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
