Amenorrhea

Question 1

Primary amenorrhea

Answer 1

No menses by 14 and absence of secondary sexual characteristics
OR
No menses by 16 with presence of secondary sexual characteristics

Question 2

Secondary amenorrhea definition

Answer 2

Previous history of menstruation
AND
No menses for 3 cycles or 6 months

Question 3

What are some good physical signs in vagina that estrogen is present?

Answer 3

Tissues are pale pink

Whiteish vaginal discharge

Question 4

Level of FSH, LH, and estradiol in

1. Hypogonadotropic hypogonadism
2. Eugonadotrophic eugonadism
3. Hypergonadotropic hypogonadism

Answer 4

1. Low, Low, Low
2. Normal, normal, normal
3. High, high, low

Question 5

Hypogonadotropic hypogonadism

Answer 5

Can be from structural of endocrinological CNS causes
Do hormone tests, then MRI head
Can also be caused by non CNS causes (anorexia, stress, primary hypothyroidism, etc)

Question 6

Sheehan’s syndrome

Answer 6

Such a bad PPH that you damage the pituitary from lack of blood flow
They stop making the hormones and cause secondary amenorrhea
Rare

Question 7

Kallman’s syndrome

Answer 7

Isolated GnRH deficiency caused by disrupted GnRH neuron migration
Anosmia, +/- midline facial defects

Question 8

Eugonadotrophic eugonadism

Answer 8

Endocrinological etiology (PCOS, hyper PRL)
Structural (ex: no uterus)
Special testa: physical exam, TSH/PRL/androgens, progestin challenge test, US

Question 9

Progesterone challenge test

Answer 9

Provides an estimate of the estrogen concentration and confirms the presence of an estrogen-primed uterus
After giving the progesterone for 5-10 days you should get a period

Question 10

Criteria for PCOS

Answer 10

2 out of 3 of
Androgen excess (biochemical or clinical)
Ovulatory dysfunction (anovulation, oligoovulation)
Polycystic ovaries

Question 11

Hyperprolactinemia

Answer 11

Elevated PRL, low/normal gonadotropin levels

Causes: PRL inducing meds, hypothyroidism, pituitary tumor

Question 12

Mullerian agenesis

Answer 12

Defect in anti-mullerian hormone gene
Normal breasts, pubic hair, and ovaries
No uterus, cervic or upper vagina
Hormones still come from ovaries so those will be normal and cause normal secondary characteristics
Create a vaginal with vaginal dilators or surgery

Question 13

Turner syndrome

Answer 13

Short stature
Webbed neck
Low set ears/hairline
Wide spaced nipples/shield chest
Short 4th metacarpal
Wide carrying angle
Absent sexual development

Question 14

Androgen insensitivity syndrome

Answer 14

Inguinal testes, breast development, no pubic hair, blind vagina, no uterus
Breast development from the peripheral conversion of testosterone to estrogen
Gonadectomy at puberty because testes at cancer risk
If incomplete and we dont take them out in time they can get virilized at puberty