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Flashcards in Ovulation Disorders- Type 1 Deck (41)
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1

What is the definition of oligomenorrhoea?

Reduction in the frequency of periods to < 9/year or a cycle of > 35 days

2

What is the definition of primary amenorrhoea?

Failure of menarche by age 16

3

What is the definition of secondary amenorrhoea?

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

4

If there is anatomical or congenital problems, which type of amenorrhoea will this cause?

Primary

5

What are the physiological causes of amenorrhoea?

Pregnancy or post-menopausal

6

What should always be checked for first in an individual with amenorrhoea?

Pregnancy test

7

What diagnoses should be considered in an individual with primary amenorrhoea?

Congenital disorders such as Turner's or Kallman's

8

What are some causes of secondary amenorrhoea?

Ovarian or uterine problems, hypothalamic or pituitary dysfunction

9

What are some causes of hypothalamic dysfunction?

Weight loss, excessive exercise, stress, infiltrative disease

10

What are two examples of pituitary problems which can cause hypogonadism?

Prolactinoma, hypopituitarism

11

Give 3 symptoms of oestrogen deficiency?

Flushing, decreased libido, dyspareunia

12

Anosmia is a feature of which condition?

Kallman's

13

Why is it so important to ask about drug history in a patient with amenorrhoea?

Many drugs are associated with raised prolactin

14

All patients with oligo/amenorrhoea should have what hormones measured?

LH, FSH, oestrogen, thyroid function, prolactin

15

What are some additional investigations which may/may not be used for oligo/amenorrhoea?

Karyotyping, testosterone levels, pituitary levels and MRI ovarian ultrasound

16

Low LH and FSH suggests the problem is where?

Pituitary

17

High LH and FSH suggests the problem is where?

Ovaries

18

What defines hypogonadism in females?

Low levels of oestrogen

19

Primary hypogonadism is a problem where? What type of hypogonadism is it?

Ovaries- hypergonadotrophic hypogonadism

20

Secondary hypogonadism is a problem where? What type of hypogonadism is it?

Hypothalamus/pituitary- hypogonadotrophic hypogonadism

21

Give 3 examples of primary hypogonadism?

Premature ovarian failure, PCOS, congenital ovarian problems

22

What is group 1 of the WHO classification of ovarian disorders?

Hypothalamus/pituitary failure

23

Give 5 key features of group 1 ovulatory disorders?

Hypogonadotrophic hypogonadism, amenorrhoea, low LH/FSH, oestrogen deficiency, normal prolactin

24

How is oestrogen deficiency proven?

Progesterone challenge test

25

Describe what would happen in a progesterone challenge test on a normal individual?

There would be a menstrual bleed in response to a 5 day course of progesterone

26

Give some causes of group 1 ovarian failure?

Hypothalamic disease, hypothalamic/pituitary tumours, Kallmanns, idiopathic, drugs

27

What drugs can cause group 1 ovarian failure?

Steroids, opiates

28

What is the first step in management of group 1 ovarian failure?

Stabilise weight (if that is an issue)

29

If a patient is hypo/hypo, what medications need to be given?

Pulsatile GnRH (SC or IV) and daily injections of FSH and LH

30

What treatment for hypogonadotrophic hypogonadism comes with a risk of multiple pregnancies?

FSH and LH daily injections

31

Treatment for hypogonadotrophic hypogonadism requires what monitoring?

Regular ultrasound monitoring of response

32

What are 3 rarer causes of hypogonadotrophic hypogonadism?

Idiopathic, Prader-Willi, haemochromatosis

33

How is idiopathic hypogonadotrophic hypogonadism (IHH) identified?

Absent/delayed sexual development with low levels of gonadotrophin and sex hormone in the absence of any anatomical/functional problem

34

What is the major defect in IHH?

Inability to activate pulsatile GnRH secretion during puberty

35

A mutation where has been associated with IHH?

The GPCR KISS1R

36

KISS1R produces the ligand for what?

Kisspeptin, a potent stimulator of GnRH secretion

37

What is Kallmann's syndrome?

Isolated GnRH deficiency

38

What are some features which may/may not be associated with Kallmann's syndrome?

Anosmia, cleft palate, colour blindness

39

How is Kallmann's syndrome inherited? What gene is affected?

X-linked, KAL-1 gene

40

Is fertility possible in Kallmann's?

Yes

41

Kallmann's is more common in which sex?

Males (4:1)