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Endocrine (Zoe) > Amenorrhea > Flashcards

Amenorrhea Flashcards

1
Q

What counts as oligomenorrhea?

A

Less than 9 periods a year

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2
Q

What 5 tests should all patients presenting with ameonorrhea have?

A 
LH
FSH
Oestradiol
Thyroid function
Prolactin
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3
Q

What blood test should you perform if a patient has hirsutism?

A

Androgen levels

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4
Q

What test should you perform if a patient has a low oestrogen a low serum FSH and is having problems with vision.

A

Pituitary MRI

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5
Q

What hormone is low in female hypogonadism?

A

Oestrogen

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6
Q

High LH/FSH and low oestrogen.

A

Primary hypogonadism (hypergonadotrophic hypogonadism)

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7
Q

Low LH/FSH and low oestrogen

A

Secondary hypogonadism (hypogonadotrophic hypogonadism)

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8
Q

What genetic syndrome is associated with premature ovarian failure?

A

Turners

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9
Q

A female patient presents with ameonorrhea. What should her FSH measurements be to confirm a diagnosis of premature ovarian failure?

A

FSH of above 430 on 2 separate occasions 1 month apart

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10
Q

What genetic conditions causes a hypothalamic secondary hypogonadism?

A

Kallmans

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11
Q

No GnRH secretion + anosmia

A

Kallmans syndrome

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12
Q

What is the rotterdam criteria for PCOS?

A

2 out of:

  1. Menstrual irregularity
  2. Hyperandrogenism
  3. Polycystic ovaries
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13
Q

Give two reasons why you get androgen excess at the hair follicle in PCOS?

A

Excess circulating androgen

Increased peripheral conversion at the hair follicle

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14
Q

What is the most likely enzyme that is deficient in CAH?

A

21α-hydroxylase

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15
Q

Is CAH dominant or recessive?

A

Revessive

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16
Q

A lady presents with amenorrhea for the last 3 months. She has signs of virilisation and a serum testosterone level of 7nmol.

A

Androgen secreting tumour

17
Q

What is the treatment for PCOS?

A 
OCP
Cyproterone acetate (often combined with OCP as dianette)
18
Q

Name a local anti androgen cream

A

Efflornithine

19
Q

What is the karotype in turners?

A

XO

20
Q

What is testicular feminisation?

A

Androgen insensitivity syndrome. Genetically XY but phenotypically female.

21
Q

A surge in what hormone causes ovulation?

A

LH

22
Q

At which point in the menstrual cycle are oestrodial levels highest?

A

Before ovulation

23
Q

At which point in the menstrual cycle are progesterone levels highest?

A

After ovulation

24
Q

When should you measure progesterone levels?

A

Day 21 (Mid luteal)

25
Q

When should you check levels of FSH, LH, estradiol, Prolactin, TSH and free androgens.

A

Day 2 - 5 (Early follicular phase)

26
Q

Explain the progesterone challenge test.

A

5 - 7 days of progesterone given. When this is stopped there should be a bleed.
If there is a bleed: Oestrogen levels fine but no ovulation occurring.
If no bleed: Problem with the uterus itself or oestrogen levels are very low.

27
Q

What is the free androgen index?

A

Serum testosterone/SHBG

28
Q

Explain the WHO classification of amenorrhea?

A

Group 1: Hypothalamic pituitary failure
Group 2: Hypothhalamic pituitary dysfunction
Group 3: Ovarian problems

29
Q

What are the management options for hypothalamic anovulation?

A

Pulsatile GnRH (SC or OV)
FSH and LH daily injections
Both need ultrasound tracking and monitoring of response

30
Q

What are the biochemical test results in hypothalamic pituitary dysfunction?

A

Normal gonadotrophins
Normal oestrogen
Anovulation

31
Q

How does insulin resistance lead to hyperandrogenism?

A

Insulin lowers SHBG levels and so increases free testosterone.

32
Q

Name three theraputic options for the induction of ovulation in PCOS

A
  1. Clomifene citrate
  2. Daily FSH and LH injections
  3. Laproscopic ovarian dithermy
33
Q

What is the first line treatment for induction of ovulation in PCOS?

A

Clomifene citrate

34
Q

Name two dopamine agonists

A

Cabergoline

Bromocriptine

35
Q

A patient who was being treated with dopamine agonists for a prolactinoma falls pregnant. What do you do?

A

Stop dopamine agonist.

Endocrine (Zoe) (12 decks)

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