Amenorrhea

Question 1

3 criteria for clinical Amenorrhea

Answer 1

1. no mens at 14yo + no secondary sex char.
2. no mens at 16yo + w/ or w/o secondary sex char.
3. has mens in the past but currently 6 mos w/o mens

Question 2

Clinical demonstration of menstrual fxn

Answer 2

visible external menstrual discharge

Question 3

mens depends on what structures?

Answer 3

patent outflow tract, endometrium, ovaries, ant. pituitary gland, hypothalamus

Question 4

hormone produced by hypothalamus for reproductive cycle

Answer 4

GnRH

Question 5

hormone produced by Ant. Pituitary gland for reproductive cycle

Answer 5

LH and FSH

Question 6

What happens in Turner Syndrome

Answer 6

normal germ cell migration and mitosis; oogonia dont undergo meiosis –> rapid loss of oocyes –> gonads w/o follicles by birth –> appears as fibrous streak

Question 7

Hormones produced by Ovary for reproductive cycle

Answer 7

estrogen and progesterone

Question 8

What are the 4 compartments?

Answer 8

Compartment I - outflow tract and uterus

Compartment II - ovary

Compartment III - Ant pituitary gland

Compartment IV - CNS and hypothalamus

Question 9

What the use of the 4 compartmets

Answer 9

used in diagnosis. any disorder could be classified using the 4 compartments

Question 10

Info needed to evaluate amenorrhea

Answer 10

Psychological state
Genetic anomalies
Nutritional status
Growth and Devt
Anatomy of Reproductive tract
Any CNS disease

Question 11

An important clinical sign. A term used for nonpuerperal breast secretion

Answer 11

Galactorrhea

Question 12

1st step in evaluating a patient with amenorrhea

Answer 12

Check for pregnancy

Question 13

After checking for pregnancy, what are the succeeding steps in the workup for amenorrhea

Answer 13

TSH measurement
Prolactin levels
Progestational challenge

Question 14

Initial step in patient presenting with galactorrhea

Answer 14

TSH and prolactin measurements + imaging of sella turcica

Question 15

effect of Hypothyroidism on galactorrhea

Answer 15

dec in hypothalamic content of dopamine –> unopposed TRH efect on pituitary cells –> cells secrete prolactin

Question 16

Constant stimulation by TRH to the ant pituitary gland due to hypothyroidism results in?

Answer 16

hypertrophy/hyperplasia of pituitary –> tumor like presentation on radiography

Question 17

2 hormonal factors resulting in amenorrhea

Answer 17

hypothyroidism and hyperprolactinemia

remember that breastfeeding is contraceptive

Question 18

What is the purpose of the progestational challenge?

Answer 18

assess the level of endogenous estrogen and patency of outflow tract

Question 19

How do you interpret the results of the progestational challenge

Answer 19

after 2-7 days:
(+) withdrawal response or bleeding –> diagnosis of anovulation, fxnal outflow tract, fxnal endometrium –> minimal fxn of ovary, pituitary and CNS is established

Question 20

What does blood spots mean in progestational challenge

Answer 20

marginally positive response; need to be monitored; may be recategorized after some time

Question 21

What does a negative withdrawal response in the progestational challenge mean if endogenous estrogen is within normal levels?

Answer 21

means that the endometrium is decidualized (will not shed)

2 causes for this: due to high androgen levels and due to adrenal enzyme deficiency (leading to high androgen levels)