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Endocrine > Amenorrhea > Flashcards

Amenorrhea Flashcards

1
Q

Primary vs Secondary Amenorrhea

A

Primary: No previous menses
Secondary: absence of menses for 6 mo

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2
Q

Most common cause of amenorrhea

A

-Unrecognized Pregs (most common)

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3
Q

Amenorrhea from hypothalamic/pituitary suppression

A

-Undefined, pituitary disease/tumor
-Anorexia, excessive exerci
se (Low body fat), obesity
-Thyroid disease (Hypo or hyper)
-Hyperprolactinemia - Usually due to a pit tumor (prolactin suppresses GnRH release)

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4
Q

Amenorrhea due to Anovulation

A

1) PolyCystic Ovarian Syndrome (PCOS)
- Most common endocrine disorder in reproductive-age women
- ANDROGEN EXCESS

2) Ovarian Tumor
- Disruption E/P synthesis/balance

3) Congenital adrenal hyperplasia (Excessive androgen)

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5
Q

Last cause of Amenorrhea

A

Premature ovarian insufficiency

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6
Q

Treatment with Progestins. Why?

A

To identify cause

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7
Q

Diagnostic Oral or IM MPA for 10-14 d

A

1) If estradiol levels are sufficient, withdrawal bleeding will occur upon cessation
- -> Amenorrhea is anovulatory
2) failure to induce menses –> low estrogen levels
- -> ovarian dysfunction
- ->hypothalamic/pit dysfunction, hyperprolactinemia
3) Uterine problems

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8
Q

Hypothalamic (Hypoestrogenic) amenorrhea

Tx

A
  • Treat with estrogen +/- progestins

- Will reduce the risk of oteoporosis and other signs of insufficient estrogen (hot flashes, insomnia)

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9
Q

Hyperprolactinemia

Dx

A

blood prolactin levels over 100 ng/ml –> pituitary adenoma

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10
Q

Hyperprolactinemia:

Other etiologies

A

OC, antipsychotics, antidepressants:

  • Antag. dop release –> disinhibition of prolactin release
  • DAR blockers
  • Imipramines & SSRIs
  • H2 antagonist
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11
Q

Hyperprolactinemia

Tx

A

Dopamine agonist:
Cabergoline first line
2X weekly

-dopamine will suppress prolactin release

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12
Q

PCOS

presentation

A
  • Amenorrhea or menorrhagia
  • Anovulatory bleeding (non-cyclical)
  • -> CL does not form and progesterone not secreted
  • ->increased LH
  • -> Unopposed production of estradiol (Fat tissue) –>endometrium overgrowth–>necrosis and irregular bleeding
  • Increased T from Theca cells
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13
Q

What is considered to be a disorder of androgen excess?

A

PolyCystic Ovarian Syndrome

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14
Q

What is PCOS a risk factor for?

A

Metabolic syndrom, T2DM, dyslipidemia, and CVD

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15
Q

Characteristics of PCOS

A

-Menstrual abnormalities
-Infertility
-Hyperandrogenism/virilization
-Obesity
Symptoms of diabetes/insulin resistance

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16
Q

What is the most frequent cause of anovulatory infertility and most common endocrine disease of reproductive age women?

A

PCOS

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17
Q

PCOS Risk Factors

A

Family History of PCOS

Central obesity

18
Q

PCOS cause/Dx

Estrogen

A

Underlying defect unknown

  • Elevated LH/FSH ratio
  • Arrest of follicular development
  • Adipose cells contribute to androgen aromatization to estrogen –> estrogen up–> FSH down –> Obese have increased E and T
19
Q

PCOS cause/Dx

Testosterone

A

Elevated plasma T

  • Total T normal
  • free T elevated due to lower Sex Hormone Binding Globulin

-Must exclude androgen-secreting tumors

20
Q

PCOS Tx goals

A

1) Reduce ovarian androgen secretion and restore normal hormonal cycle
- Normalize endometrium
- Restore fertility

2) Reduce insulin resistance
- Weight Loss
- Metformin

21
Q

PCOS first line therapy

A

CHC

22
Q

PCOS CHC effects

A

1) Restores normal hormonal cycle
2) increases SHBG to decreasae free T
3) Reduce ovarian hormone production –> decreased androgen
4) Decrease hyperandrogenemia, hirsutism,

23
Q

PCOS CHC Contraindications

A

-Not if pregnancy is goal
-not if estrogens are contraindcated
Eg, Breast/uterine/endoM/ ovarian cancers, CVD
-Androgenic progestins avoided

24
Q

PCOS CHC preferred progestin. Why

A

Desogestrel.

Non-androgenic

25
Q

PCOS pharmacotherapy:

Progesterone only use

A

Suppresses ovulation and prevents endometrial hyperplasia

*Especially appropriate with menorrhagia

26
Q

PCOS pharmacotherapy:

Prog only ADRs

A

Fewer than COC

  • Weight gain
  • Doesn’t suppress androgenic effects
27
Q

PCOS pharmacotherapy:

Progestin only contraindications

A

Breast/cervical/uterine/vaginal cancers

Thromboembolic disease, stroke

28
Q

PCOS pharmacotherapy: prog-only Oral

A

Medroxyprogesterone

  • 12-14 d to induce withdrawal bleeding
  • Does not provide contraception
  • Not FDA approved
  • Slightly androgenic–> can worsen hirsutism, acne
29
Q

PCOS pharmacotherapy

Prog-only IUD

A

levonorgestrel

Continuous prog, prevents pregnancy and endometrial hyperplasia

30
Q

PCOS pharmacotherapy

Metformin/thiazolidinediones

A
  • Improve insulin sensitivity
  • Increase SHBG levels
  • Lower free androgen
  • Increase ovulatory rate
31
Q

PCOS and Infertility Pharmacotherapy

Antiandrogens:Glucocorticoids

A
  • Suppress Adtrenal androgen production
  • Does not restore fertility
  • Not FDA approved for PCOS
32
Q

PCOS and Infertility Pharmacotherapy

Spironolactone, flutamide

A
  • Androgen receptor antagonists
  • In conjunction w/ COCs
  • F more effective, but is hepatotoxic
  • NEITHER treatment FDA approved for PCOS
33
Q

PCOS and Infertility Pharmacotherapy:
Infertility:
Clomiphene (Clomid)

A

An Estrogen receptor antagonist: Increases FSH and LH by induction of GnRH pulse rate

*Used after MPA to induce withdrawal bleeding

34
Q

PCOS and Infertility Pharmacotherapy

Metformin

A

Increases ovulatory rates (minimal)
Effective in clomiphene resistant p.
**Decreases miscarriage rates

35
Q

Premature Ovarian Insufficiency

Defined:

A

Sex steroid deficiency, amenorrhea, and infertility in women under 40

36
Q

Premature Ovarian Insufficiency

Characteristics

A
  • > 4 mo amenorrhea
  • High FSH
  • After normal menses establisment
  • Increases risk of osteoporosis and cardiovascular disease
37
Q

Is Premature Ovarian Insufficiency considered early menopause?
Why or why not?

A

NO.
Normal menopause is due to follicle depleation.
In POI, folicles present but sex steroids are deficient

38
Q

Premature Ovarian Insufficiency

Clinical characteristics

A
  • Hx of oligomenorrhea (light or infrequent periods)

- Hot flashes, night sweats, mood changes

39
Q

Premature Ovarian Insufficiency

Tx

A

1) low dose estrogen, build up.
2) progestins added for 12-14 d/mo
3) T replacement for BMD. Libido?

40
Q

Premature Ovarian Insufficiency

Do estrogens or OCs prevent ovulation in pts w/ elevated FSH+LH?

A

Nope.

Endocrine (6 decks)

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