Pathology - Ovary and uterus Flashcards
(75 cards)
What are the 2 layers of the endometrium?
- Functionalis layer (shedded) (outer layer)
- Basalis (regenerative) layer - regenerates functionalis
What is asherman syndrome?
Secondary amenorrhea due to loss of basalis (regenerative) layer and scarring
What can ashermans be due to?
- Overaggressive dilation and curettage (removal of tissue often for diagnosis or as treatment) or abortion
What is a anovulatory cycle?
Cycle with lack of ovulation
What can primary ovarian insufficiency also be called?
Premature ovarian failure
What is primary ovarian insufficiency?
- Premature atresia of ovarian follicles in females of reproductive age (before 40)
What are the common causes of primary ovarian insufficiency?
- Idiopathic (most common)
- Chromosomal anomalies (esp < 30 yrs)
- Autoimmunity
What are the most common causes of anovulation?
- Pregnancy
- PCOS
- Obesity
- HPO axis abnormalities/immaturity
- Premature ovarian failure
- Hyperprolactinemia
- Thyroid disorders
- Eating disorders (low BMI)
- Cushing syndrome
- Adrenal insufficiency
- Chromosomal anomalies (Turner’s)
What is functional hypothalamic amenorrhea due to?
- Calories burned greater than consumed - low BMI or increased stress
- Functional disruption of pulsatile GnRH secretion - decreasing LH, FSH and estrogen
- Pathogenesis includes decreased leptin (due to less fat) and increases cortisol (stress, exercise)
What are the components of the female athlete triad?
- Decreased calorie availability/ excessive exercise
- Decreased bone mineral density
- Menstrual dysfunction
Describe the pathogenesis of PCOS
- Hyperinsulinemia and/or insulin resistance
- This alters the hypothalamic hormonal feedback response, increasing LH to FSH ratio increasing androgens from theca interna cells
- This decreases rate of follicular maturation resulting in unruptured follicles (cysts) + anovulation
What does PCOS present with?
- Decreased fertility
- Amenorrhea/oligomenorrhea
- Hirsutism
- Acne
- Unopposed estrogen from repeated anovulatory cycles
- Obesity
- Acanthosis nigricans
- Enlarged bilateral cystic ovaries
What disease does PCOS increase the risk of?
Endometrial cancer due to unopposed estrogen
How is PCOS treated?
- Cycle regulation via weight reduction (decreased peripheral estrone formation)
- OCPs (prevents endometrial hyperplasia due to unopposed estrogen)
- Clomiphene (ovulation induction)
- Antiandrogen (spironolactone, finasteride, flutamide)
What drug can induce ovulation?
Clomiphene
What is primary dysmenorrhea due to?
Uterine contractions to decrease blood loss -> ischemic pain
- Mediated by prostaglandins
What is primary dysmenorrhea treated with?
NSAIDs
What is a follicular cyst due to?
Unruptured Graafian follicle
What are follicular cysts associated with?
- Hyperestrogenism
- Endometrial hyperplasia
What is the most common ovarian mass in young females?
Follicular cyst
What is a theca lutein cyst also known as?
Hyperreactio luteinalis
What are theca lutein cysts due to?
hCG overstimulation
- Associated with choriocarcinoma and hydatidiform moles
What is the action of estrogen on the endometrium?
Growth p(proliferative phase)
What does hemorrhage into the corpus luteum result in?
Hemorrhagic luteal cyst