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Endocrine Week 5 2017/18 > 2: Ovulatory disorders (gynae) > Flashcards

2: Ovulatory disorders (gynae) Flashcards

1
Q

What is oligomenorrhoea?

A

Menstrual cycles lasting longer than 35 days

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2
Q

What is amenorrhoea?

A

Absent menstruation

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3
Q

Amenorrhoea can be either ___ or ___.

A

primary

secondary

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4
Q

Which abnormal event of the menstrual cycle can cause oligomenorrhoea or amenorrhoea?

A

Anovulation

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5
Q

GnRH is released from the hypothalamus in a pulsatile manner.

Which types of pulses cause the secretion of

a) FSH
b) LH?

A

a) FSH is secreted by low frequency GnRH pulses

b) LH is secreted by high frequency GnRH pulses

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6
Q

Which hormones cause thickening of the endometrium during the menstrual cycle?

A

Oestradiol

FSH

LH

Progesterone

hCG

basically all of them

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7
Q

Which organs secrete oestrogens?

A

Ovaries

Adrenal cortex

Placenta

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8
Q

Oestrogens cause the (thickening / thinning) of the cervical mucus.

A

thinning

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9
Q

Which process does high concentrations of oestrogen cause?

Which hormones are affected?

A

Negative feedback AND Positive feedback

FSH, Prolactin secretion inhibited

LH secretion stimulated

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10
Q

Secretion of which hormone is inhibited by progesterone?

A

LH

seeing as LH surges to cause ovulation, and progesterone secretion marks the luteal phase and menstruation

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11
Q

What effect does progesterone have on body temperature?

A

Increases body temperature

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12
Q

Progesterone is a smooth muscle (relaxant / contractor).

A

smooth muscle relaxant

presumably to make menstruation easier

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13
Q

Regular menstrual cycles suggests that ___ is occuring as normal.

A

ovulation

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14
Q

Irregular menstrual cycles indicate that which abnormal event is occuring?

A

Anovulation

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15
Q

___ disorders are a common cause of presumed infertility.

A

Ovulatory disorders

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16
Q

What are three causes of anovulation according to the World Health Organisation?

A

I - Hypothalamic-pituitary failure - hypogonadotrophic hypogonadism

II - Hypothalamic-pituitary dysfunction - PCOS, hyperprolactinaemia

III - Ovarian failure - menopause, premature

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17
Q

What is hypothalamic-pituitary failure, causing anovulation, also known as?

A

Hypogonadotrophic hypogonadism

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18
Q

What are four important causes of hypogonadotrophic hypogonadism?

A

Stress

Low BMI (e.g anorexia nervosa)

Excessive exercise (often goes with the above, or eating disorders)

Kallmann syndrome (associated with anosmia)

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19
Q

What hormone abnormalities are seen in hypogonadotrophic hypogonadism?

A

Low GnRH

Low FSH and LH

so low oestrogen

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20
Q

What is the main symptom of hypogonadotrophic hypogonadism?

A

Amenorrhoea

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21
Q

How can hypogonadotrophic hypogonadism be diagnosed?

A

Progesterone challenge test

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22
Q

How is hypogonadotrophic hypogonadism treated?

A

Treat underlying causes (stress, sort BMI, hormone tests/USS for tumours)

GnRH pump

IV FSH/LH injections

23
Q

What are two ovulatory disorders which come under WHO II: Hypothalamic-pituitary dysfunction?

A

Polycystic ovary syndrome (PCOS)

Hyperprolactinaemia

24
Q

What is PCOS?

A

Polycystic ovary syndrome

Causes hyperandrogenism (acne, hirsutism) and oligo- or amenorrhoea

25
Q

What are the three diagnostic criteria for PCOS?

A

1. Oligo- or amenorrhoea

2. Evidence of polycystic ovaries on USS

3. Hyperandrogenism symptoms (acne, hirsutism)

26
Q

What is an endocrine complication of PCOS?

A

Insulin resistance

27
Q

What two effects does hyperinsulinaemia have on the HPO axis?

A

Elevates LH

Reduces SHBG levels, leading to increased levels of free testosterone > hyperandrogenism

28
Q

What BMI must patients be under before they are considered for any sort of infertility treatment?

A

< 35, <30 depending on some places

29
Q

What supplement are all pregnant women given?

Why?

A

Folic acid

Helps to prevent birth defects

30
Q

What general type of treatment is used for patients with PCOS?

A

Ovulation induction

31
Q

What is the first line type of ovulation induction in patients with PCOS?

A

Clomiphene citrate therapy

32
Q

If clomifene citrate isn’t effective in women with PCOS, what other types of ovulation induction can be attempted?

A

Gonadotrophin injections

As hyperandrogenism arrests follicular growth, FSH injections are used to restimulate it

33
Q

What is an uncommon type of ovulation induction?

A

Laparoscopic ovarian drilling

somehow causes ovulation

34
Q

What are three complications of ovulation induction therapy?

A

Ovarian hyperstimulation (which can be lethal)

Multiple pregnancy (woo twins)

Possibly ovarian cancer

35
Q

What are the two types of twins?

A

Monozygotic (identical) twins - the one egg splits into two zygotes

Dizygotic (fraternal) twins - two sperm cells fertilise two eggs

36
Q

What complication of multiple pregnancy involves transfusion of blood from one twin to another (& actually happened to me and scott lol)?

A

Twin-twin transfusion syndrome

37
Q

Apart from PCOS, what is another hypothalamic-pituitary disorder which can cause anovulation?

A

Hyperprolactinaemia

38
Q

Why does hyperprolactinaemia cause anovulation?

A

Prolactin inhibits the secretion of GnRH

39
Q

What should be assessed on examination of anyone with suspected pituitary gland swelling or tumours?

A

Visual fields

for bitemporal hemianopia

40
Q

How is hyperprolactinaemia treated?

A

Dopamine agonists

e.g CABERGOLINE

41
Q

In women with hyperprolactinaemia who are trying to conceive, when should the use of dopamine agonists be stopped?

A

Once they become pregnant

42
Q

What is the third cause of anovulation according to the WHO?

A

Ovarian failure

43
Q

What level of

a) gonadotrophins
b) oestrogen

is seen in ovarian failure?

A

a) High gonadotrophins (in an attempt to compensate)

b) Low oestrogen (because the ovaries can’t produce any)

44
Q

When does ovarian failure occur normally?

A

Menopause

45
Q

When is ovarian failure premature?

A

When it occurs before the age of 40

46
Q

Ovarian failure causes (oligomenorrhoea / amenorrhoea).

A

amenorrhoea

47
Q

What are the “menopausal” symptoms of ovarian failure?

A

Hot flushes

Night sweats

Vaginal dryness

Irritability

Reduced libido

48
Q

What is a genetic cause of premature ovarian failure?

A

Turner’s syndrome

49
Q

What is the karyotype of Turner’s syndrome?

A

45 XO

50
Q

What is the presentation of someone with Turner’s syndrome?

A

Girl of short stature and undeveloped sexual characteristics

Amenorrhoea

51
Q

Apart from Turner’s, what are some other causes of premature ovarian failure?

A

Iatrogenic - radio/chemotherapy, surgery

Autoimmune

52
Q

How can women with premature ovarian failure raise their own family?

A

Egg donation

53
Q

What may women with premature ovarian failure be put on to control their symptoms?

A

HRT

i.e oestrogen/progesterone via combined contraceptive pill

Endocrine Week 5 2017/18 (7 decks)

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