissexual precocity - exposure to estrogens independent to HPO axis (estrogen producing tumors)

47
Q

How do you diagnose true isosexual precocious puberty?

A

GnRH stimulation test - admin exogenous GnRH and see if normal rise in LH occurs; but if caused by CNS disorder (10%) diagnose with head MRI

48
Q

How do you treat true isosexual precocious puberty?

A

GnRH agonist (leuprolide acetate); if left untreated 50% of girls will not attain an adult height of 5 feet

49
Q

What typically occurs if true isosexual precocious puberty is left untreated?

A

will not attain an adult height of 5 feet; treated with GnRH agonist (leuprolide acetate)

50
Q

What are the two common causes of pseudoissexual precocity?

A
  1. McCune-Albright syndrome (Polyostotic fibrous dysplasia)
  2. Peutz-Jeghers syndrome
51
Q

When is puberty considered delayed?

A
  • secondary characteristics have not appeared by 13 yrs
  • thelarche has not occurred by 14 yrs
  • no menarche by 15-16 yrs
  • menses has not occurs 5 yrs after onset of thelarche
52
Q

Hypergonadotropic Hypogonadism

A

FSH > 30mIU/mL; will see delayed puberty; gonadal dysgenesis; commonly see in Turner syndrome (45 X,O)

53
Q

Definition of primary amenorrhea

A

no spontaneous uterine bleeding by age 13 w/o secondary sexual characteristics OR no menstruation by 15 w/ secondary sexual characteristics

54
Q

Definition of secondary amenorrhea

A

patient w/ prior menses has absent menses for 6 months or more

55
Q

Kallman syndrome

A

delated puberty; hypogonadotrophic hypogonadism (FSH and LH <5 IU/L); mut in KAL gene on X chromosome that prevents the migration of the GnRH neurons in the hypothalamus; patients will present with anosmia or hyosmia (decreased or absence smell)

56
Q

Hypergonadotrpoic hypogonadism

A

think of Turner’s syndrome; get a karyotype test; results are 45 XO; most common form of female gomadal dysgenesis; no signs of secondary sexual characteristics; webbing of the neck; broad flat “shield” chest; short stature; streaked ovaries; **coarctation of the aorta

57
Q

primary amenorrhea + secondary sexual characteristics + US with absent uterus, what is your next step?

A

karyotype analysis;
46 XY - androgen insensitivity syndrome
46 XX - mullerian agenesis

58
Q

Androgen insensitivity syndrome

A

46 XY; there is a normal male level of testosterone, but defect in the androgen receptor; testes are in the abdominal wall; external female genitalia w/ absent pubic hair

59
Q

Mullerian agenesis

A

46 XX; levels of testosterone consistent w females; primary amenorrhea, breast development; absence of normal uterus (Meyer-Rokitansky-Kuster-Hauser syndrome); failure of the mullerian ducts to fuse distally

60
Q

Meyer-Rokitansky-Kuster-Hauser syndrome

A

46 XX; most common cause of primary amenorrhea in women w normal breast development; normal female range testosterone

61
Q

primary amenorrhea + secondary sexual characteristics + US with uterus, what is your next step?

A

check for an outflow obstruction;
no - evaluate for secondary amenorrhea
yes - imperforate hymen or transverse vaginal septum

62
Q

Definition secondary amenorrhea

A

absence of menstruation for 6 month; always get a urine hCG test! and check hormone levels (TSH, Prolactin and FSH)

63
Q

patient with secondary amenorrhea w normal prolactin and abnormal TSH

A

thyroid disease

64
Q

patient with secondary amenorrhea w abnormal prolactin and normal TSH

A

get MRI of head; really high prolactin >100 ng/mL - can be pituitary adenoma or empty sella syndrome

low prolactin <100 ng/mL - ectopic production (renal cell carcinoma)

65
Q

Prolactinoma

A

(pituitary adenoma) - microadenoma vs macroadenoma >10 mm can be treated w dopamine agonist; galactorrhea is a common symptom; compresses optic chiasm and causes bitemporal hemianopia

66
Q

Secondary amenorrhea with normal TSH and prolactin, what is the next step?

A

do a progesterone challenge test (PCT); positive = PCOS

67
Q

What are some anatomic causes of secondary amenorrhea?

A

Asherman syndrome
cervical stenosis

68
Q

Polycystic ovarian syndrome (PCOS)

A

female anovulatory infertility; insulin sensitivity; increased circulating testosterone; need 2 of the 3
1. oligomenorrhea or amenorrhea
2. LH to FSH 2:1
3. multiple small cysts on US “string of pearls”

69
Q

Treatment for PCOS

A

weight loss; oral contraceptives; insulin-sensitizing agents (metformin)

70
Q

Polymenorrhea

A

abnormal frequent menses at intervals at <21 days (occurring more often but for a shorter duration - ie two cycles lasting 3 days in one month)

71
Q

Menorrhagia

A

excessive or prolonged bleeding >80mL occurring at normal intervals (HEAVY bleeding)

72
Q

Menometrorrhagia

A

heavy and irregular uterine bleeding

73
Q

Oligomenorrhea

A

menstrual cycles occurring >35 days (less often, one period every other month)

ENRP Exam I (24 decks)

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