Amenorrhea

Question 1

Physiological Amenorrhea

Answer 1

Primary: before puberty
Secondary: during pregnancy and after menopause

Question 2

Pathological menopause

Answer 2

Can be due to pathological situations in the hypothalamus, hypophysis or several cases in the ovaries

Question 3

Pathological amenorrhea linked to hypothalamus

Answer 3

Kallman syndrome and anorexia nervosa

Question 4

Kallman syndrome

Answer 4

Kallman syndrome is a genetic disease, where the hypothalamic neurons responsible for GnRH fail to migrate into the hypothalamus during embryogenesis.
Main symptom is the failure to start puberty or the failure to fully complete it. Leads to primary amenorrhea. Also: anosmia/hypoosmia - decreased or no sense of smell, hypogonadism and infertility is also common.

Question 5

Hypophyseal amenorrhea

Answer 5

Sheehan syndrome, hyperprolactinemia, as prolactin inhibits GnRH secretion, which then results in low FSH and LH secretion and so it does not stimulate gamete production and gonadal steroid synthesis.

Question 6

Ovarial amenorrhea

Answer 6

Dysgenesis of the ovaries - Turner syndrome, Stein-Leventhal syndrome

Question 7

Turner syndrome

Answer 7

Partial or complete monosomy of the short arm of X-chromosome.
Clinical features of Turner syndrome: streak ovaries, infertility, primary amenorrhea, bicuspid aortic valve, coarctation of the aorta, short stature, webbing of the neck, cubitus valgus

Question 8

Stein-Leventhal/Polycystic ovary syndrome

Answer 8

Characterized by an increased level of male hormones, hyperandrogegism, and infrequent or absent ovulation

Hormone results in PCO: increased testosterone and DHEAs, high insulin concentration (OGTT), increased LH/FSH ratio

Therapy: Weight reduction, metformin against insulin resistance, contraceptive pills, induction of ovulation, gynecologic interventions