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Repro 2 > Puberty, Development and Menstrual Disorders - Moulton > Flashcards

Puberty, Development and Menstrual Disorders - Moulton Flashcards

(58 cards)

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1
Q

Average age of menarche

98% have it by age ___

In relation to Thelarche?

A

12.43

15

2-3 years after breast budding

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2
Q

***Primary amenorrhea (2)

A

No menarche nor secondary sexual characteristics by 13

OR

No menarche WITH secondary secondary sexual characteristics by 15

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3
Q

Menorrhagia - definition

A

More than 80cc blood, or changing pad every 1-2 hours for more than 7 days

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4
Q

Essential weight to start menstrual cycles

A

106 lbs

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5
Q

Initial endocrine change associated w/ puberty

A

Androgen production by adrenal cortex

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6
Q

TAG Me

A

Stages of normal development

  • Thelarche
  • Adrenarche
  • Growth peak
  • Menarche
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7
Q

Tanner stages - breasts

A 
1 = prepuberty (flat)
2 = primary bud, areola grows
3 = further enlargement
4 = secondary mound (areola)
5 = mature, areola recession
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8
Q

Tanner stages - pubic hair

A 
1 = none
2 = sparse along labia
3 = darker, coarser
4 = more, not on thighs
5 = medial thighs (triangle)
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9
Q

Heterosexual vs. isosexual precocious puberty

A 
Heterosexual = opposite sex (virulization, CAD, etc.)
Isosexual = appropriate sex
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10
Q

Congenital adrenal hyperplasia

A

21-hydroxylase deficiency –> excessive androgen production –> virulization/masculinization

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11
Q

True isosexual vs. Pseudoisosexual

A

True = early onset of normal axis

Pseudo = early estrogens outside of axis (tumor, etc)

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12
Q

Diagnosing true isosexual precocious puberty

Treatment?

A

Administer exogenous GnRH, see rise in LH

Leuprolide (GnRH agonist)

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13
Q

10% of true isosexual precocious puberty are caused by a _____

Diagnosing?

A

CNS disorder

MRI of head

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14
Q

Most common effect of untreated precocious puberty

A

Short stature (under 5 feet)

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15
Q

Precocious puberty, cystic bone lesions, cafe au lait spots, hypercortisolism

A

McCune-Albright syndrome (polyostic fibrous dysplasia)

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16
Q

Precocious puberty, high estrogen level, GI polyps, hyperpigmentation in and around mouth

A

Peutz-Jeghers syndrome (estrogen-secreting sex cord tumor)

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17
Q

When is puberty considered delayed? (3 options)

A

No secondary sexual characteristics by 13

No menarche by 15-16

No menarche after 5 years from thelarche

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18
Q

Kind of Hypergonadotropic Hypogonadism

A

Gonadal dysgenesis (Turner syndrome)

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19
Q

Kinds of Hypogonadotropic hypogonadism (6)

A
  • Physiologic delay
  • Kallmann syndrome
  • Anorexia/extreme exercise
  • Pituitary tumors/disorders
  • Hyperprolactinemia
  • Drug use
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20
Q

Anatomic causes of delayed puberty (3)

A
  • Mullerian agenesis
  • Imperforate hymen
  • Transverse vaginal septum
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21
Q

Secondary amenorrhea - definition

A

Prior menses, now none for 6 months or more

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22
Q

Kallmann syndrome

Type of hypogonadism

A

KAL gene (X chromosome) – prevents GnRH neurons into hypothalamus – Primary amenorrhea + anosmia/hyposmia

Hypogonadotropic

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23
Q

Webbed neck, flat shield chest, coarctation of aorta, rudimentary streaked ovaries, no sexual development

A

Turner syndrome (hypergonadotropic hypogonadism)

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24
Q

Androgen insensitivity syndrome – what is it?

Patient genotype?

Phenotype? (findings)

Study These Flashcards
A

Androgen receptor defect (high testosterone level)

46 XY

Undescended testes, no uterus, female external genitalia, little pubic hair

25
Primary amenorrhea, normal breast development, low testosterone, 46XX, vaginal obstruction, no cervix or uterus, normal fallopian tubes Cause?
Mullerian agenesis (Meyer-Rokitansky-Kuster-Hauser syndrome) Failure of mullerian ducts to fuse distally and create upper genital tract
26
Primary amenorrhea, normal breast development, normal uterus, monthly dysmenorrhea, no vaginal bleeding, vaginal bulge and midline cystic mass Tx?
Imperforate hymen Hymenectomy
27
Primary amenorrhea, normal breast development, normal uterus, monthly dysmenorrhea, no vaginal bleeding. No vaginal bulge.
Transverse vaginal septum
28
MOST COMMON cause of secondary menstrual irregularity
PREGNANCY
29
Endocrine causes of secondary amenorrhea (6)
- Poorly-controlled DM - PCOS - Cushing's - Thyroid dysfunction - Premature ovarian failure - Late-onset CAH
30
Acquired causes of secondary amenorrhea (4)
- Stress - Meds - Exercise - Eating disorders
31
Tumor causes of secondary amenorrhea (3)
- Ovarian - Adrenal - Prolactinoma
32
Secondary amenorrhea - labs?
- Urine hCG (pregnancy) - TSH (hypothyroid) - Prolactin (prolactinoma (> 100), ectopic causes (under 100)) - FSH
33
Secondary amenorrhea. TSH and prolactin are normal. Now do what? Result meanings?
Progesterone challenge test - Bleeding = PCOS, other - No bleeding = low estrogen or outflow abnormality
34
Secondary amenorrhea. TSH and prolactin are normal. Progesterone challenge test is negative. Now do what? Result meanings?
Estrogen/progesterone challenge test - No bleeding = outflow obstruction - Bleeding = HP axis or ovarian issue
35
Secondary amenorrhea. TSH and prolactin are normal. PCT is negative, E/P challenge test is positive. Now what? Result meanings?
FSH and LH levels - High = ovarian issue - Normal/low = H-P axis issue
36
How to distinguish hypothalamic from pituitary cause of secondary amenorrhea?
MRI of head -- no mass = hypothalamic issue Mass = pituitary issue
37
Secondary amenorrhea, TSH and prolactin are normal, PCT and E/PCT are negative... Causes of secondary outflow tract obstruction (2)
Asherman syndrome - scarring in uterus from previous procedure Cervical stenosis
38
Secondary amenorrhea. TSH and prolactin are normal. PCT is positive...diagnoses?
- Nonclassic CAH - Cushing's - Adrenal androgen tumor - PCOS - Sertoli-Leydig tumor - Exogenous androgens
39
Diagnosing PCOS - criteria
2 of 3: - Chronic anovulation - LH:FSH = 2:1 - Cysts beneath ovary cortex
40
How to treat PCOS? (5)
- Weight loss - OCPs (reduces FSH/LH, and increases sex hormone binding globulins, thus decreasing testosterone level) - Clomiphene - Spironolactone (competes for testosterone binding sites) - Metformin
41
PCOS - increased risk of what?
Endometrial cancer (high estrogen)
42
Positive PCT, positive E/PCT, high FSH and LH...issue? (5 possibilities)
Primary ovarian issue - Ovarian failure (menopause or premature) - Surgical injury - Radiation/chemo - Fragile X carrier - Mumps
43
Positive PCT, positive E/PCT, low FSH and LH, normal head CT...issue? (6 possibilities)
Hypothalamic issue - Eating disorder - Chronic illness - Cranial radiation - Excessive exercise - Malnutrition/weight loss - Sheehan syndrome
44
Hyperandrogenism - most common causes
PCOS, CAH
45
Hyperandrogenism, high 17-hydroxyprogesterone
CAH (21-hydroxylase deficiency)
46
Hyperandrogenism, high urinary cortisol
Cushing's
47
Hyperandrogenism, high DHEA or testosterone
Androgen-producing tumor (adrenal or testicle)
48
***Polymenorrhea - definition
Abnormally frequent menses ( less than 21 day intervals)
49
***Menorrhagia - definition
Excessive and/or prolonged menstrual bleeding ( >80 mL and/or > 7 days)
50
***Metrorrhagia - definition
Irregular bleeding
51
***Menometrorrhagia - definition
Heavy AND irregular bleeding
52
***Intermenstrual bleeding - definition
Scant bleeding at ovulation
53
***Oligomenorrhea - definition
Menstrual cycles > 35 days but less than 6 months
54
Most common cause of DUB
Anovulation due to HPO axis issue
55
Acronym and List of DUB causes/groups
PALM COEIN - Polyp - Adenomyosis - Leiomyoma - Malignancy/hyperplasia - Coagulopathy (VWD) - Ovulatory issue (PCOS) - Endometrial (Infection) - Iatrogenic (IUD, exogenous) - Not yet classified (AVM)
56
Treating massive AUB
Estrogens, then combo HC
57
Treating moderate AUB
Combo HC
58
Treating unresponsive AUB
Endometrial ablation, hysterectomy

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