Reproductive Flashcards
(40 cards)
What is polycystic ovarian syndrome (PCOS)?
Disease characterised by excess ovarian androgen production
What is the pathophysiology of polycystic ovarian syndrome (PCOS)?
Poorly understood but related to insulin resistance
Insulin increases LH secretion
Insulin lowers sex-hormone binding-globulin increasing free testosterone
How is polycystic ovarian syndrome (PCOS) diagnosed?
2 or more of
- oligo/amenorrhoea
- polycystic ovaries on US
- hyperandrogenism (acne, oily skin, hirsutism)
What would you expect to see with the following blood tests in polycystic ovarian syndrome (PCOS)?
- LH
- FSH
- oestrogen
- testosterone
- progesterone
LH: high FSH: low (high LH:FSH ratio) Oestrogen: normal Testosterone: high Progesterone: high
What are the treatments for polycystic ovarian syndrome (PCOS)?
- Lifestyle modification
- Clomifene citrate + metformin
- Gonadotrphin injection or ovarian drilling
What risk does ovulation induction pose?
Multiple pregnancy (twin-twin-transfusion-syndrome, perinatal mortality, prematurity)
What is idiopathic hypogonadotrophic hypogonadism (IHH)?
Inability to activate GnRH secretion causing hypogonadism
What is Kallman’s syndrome?
Inability to activate GnRH secretion causing hypogonadism, delayed puberty and anosmia
What is Turner’s syndrome and what is its phenotype?
Genetic XO karyotype
Short, webbed neck, shield chest, low ears
How does Turner’s syndrome cause amenorrhoea?
Chromosomal abnormality (XO) causes gonadal dysgenesis resulting in non-functioning ovaries.
If this occurs in childhood = primary amenorrhoea
If this occurs in adulthood = secondary amenorrhoea
How does Turner syndrome affect pubertal development?
No breast development (if ovaries fail in childhood)
Pubic hair development spared as androgen production functioning
What is primary amenorrhoea and what does it raise suspicion of?
No periods by 16
Underlying genetic disorder
What gene is associated with idiopathic hypogonadoptrophic hypogonadism (IHH)?
Kisspepsin gene
What is secondary amenorrhoea and what causes it?
Cessation of periods
Problem with HPO axis (hypothalamus, pituitary, ovaries) or the uterus
What can cause functional hypothalamic amenorrhoea?
Stress
Excessive exercise
Low bMI
What pituitary problems can cause amenorrhoea?
Prolactinoma
Panhypopituitarism
Infarction (apoplexy, Sheehan)
What is premature ovarian failure and what can cause it?
Menopause before 40 years
Chromosomal abnormalities (e.g. Turners)
Pelvic radio/chemotherapy
What blood test is used to confirm pregnancy?
Human chorionic gonadotrophin
What blood test is used to confirm ovulation?
Mid-luteal (d21) progesterone
What test confirms normal oestrogen levels?
Progesterone challenge test
menstrual bleed 5 days after progesterone course confirms normal oestrogen levels
What are the three classifications of anovulation and what pattern would they show on blood tests?
Hypothalamic-pituitary failure (Group I)
- low gonadotrophin
- normal prolactin
- low oestrogen
Hypothalamic-pituitary dysfunction (Group II)
- abnormal gonadotrophin (e.g. high LH:FSH ratio in PCOS)
- possible high prolactin (e.g. prolactinoma)
Ovarian failure (Group III)
- high gonadotrphin
- low oestrogen
What blood tests would you do in a patient with irrefular menstrual cycles?
Pregnancy test (hCG)
Confirm if ovulation (mid-luteal progesterone)
If anovulatory, classify it with
- gonadotorphin
- prolactin
- oestrogen
Measure thyroid status (thyroid dysfunction can cause ovulatory disorders)
What can cause hypothalamic-pituitary failure anovulation (group I)
Physioloigcal stress
Pituitary tumour
Idiopathic hypogonadotrophic hypogonadism
How can ovulation be induced in patients with hypothalamic-pituitary failure anovulation (group I)?
Pulsatile GnRH (subcutaneous pump)
Gonadotrophin injection
