183- female endocrine 2

Question 1

hypothalamic/cns disorders causing amenorrhea

Answer 1

granulomas (esp sarcoid)

Question 2

Functional hypothalamic amenorrhea: what is decreased? what other levels are abnormal? what are some causes?

Answer 2

decreased GnRH/LH/FSH

Opioid tone is increased, leptin levels are decreased

stress, nutrition, exercise (think runners, gymnasts, kiera knightly)

Question 3

what pituitary disorders can cause irregular menses

Answer 3

increased prolactin form adenomas/drugs (accompanied by galactorrhea)

Question 4

what is the basic cycle of hyperandrogenic chronic anovulation? is it common?

Answer 4

most common cause of irregular menses. Increased frequency of GnRH pulses -> more LH and less FSH -> ovary makes more androgens -> masculinization, peripheral aromatization to estrogen leads to unopposed endometrial proliferation and cancer. Testosterone blocks feedback to pituitary as well as insulin resistance (lots of DM2)

Question 5

two most common causes of hyperandrogenic chronic anovulation

Answer 5

polcyistic ovary syndrome. non-classic CAH

Question 6

how is insulin involved in repro?

Answer 6

increases LH secretion from pituitary, increases androgens from adrenal and ovary

Question 7

most sensitive marker of ovary damage? when would you expect to see change?

Answer 7

FSH. Not increased in hypothalamic, pituitary, or anatomic disease. Increased in ovarian disease only

Question 8

progestin challenge

Answer 8

assay to determine whether endometrium has been exposed to estrogen. If you give P and they have bleeding, there has been exposure to estrogens