amenorrhea Flashcards
absence of normal menses for 3 normal menstural cycles of 6 mo or longer
amenorrhea
absence of menses in a woman who has never menstruated by 15y/o regardless if px has 2ndary sex char or not
primary amenorrhea
absence of menses by 13 y/o when there is no visible 2ndary sex char dev or by 15 y/o in the presence of normal 2ndary sex char
primary amenorrhea
absence of menses for an arbitrary period usu longer than 6-12mo;
those who have previously menstruated
secondary amenorrhea
for a female to develop breast, she should have
estrogen stimulation from ovaries
most common cause of primary amenorrhea
gonadal failure
gonadal failure is most commonly caused by
chromosomal disorder rarely by 17 a hydoxylase deficiency
enzyme that is needed in the production of mineralocorticoids and glucocorticoids
17a hydroxylase
what is the char of the chromosomes and gonads in pure gonadal dysgenesis
normal chromosomes
gonads do not develop
do px with gonadal failure have internal genitalia?
yes, and they will look grossly female
karyotype of px with turner syndrome
45XO missing X chromosome
what is the effect on height if the deletion occurs on the long arm
no effect on height
short arm - short stature
px 20y/o came in. PE shows webbed neck, low set ears and widely spaced nipples. Ht = 4’2”. This px can have associated problems such as
Coarc tricuspid valve probs renal ab autoimmunde disorders like thyroiditis and myesthenia gravis hypothyroidism (most common)
px 20y/o came in. PE shows webbed neck, low set ears and widely spaced nipples. Ht = 4’2”. This px can have associated problems such as
(TURNER syndrome) Coarc tricuspid valve probs renal ab autoimmunde disorders like thyroiditis and myesthenia gravis hypothyroidism (most common)
in px w/ hypothalamic disorder, low estrogen lvls are due to
very low gonadotropin release from the pituitary
Causes of hypothalamic disorder causing primary amenorrhea
Lesions
inadequate release and/or synthesis from hypothalamus
isolated gonadotropin deficiency in pituitary gland
most common lesion that can cause hypothlamic pituitary disorder
prolactinoma - pituitary adenoma
in this disorder, the deficient is only FSH or LH
isolated gonadotropin deficiency in pituitary gland
isolated gonadotropin deficiency in pituitary gland is associated with
thalassemia major or retinitis pigmentosa
what hypothalamic disorder can be secondary to mumps encephalitis
isolated gonadotropin deficiency in pituitary gland
androgen resistance syndrome is aka
testicular feminization/ androgen insensitivity
karyotype of px with androgen resistance syndrome
XY
in this disorder, there is an absence of an X chromosome gene resp for the cytoplasmic or nuclear testosterone receptor function
Androgen resistance syndrome
main problem in androgen resistance syndrome
testosterone RECEPTOR
px came in with amenorrhea as cc. PE showed normal breast. scanty to absent pubic and axillary hair. No internal female organs upon examination. what could be the testosterone level of this px
This px has androgen resistance syndrome, testosterone lvls are normal since the problem is on the receptors. there is breast dev bcoz they still produce little estrogen
abnormal gonads have a high risk of malignancy esp
gonadoblastoma and dysgerminoma
karyotype of px with congenital absence of the uterus
46XX
karyotype of px with Mayer Rokitansky Kuster Hauser Syndrome
46XX
if there is regression of the mullerian ducts the px may have
absent uterus
absent or short vagina
normal ovaries
in px with vanishing testes syndrome why do they have absent male and female ganitalia
these px have AMH in utero which prevents dev of female genitalia, upon birth the testes would disappear and there is regression of gonads hence male genitalia is also absent
very high FSH and low estrogen results in
ovarian failure
medication for px with 17a hydorxylase deficiency
estrogen progestin replacement and cortisol replacement
estrogen - breast dev
progestin - protection of uterus vs mitotic proliferaton by estrogen
px came in complaining with amenorrhea even she has premenstrual symptoms. PE showed normal breast dev . She asked if can she still get pregnant, what would be your answer?
Yes since she has ovaries she can get pregnant thru IVF and transfer of fertilized ova to a surrogate recipient.
why gonads must be fremoved after epiphyseal closure and breast dev what medication can you give after removal
there is a tendency of malignancies (gonadoblastoma and dysgerminoma);
estrogen therapy progestin is not needed bcoz px don’t have uterus
in px with functional hypothalamic amenorrhea the abnormal GnRH pulsatility is caused by
increased opiod activity
In px with anorexia the decrease in leptin would result in an increase in
Neuropeptide Y
common lesions found in secondary amenorrhea
craniopharyngiomas, TB sarcoidosis
how can Craniopharyngiomas cause secondary amenorrhea
they interfere with GnRH release and low gondatotropin and estrogen lvls
almost all pituitary tuimors secrete
prolactin
most common non-prolactin secreting tumor
chromophobe adenoma
treatment in px who have chromophobe adenoma where surgery is contraindicated
bromocriptine
common cause of amenorrhea in px who are <40
premature ovarian failure
in px who are 25 who has amenorrhea you should screen for
immunologic d/o
Asherman’s syndrome is usually secondary to
uterine surgery
Gold standard for the diagnosis of intrauteirine syndrome/adhesions
hysterescopy
most common cause of endometritis causing adhesions
Pelvic TB
