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WH1 > Amenorrhea > Flashcards

Amenorrhea Flashcards

1
Q

primary amenorrhea

A

NO menses by 13 + absence of growth of secondary sex characteristics

NO menses by 15 but secondary sex characteristics present

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2
Q

secondary amenorrhea

A

previously had menses AND

absence of menses more than 3 mo in girls who had REGULAR menses

OR 6 mo in girls who had IRREGULAR menses

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3
Q

causes of primary amenorrhea

A

genetic, anatomic abnormalities

  1. chromosome
  2. absence of structure
  3. physiologic delay
  4. PCOS
  5. Isolated GnRH deficiency
  6. transverse vaginal septum/imperforate hymen
  7. weight loss/anorexia
  8. pituitary disease
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4
Q

MC cause of secondary amenorrhea

A

pregnancy

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5
Q

HPO axis

A

hypothalamus -> GnRH -> anterior pituitary -> LH/FSH -> ovaries -> progesterone and estrogen -> hypothalamus

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6
Q

amenorrhea work up

A
  1. Serum HCG (r/o pregnancy)
  2. TSH, FSH, Prolactin
  3. pelvic U/S
  4. Progestin Challenge Test
  5. +/- MRI
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7
Q

Progestin Challenge Test

why do we do it>

A

asses level of endogenous estrogen and competence of outflow track

give stimulant to start

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8
Q

Progestin Challenge Test options (3) for step 1

A
  1. parenteral progesterone oil
  2. oral micronized progesterone
  3. oral medroxyprogesterone acetate
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9
Q

what to we look for in step 1 of Progestin Challenge Test ? what does it mean?

A

Did vaginal bleeding occur in 2-7 days?

yes: bleeding = anovulation
no: hypogonadism

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10
Q

why do we treat anovulatory patients?

A

if untreated unopposed estrogen can cause endometrial hyperplasia

tx: provera at beginning of month + OCP

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11
Q

Progestin Challenge Test

withdrawal bleeding NOT occur - management

A

target organ outflow tract is not working - estrogen proliferation of endometrium has not occurred

give estrogen and progesterone (STEP 2)

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12
Q

following step 2: if bleeding does NOT occur possible etiology

Progestin Challenge Test

A

endometrium or outflow tract obstruction

RARE

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13
Q

causes of endometrium or outflow tract

A

aggressive curettage/Asherman’s

infection

genetic anomaly (Mullareian dysgenesis or agenesis)

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14
Q

Progestin Challenge Test bleeding occurs following step 2

A

issue is with body’s ability to stimulate estrogen production

continue to step 3

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15
Q

step 3 of Progestin Challenge Test

A

bioassay levels of gonadotropins

2 weeks after e/p test

draw LH and FH levels

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16
Q

hypergonadotrophic causes (main)

A

bilateral oophorectomy
post menopausal
ovarian failure

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17
Q

hypergonadotrophin increases GnRH

A
  1. ectopic gonadotropin
  2. perimenopausal period (rising FSH)
  3. gonadotropin secreting pituitary adenomas
  4. resistant or insensitive ovary syndrome

5-7. autoimmune dz, galactosemia, 17 hydroxylase

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18
Q

causes of hypogonadotrophic

A
  1. pre pubertal
  2. hypothalamic dysfunction
  3. pituitary dysfunction
19
Q

evaluation of hypogonadotrophc

A

imaging of sella turcica = MRI

micro adenomas - not important

macro adenoma= refer and serious

20
Q

disorder of outflow tract of uterus (list)

A
  1. asherman’s syndrome
  2. mullarian anomalies
  3. mullein agenesis
  4. androgen insensitivity
21
Q

asherman’s syndrome

A

intrauterine scaring and adhesions

diagnosed by hysteroscopy

tx: lysis of adhesions

22
Q

complications of asherman’s

A

infertility
miscarriage
dysmenorrhea

23
Q

mullerian anomalies

causes

A

imperforate hymen
obliteration of oriface
presence or absence of uterus or cervix

24
Q

mullerian anomalies

associated s/s

A

pelvic pain

infertility or recurrent miscarriages

25
Q

mullerian agenesis

A

complete lack of mullerian development

mayer rokitansky-kuster Hauser syndrome

absence or hypoplasia of internal vagina

26
Q

workup of mullerian agenesis and tx

A

karyotype

tx: vaginal dilators and surgery

27
Q

androgen insensitivity

A

complicate androgen insensitivity

male karyotype with female appearance

nil or elevated testosterone

28
Q

disorders of the ovary list

A
  1. Turner syndrome
  2. mosaicism
  3. XY gonadal dysgenesis
  4. gonadal atresia
  5. resistant ovary syndrome
  6. premature ovarian failure
29
Q

Turner syndrome `

A

short stature, webbed neck, shield chest,

hypergonadotropic hypoestrogenic amenorrhea

lack of ovarian follicles, no sex hormone production, primary amenorrhea

30
Q

premature ovarian failure

A

early depletion of follicles causing periods to stop around 40

31
Q

what may cause disorder of the ovary

A

radiation and chemotherapy

32
Q

who do you karyotype in patients with hypergonadotrophic ovarian disorders

A

ovarian failure
elevated gonadotropins
age under 30

if over 30 –> DO NOT karyotype

33
Q

premature ovarian failure tx

A

hormone replacement therapy

estrogen with progestin due to intact uterus

mimic NML physiology

exervise

smoking cessation

34
Q

pituitary tumors

A

grow and cause compression of optic chasm = visual change

nonfunctioning adenomas

prolactin secreting adenomas

35
Q

nonfunctioning adenomas

A

reduces level of dopamine

secrete FSH and LH

elevated PRL on eval

36
Q

treatment of nonfunctioning adenoma

A

micro= no tx

macro= surgical resection + radiation

37
Q

MC pituitary tumors

A

prolactin secreting tumors

38
Q

prolactin secreting tumors tx

A

dopamine agonist (bromocriptine)

if pt wants to get prig, d/c when temperature indicates ovulation

39
Q

bromocriptine regression in prolactin secreting tumors

A

regress with tx

shrinkage occurs

40
Q

surgery of prolactin secreting tumors

A

transphenoidal neruosurgery

if amenorrhea continues = PRL level q 6 mo

41
Q

pregnancy and prolactin adenomas

A

80% achieve pregnancy with dopamine agonist tx

some women resume cyclic menses after pregnancy and bromocriptine is safe in pregnancy

42
Q

Sheehan;s syndrome

A

infarction and necrosis of pituitary gland due to post part hemorrhage and shock

failure of lactation and loss of pubix.axillary hair

43
Q

List of CNS disorders

A
  1. hypothalamic amenorrhea
  2. weight loss, anorexia, bulimia
  3. exercise and amenorrhea
  4. eating disorders and pregnancy
  5. inherited genetic defects
  6. post pill amenorrhea

WH1 (6 decks)

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