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Flashcards in Ovulation disorders Deck (66):
1

What is oligomenorrhea?

Reduction in frequency of periods to less than 9 a year

2

What is primary amenorrhea?

Failure of menarche after age 16

3

What is secondary amenorrhea?

Cessation of periods for over 6 months in an individual who has previously menstruated

4

What are the physiological causes of amenorrhea?

Pregnancy
Post menopause

5

What are the causes of primary amenorrhea?

Congenital conditions (e.g turner's, kallman's)

6

What are the ovarian causes of secondary amenorrhea?

Polycystic ovarian syndrome
Premature ovarian failure

7

What are the uterine causes of secondary amenorrhea?

Uterine adhesions

8

What are the Hypothalamic causes of secondary amenorrhea?

Weight loss
Exercise
Stress

9

What are the pituitary causes of secondary amenorrhea?

High prolactin
Hypopituitarism

10

What are the symptoms of low oesteogen?

Low libido
Flushing
Dyspareunia (pain on sex)

11

What are the symptoms of hypothalamic problems?

Weight loss
Exercise
Stress

12

What are the features of androgen excess/PCOS?

Hirtuism
Acne

13

What would amenorrhea and anosmia indicated?

Kallman's syndrome

14

What are the symptoms of hypopituitarism/pituitary tumour?

Galactorrhea

15

Are drugs associated with hyperprolactinemia?

Yes certain drugs (antidepressants, antipsychotics)

16

What should you look for on examination when someone presents with amenorrhea?

Body habitus (turners)
Visual field defects
Anosmia
Breast development
Hirsutism
Acne
Androgen excess

17

How should amenorrhea be investigated?

LH, FSH, oestradiol
Thyroid function
Prolactin

Ovarian USS +/- endometrial thickness
Testosterone (hirsutism)
Pituitary function tests
Pituitary MRI
Karyotype (primary)

18

What is female hypogonadism?

Low levels of oestrogen

19

What is primary hypogonadism?

Problem with the ovaries where there is high LH and FSH but low oestrogen (hypergonadotrophic hypogonadism)

20

What is an example of primary hypogonadism?

Premature ovarian failure

21

What is secondary hypogonadism?

Problem with hypothalamus or pituitary where there is low LH and FSH and low oestrogen (hypogonadotrophic hypogonadism)

22

Give two examples of secondary hypogonadism

High prolactin
Hypopituitarism

23

How do you differentiate between primary and secondary hypogonadism?

Primary - low oestradiol and high LH/FSH
Secondary - low oestradiol and low LH/FSH

24

What is premature ovarian failure and how does it present?

Loss of ovarian function occurring before 40 years old

Amenorrhea, low oestrogen and high gonadotrophins

25

What is the diagnostic criteria for premature ovarian failure?

FSH 430+ on 2 separate occasions more than 1 month apart

26

What are the chromosomal causes of premature ovarian failure?

Turner's
Fragile X

27

What genetic mutations cause premature ovarian failure?

FSH/LH receptor mutations

28

What are the autoimmune conditions associated with premature ovarian failure?

Addison's
Autoimmune thyroid disease

29

What are the iatrogenic causes of premature ovarian failure?

Radiotherapy
Chemotherapy

30

What are the hypothalamic causes of secondary hypogonadism?

Functional disorder
Kallman's
Idiopathic hypogonadotrophic hypogonadism

31

What are the miscellaneous causes of secondary hypogonadism?

Prader-willi syndrome
Haemochromotosis

32

What are the causes of functional hypothalamic amenorrhea?

Weight change
Stress
Exercise
Steroids
Systemic illness
Iatrogenic
Head trauma
Granulamatous disorders (sarcoid)

33

What is the biochemical picture of functional hypothalamic amenorrhea?

Low gonadotrophin releasing hormone
Low LH/FSH
Low estradiol

34

What other biochemical pathways are interrupted due to functional hypothalamic amenorrhea?

Low TSH
Low leptin
Increased corticosteroids --> increased cortisol
High ghrelin

35

What is Kallman's syndrome?

Genetic disorder where there is a loss of GnRH with/without anosmia

36

Is Kallman's syndrome more common in males or females?

Males

37

What is pituitary function and MRI appearance in Kallman's syndrome?

Normal apart from LH/FSH
Missing olfactory bulbs

38

Is there typically a family history of Kallman's disease?

Yes

39

What is the biochemical picture of pituitary dysfunction?

Low LH/FSH
Low oestradiol

40

What are the pituitary causes of hypogonadism?

Non-functioning adenoma
Infarction
Hyperprolactinemia (prolactinoma, dopamine antagonists)

41

What is the diagnostic criteria for polycystic ovarian syndrome?

2/3 of:
Menstrual irregularity
Hyperandrogenism
Polycystic ovaries

42

Is congenital adrenal hyperplasia sometimes associated with amenorrhea?

Yes

43

What is the oestrogen level like in PCOS?

Normal

44

What is the gonadotrophin level like in premature ovarian failure?

High

45

What are the androgen levels like in PCOS?

High

46

What is hirsutism?

Excess hair distributed in the male pattern

47

What are the causes of hirsutism?

PCOS
Congenital adrenal hyperplasia
Familial
Idiopathic

Ovarian tumour
Adrenal tumour

48

How do the non-tumour causes of hirsutism present?

Long history
Elevated testosterone
No signs of virilisation

49

How do the tumour causes of hirsutism present?

Short history
Very high testosterone
Signs of virilisation (clitomegaly, deep voice)

50

What is congenital adrenal hyperplasia?

Group of inherited genetic conditions characterised by a deficiency in one of the enzymes needed for cortisol synthesis

51

What is the most common enzyme deficiency in congenital adrenal hyperplasia?

21 alpha hydroxylase

52

Is congenital adrenal hyperplasia dominant or recessive?

Recessive

53

When does classic congenital adrenal hyperplasia present?

In infancy

54

When does non-classic congenital adrenal hyperplasia present?

In adolescence
Hirsutism
Menstrual irregularity
Infertility due to anovulation

55

How should hirsutism with a suspected tumour cause be investigated?

MRI adrenals and ovaries

56

How is PCOS treated?

Oral contraceptive
Anti-androgens (cyproterone acetate)
Local anti-androgens (efflornithine cream)
Cosmesis (electrolysis, laser)

57

How is low onset CAH treated?

Low dose glucocorticoid

58

What is the chromosomal abnormality of Turner's syndrome?

Only one X chromosome

59

Which sex does turner's syndrome affect?

Females

60

How does turner's syndrome present?

Short stature
Webbed neck
Shield chest with wide spaced nipples
Cubitus valgus
Normal adrenarche
With/without breast development
Some pubertal development

61

How does Turner's syndrome present in adults?

Primary or secondary amenorrhea
Infertility
Habitus

62

What are the CVS signs of turner's syndrome?

Coarctation of the aorta
Bicuspid aortic valve
Hypoplastic left heart

63

What are the GI signs of turner's syndrome?

Vascular malformation --> bleed
Increased incidence of UC/crohns

64

What are the mis symptoms of turner's syndrome?

Lymphoedema
Autoimmune hypothyroidism
Osteoporosis
Scoliosis
Otitis media
Renal abnormalities

65

What is XX gonadal dysgenesis?

Absent ovaries with no chromosomal abnormalities

66

What is testicular feminisation?

Androgen insensitivity syndrome (genetically XY but phenotypically female)

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