Adolescent gynae

Question 1

Gillick competence

Answer 1

• A child’s capacity to consent

Their age, mental capcity and maturity
Their understanding of the issue - advantages, disadvantages, long term impact, consequences
Alternate options

If you don’t think a child is gillick competent you must seek consent from their parent or carer

Question 2

Fraser guidelines
- For contraception, sexual health, STI’s, TOP

Answer 2

The young person cannot be persuaded to inform their parents
The young person understands the advice
The young person’s physical or mental health are likely to suffer unless they receive the treatment or advice
It is in the young person’s best interest to receive the advice etc without their parents consent
The young person is very likely to continue having sex with or without contraceptive treatment

Question 3

Primary amenorrhoea starting investigations

Answer 3

HCG
FSH
E2
TSH –> refer endocrinologist
Prolactin –> MRI if abnormal
Pelvic USS

Question 4

Primary amenorrhoea with uterus present ddx

Answer 4

High FSH, Low E2 - POI (Turners, FMR1 mutation, perrault syndrome (hearing test), ovarian damage, TPO Ab

Low FSH, Low E2 - central amenorrhoea.
- Functional hypothalamic
GnRH deficiency
Other hypothalamic pituitary pathology
Consitutional delay
- Screen for eating disorder, stress, over exercise, smeel test, moelcular genetic testing for KS, brain MRI

Normal FSH and normal / low E2
- Distal outflow tract obstruction

Normal FSH and normal low E2 but hyperandrogenism - do testosterone, SHBG, DHEAS, 17OH P, urine free cortisol, consider adrenal and ovarian imaging
- PCOS
- Late onset CAH
- Cushings syndrome
- Androgen secreting tumour

Question 5

Primary amenorrhoea without uterus

Answer 5

Do Karyotype and testosterone levels
- 46XX - mullerian agenesis (MKRH) - has female range testosterone

• 46XY - Androgen insensitivity syndrome - male range testosterone syndrome

Question 6

Causes of POI

Answer 6

Chromosomal:
45XO also moasics
X structural anomalies - deletions etc
46XY - swyers syndrome
46XX pure gonadal dysgenesis

Single gene mutations
Fragile X
Galactossaemia

Enzyme deficiency
- 17OH
Aromatase deficiency

Autoimune disorders
- Autoimmune throiditis or oophoritis

Injury
Chemo, radiation
Mumps oophoritis