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Ovulation disorders Flashcards

1
Q

What is oligomenorrhea?

A

Reduction in frequency of periods to less than 9 a year

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2
Q

What is primary amenorrhea?

A

Failure of menarche after age 16

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3
Q

What is secondary amenorrhea?

A

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

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4
Q

What are the physiological causes of amenorrhea?

A

Pregnancy

Post menopause

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5
Q

What are the causes of primary amenorrhea?

A

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

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6
Q

What are the ovarian causes of secondary amenorrhea?

A

Polycystic ovarian syndrome

Premature ovarian failure

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7
Q

What are the uterine causes of secondary amenorrhea?

A

Uterine adhesions

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8
Q

What are the Hypothalamic causes of secondary amenorrhea?

A

Weight loss
Exercise
Stress

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9
Q

What are the pituitary causes of secondary amenorrhea?

A

High prolactin

Hypopituitarism

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10
Q

What are the symptoms of low oesteogen?

A

Low libido
Flushing
Dyspareunia (pain on sex)

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11
Q

What are the symptoms of hypothalamic problems?

A

Weight loss
Exercise
Stress

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12
Q

What are the features of androgen excess/PCOS?

A

Hirtuism

Acne

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13
Q

What would amenorrhea and anosmia indicated?

A

Kallman’s syndrome

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14
Q

What are the symptoms of hypopituitarism/pituitary tumour?

A

Galactorrhea

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15
Q

Are drugs associated with hyperprolactinemia?

A

Yes certain drugs (antidepressants, antipsychotics)

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16
Q

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

A 
Body habitus (turners)
Visual field defects
Anosmia
Breast development
Hirsutism
Acne
Androgen excess
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17
Q

How should amenorrhea be investigated?

A

LH, FSH, oestradiol
Thyroid function
Prolactin

Ovarian USS +/- endometrial thickness
Testosterone (hirsutism)
Pituitary function tests 
Pituitary MRI
Karyotype (primary)
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18
Q

What is female hypogonadism?

A

Low levels of oestrogen

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19
Q

What is primary hypogonadism?

A

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

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20
Q

What is an example of primary hypogonadism?

A

Premature ovarian failure

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21
Q

What is secondary hypogonadism?

A

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

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22
Q

Give two examples of secondary hypogonadism

A

High prolactin

Hypopituitarism

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23
Q

How do you differentiate between primary and secondary hypogonadism?

A

Primary - low oestradiol and high LH/FSH

Secondary - low oestradiol and low LH/FSH

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24
Q

What is premature ovarian failure and how does it present?

A

Loss of ovarian function occurring before 40 years old

Amenorrhea, low oestrogen and high gonadotrophins

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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)

Year 2 (72 decks)

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