PRIMARY AMENORRHEA. Flashcards
(35 cards)
What is the definition of primary amenorrhea according to the text?
- Absence of menstrual bleeding by age 16 years in the presence of normal secondary sexual characteristics, OR
- Absence of menstrual bleeding by age 13 years in the absence of other evidence of puberty (breast development)
Well done!
What percentage of causes of primary amenorrhea are of developmental (genetic or structural) origin?
about 60% of causes of primary amenorrhea are of developmental (genetic or structural) origin.
Well done!
What must be ruled out in cases of primary amenorrhea?
Pregnancy
What are the compartments into which disorders of menstrual function can be categorized, according to physiological principles?
disorders of menstrual function can be compartmentalized into:
- Central nervous system
- Anterior pituitary
- Ovary
- Outflow tract
Well done!
delayed puberty is a diagnosis of exclusion.
True or False
True
Here’s the first question:
What is an example of a hypothalamic factor that can cause primary amenorrhea?
- Chronic illness
- Space occupying brain lesion
- Stress
- Exercise
- Weight-related (Low body weight, excessive weight loss, obesity)
Well done!
Next question: What is an example of an anterior pituitary disorder that can cause primary amenorrhea?
Pituitary adenomas
Hyperprolactinaemia
Empty sella syndrome
Hypothyroidism
Drug induced
What ovarian disorder is associated with abnormal folliculogenesis?
Polycystic ovary syndrome (PCOS)
What syndrome is characterized by gonadal agenesis/dysgenesis?
Turner’s syndrome
What is an example of a condition where there’s abnormal or absent germ cells?
(Aside from Turner’s syndrome, which one is mentioned alongside it?)
1) Resistant ovary syndrome
2) Premature ovarian failure
What are some causes of primary amenorrhea related to outflow tract disorders? (According to the compartment 4 mentioned earlier)
You’re doing great!
1) Mechanical
- Müllerian agenesis/dysgenesis, (Rokitansky Kuster Hauser syndrome)
- Transverse septum
- Imperforate hymen
2) Androgen receptor abnormality
- Androgen insensitivity syndrome
What aspects of growth and development should be enquired about during history taking?
Enquire on
1) growth and development - seek other signs of puberty.
●Breast development
● Hair development (pubic and axillary)
●2) Psychological dysfunction or emotional stress from verbal and non-verbal cues -
3) enquire about family and social (educational) history.
What features are included in a general physical examination?
a general physical examination includes:
- Weight
- Height
- BMI
- BP
- Clinical thyroid status
- Dysmorphic signs (e.g., webbed neck, widely spaced nipples)
What stages should be assessed during the physical examination?
Tanner breast and axillary hair stages.
What is another area that should be examined besides breast and axillary hair stages?
the following areas should be examined:
Abdomen and pelvic examination.
Some specific things to look for include:
● Mass arising from pelvis
● Groin nodes
● Hernias
Well done!
What stage of pubic hair development is characterized by “Terminal hair that fills the entire triangle overlying the pubic region”?
Stage 4
What stage of pubic hair development is characterized by “No Hair”?
According to the Pubic Hair Scale:
Stage 1 corresponds to “Prepubertal; No Hair”.
What stage of pubic hair development is characterized by “Terminal hair that extends beyond the inguinal crease onto the thigh”?
Stage 5
What stage of pubic hair development is characterized by “Downy hair (soft fine hair)”?
Stage 2
What stage of pubic hair development is characterized by “Scant terminal hair (dark, thick hair)”?
Stage 3
What system/staging is used for assessing breast development and axillary hair stages?
The Tanner staging system is used to assess:
- Breast development
- Pubic and axillary hair development
The Tanner stages help track physical changes during puberty.
What stage of female breast development is characterized Breast tissue palpable outside areola;
No areolar development
Stage 3
What stage of female breast development is characterized by “Preadolescent; elevation of papilla only”?
Stage 1 is indeed characterized by:
“Preadolescent; elevation of papilla only”
What stage of female breast development is characterized by “Mature; projection of papilla only, areola recessed to general breast contour”?
“Mature; projection of papilla only, areola recessed to general breast contour”
Stage 5 represents the final stage of breast development.
