Flashcards in Ovulation disorders Deck (66):
What is oligomenorrhea?
Reduction in frequency of periods to less than 9 a year
What is primary amenorrhea?
Failure of menarche after age 16
What is secondary amenorrhea?
Cessation of periods for over 6 months in an individual who has previously menstruated
What are the physiological causes of amenorrhea?
What are the causes of primary amenorrhea?
Congenital conditions (e.g turner's, kallman's)
What are the ovarian causes of secondary amenorrhea?
Polycystic ovarian syndrome
Premature ovarian failure
What are the uterine causes of secondary amenorrhea?
What are the Hypothalamic causes of secondary amenorrhea?
What are the pituitary causes of secondary amenorrhea?
What are the symptoms of low oesteogen?
Dyspareunia (pain on sex)
What are the symptoms of hypothalamic problems?
What are the features of androgen excess/PCOS?
What would amenorrhea and anosmia indicated?
What are the symptoms of hypopituitarism/pituitary tumour?
Are drugs associated with hyperprolactinemia?
Yes certain drugs (antidepressants, antipsychotics)
What should you look for on examination when someone presents with amenorrhea?
Body habitus (turners)
Visual field defects
How should amenorrhea be investigated?
LH, FSH, oestradiol
Ovarian USS +/- endometrial thickness
Pituitary function tests
What is female hypogonadism?
Low levels of oestrogen
What is primary hypogonadism?
Problem with the ovaries where there is high LH and FSH but low oestrogen (hypergonadotrophic hypogonadism)
What is an example of primary hypogonadism?
Premature ovarian failure
What is secondary hypogonadism?
Problem with hypothalamus or pituitary where there is low LH and FSH and low oestrogen (hypogonadotrophic hypogonadism)
Give two examples of secondary hypogonadism
How do you differentiate between primary and secondary hypogonadism?
Primary - low oestradiol and high LH/FSH
Secondary - low oestradiol and low LH/FSH
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
What is the diagnostic criteria for premature ovarian failure?
FSH 430+ on 2 separate occasions more than 1 month apart
What are the chromosomal causes of premature ovarian failure?
What genetic mutations cause premature ovarian failure?
FSH/LH receptor mutations
What are the autoimmune conditions associated with premature ovarian failure?
Autoimmune thyroid disease
What are the iatrogenic causes of premature ovarian failure?
What are the hypothalamic causes of secondary hypogonadism?
Idiopathic hypogonadotrophic hypogonadism
What are the miscellaneous causes of secondary hypogonadism?
What are the causes of functional hypothalamic amenorrhea?
Granulamatous disorders (sarcoid)
What is the biochemical picture of functional hypothalamic amenorrhea?
Low gonadotrophin releasing hormone
What other biochemical pathways are interrupted due to functional hypothalamic amenorrhea?
Increased corticosteroids --> increased cortisol
What is Kallman's syndrome?
Genetic disorder where there is a loss of GnRH with/without anosmia
Is Kallman's syndrome more common in males or females?
What is pituitary function and MRI appearance in Kallman's syndrome?
Normal apart from LH/FSH
Missing olfactory bulbs
Is there typically a family history of Kallman's disease?
What is the biochemical picture of pituitary dysfunction?
What are the pituitary causes of hypogonadism?
Hyperprolactinemia (prolactinoma, dopamine antagonists)
What is the diagnostic criteria for polycystic ovarian syndrome?
Is congenital adrenal hyperplasia sometimes associated with amenorrhea?
What is the oestrogen level like in PCOS?
What is the gonadotrophin level like in premature ovarian failure?
What are the androgen levels like in PCOS?
What is hirsutism?
Excess hair distributed in the male pattern
What are the causes of hirsutism?
Congenital adrenal hyperplasia
How do the non-tumour causes of hirsutism present?
No signs of virilisation
How do the tumour causes of hirsutism present?
Very high testosterone
Signs of virilisation (clitomegaly, deep voice)
What is congenital adrenal hyperplasia?
Group of inherited genetic conditions characterised by a deficiency in one of the enzymes needed for cortisol synthesis
What is the most common enzyme deficiency in congenital adrenal hyperplasia?
21 alpha hydroxylase
Is congenital adrenal hyperplasia dominant or recessive?
When does classic congenital adrenal hyperplasia present?
When does non-classic congenital adrenal hyperplasia present?
Infertility due to anovulation
How should hirsutism with a suspected tumour cause be investigated?
MRI adrenals and ovaries
How is PCOS treated?
Anti-androgens (cyproterone acetate)
Local anti-androgens (efflornithine cream)
Cosmesis (electrolysis, laser)
How is low onset CAH treated?
Low dose glucocorticoid
What is the chromosomal abnormality of Turner's syndrome?
Only one X chromosome
Which sex does turner's syndrome affect?
How does turner's syndrome present?
Shield chest with wide spaced nipples
With/without breast development
Some pubertal development
How does Turner's syndrome present in adults?
Primary or secondary amenorrhea
What are the CVS signs of turner's syndrome?
Coarctation of the aorta
Bicuspid aortic valve
Hypoplastic left heart
What are the GI signs of turner's syndrome?
Vascular malformation --> bleed
Increased incidence of UC/crohns
What are the mis symptoms of turner's syndrome?
What is XX gonadal dysgenesis?
Absent ovaries with no chromosomal abnormalities