Amenorrhea

Question 1

DDX 2ndary Amenorrhea

Answer 1

Stress
 Weight loss
 Strenuous exercise
 Kallman’s syndrome
 Tumors
 Anovulation
 Ovarian failure/menopause
 Turner’s Syndrome or
mosaicism
 Asherman’s

Question 2

Anorexia Nervousa Def.

Answer 2

Anorexia nervosa-body image disturbance

and wt loss <85% of expected

Question 3

Hyperprolactinemia symptoms

Answer 3

Galactorrhea
Menstrual dysfunction
Infertility
Mass lesion
Hirsutism
Headache 
Visual Disturbances

Question 4

Causes of Hyperprolactinemia

Answer 4

TRH
Prolactinoma
Idiopathic 
Other pituitary or brain tumor 
Pharmacology (Dopamine)
Reglan, Aldomet, Opioids, antihystamines
Renal Disease
lactation 
pregnancy 
Stress/Exercise/Coitus etc.

Question 5

Prolactin/Thryoid/GnRH

Answer 5

Elevated TSH results from elevated TRH
 TRH also causes prolactin release from
pituitary
 PRL inhibits GnRH release, therefore
anovulation occurs

Question 6

Medical Risks of Turners

Answer 6

LEFT SIDED CARDIAC ANOMALIES OCCUR IN 50%
OF PATIENTS
RENAL ANOMALIES IN 1/3
HASHIMOTO’S THYROIDITIS IN ABOUT 50% (other autoimmune disorders)
Mild hearing loss
Insulin resistance

IF CONCEIVE, INCREASE IN BOTH TURNER AND
DOWN SYNDROME

Question 7

Primary Ovarian Insufficiency

Answer 7

5-10% will conceive spontaneously
 It is associated with Fragile X permutation
 20% of adults will have hypothyroidism
 Approximately 2% will have adrenal insufficiency
upon presentation and up to 2% more will
develop adrenal insufficiency. (This must be
detected prior to commencing transfer of oocyte
donor derived embryos)
 Other autoimmune disease may co-exist

Question 8

Fragile X

Answer 8

Gene FMR1
Number of repeats varies, if >200- affected, if
61-200 repeats -phenotypically normal but has
premutation
 A female with premutation >90 is likely to have a
child with expanded repeats

Question 9

Lab evaluation for 2ndary Amenorrhea

Answer 9

TSH
Prolactin
FSH
Progestin challenge- bleeding usually 2-7 days, sometimes 14 days (with ovulation)

Question 10

FSH low and amenorrhea

Answer 10

Hypothalamic amenorrhea

Question 11

Bromocriptine

Answer 11

Restores menstrual function in 80%

Reduces most tumors

Nausea and/or vomiting
Postural hypotension with syncope
Blurred vision

macroadenoma - 1 cm

Question 12

Premature ovarian failure autoimmune screen

Answer 12

Calcium
Phosphorus
A.M. Cortisol
ANA
Anti-adrenal
antibodies