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

Puberty, Development and Menstrual Disorders - Moulton Flashcards

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)

A

Androgen receptor defect (high testosterone level)

46 XY

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

25
Q

Primary amenorrhea, normal breast development, low testosterone, 46XX, vaginal obstruction, no cervix or uterus, normal fallopian tubes

Cause?

A

Mullerian agenesis (Meyer-Rokitansky-Kuster-Hauser syndrome)

Failure of mullerian ducts to fuse distally and create upper genital tract

26
Q

Primary amenorrhea, normal breast development, normal uterus, monthly dysmenorrhea, no vaginal bleeding, vaginal bulge and midline cystic mass

Tx?

A

Imperforate hymen

Hymenectomy

27
Q

Primary amenorrhea, normal breast development, normal uterus, monthly dysmenorrhea, no vaginal bleeding. No vaginal bulge.

A

Transverse vaginal septum

28
Q

MOST COMMON cause of secondary menstrual irregularity

A

PREGNANCY

29
Q

Endocrine causes of secondary amenorrhea (6)

A
  • Poorly-controlled DM
  • PCOS
  • Cushing’s
  • Thyroid dysfunction
  • Premature ovarian failure
  • Late-onset CAH
30
Q

Acquired causes of secondary amenorrhea (4)

A
  • Stress
  • Meds
  • Exercise
  • Eating disorders
31
Q

Tumor causes of secondary amenorrhea (3)

A
  • Ovarian
  • Adrenal
  • Prolactinoma
32
Q

Secondary amenorrhea - labs?

A
  • Urine hCG (pregnancy)
  • TSH (hypothyroid)
  • Prolactin (prolactinoma (> 100), ectopic causes (under 100))
  • FSH
33
Q

Secondary amenorrhea. TSH and prolactin are normal. Now do what?

Result meanings?

A

Progesterone challenge test

  • Bleeding = PCOS, other
  • No bleeding = low estrogen or outflow abnormality
34
Q

Secondary amenorrhea. TSH and prolactin are normal. Progesterone challenge test is negative. Now do what?

Result meanings?

A

Estrogen/progesterone challenge test

  • No bleeding = outflow obstruction
  • Bleeding = HP axis or ovarian issue
35
Q

Secondary amenorrhea. TSH and prolactin are normal. PCT is negative, E/P challenge test is positive. Now what?

Result meanings?

A

FSH and LH levels

  • High = ovarian issue
  • Normal/low = H-P axis issue
36
Q

How to distinguish hypothalamic from pituitary cause of secondary amenorrhea?

A

MRI of head – no mass = hypothalamic issue

Mass = pituitary issue

37
Q

Secondary amenorrhea, TSH and prolactin are normal, PCT and E/PCT are negative…

Causes of secondary outflow tract obstruction (2)

A

Asherman syndrome - scarring in uterus from previous procedure

Cervical stenosis

38
Q

Secondary amenorrhea. TSH and prolactin are normal. PCT is positive…diagnoses?

A
  • Nonclassic CAH
  • Cushing’s
  • Adrenal androgen tumor
  • PCOS
  • Sertoli-Leydig tumor
  • Exogenous androgens
39
Q

Diagnosing PCOS - criteria

A

2 of 3:

  • Chronic anovulation
  • LH:FSH = 2:1
  • Cysts beneath ovary cortex
40
Q

How to treat PCOS? (5)

A
  • 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
Q

PCOS - increased risk of what?

A

Endometrial cancer (high estrogen)

42
Q

Positive PCT, positive E/PCT, high FSH and LH…issue? (5 possibilities)

A

Primary ovarian issue

  • Ovarian failure (menopause or premature)
  • Surgical injury
  • Radiation/chemo
  • Fragile X carrier
  • Mumps
43
Q

Positive PCT, positive E/PCT, low FSH and LH, normal head CT…issue? (6 possibilities)

A

Hypothalamic issue

  • Eating disorder
  • Chronic illness
  • Cranial radiation
  • Excessive exercise
  • Malnutrition/weight loss
  • Sheehan syndrome
44
Q

Hyperandrogenism - most common causes

A

PCOS, CAH

45
Q

Hyperandrogenism, high 17-hydroxyprogesterone

A

CAH (21-hydroxylase deficiency)

46
Q

Hyperandrogenism, high urinary cortisol

A

Cushing’s

47
Q

Hyperandrogenism, high DHEA or testosterone

A

Androgen-producing tumor (adrenal or testicle)

48
Q

***Polymenorrhea - definition

A

Abnormally frequent menses ( less than 21 day intervals)

49
Q

***Menorrhagia - definition

A

Excessive and/or prolonged menstrual bleeding ( >80 mL and/or > 7 days)

50
Q

***Metrorrhagia - definition

A

Irregular bleeding

51
Q

***Menometrorrhagia - definition

A

Heavy AND irregular bleeding

52
Q

***Intermenstrual bleeding - definition

A

Scant bleeding at ovulation

53
Q

***Oligomenorrhea - definition

A

Menstrual cycles > 35 days but less than 6 months

54
Q

Most common cause of DUB

A

Anovulation due to HPO axis issue

55
Q

Acronym and List of DUB causes/groups

A

PALM COEIN

  • Polyp
  • Adenomyosis
  • Leiomyoma
  • Malignancy/hyperplasia
  • Coagulopathy (VWD)
  • Ovulatory issue (PCOS)
  • Endometrial (Infection)
  • Iatrogenic (IUD, exogenous)
  • Not yet classified (AVM)
56
Q

Treating massive AUB

A

Estrogens, then combo HC

57
Q

Treating moderate AUB

A

Combo HC

58
Q

Treating unresponsive AUB

A

Endometrial ablation, hysterectomy

Repro 2 (28 decks)

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