Amenorrhoea

Question 1

whats the difference between primary and secondary amenorrhoea

Answer 1

primary - never had periods

secondary - have had them - has now stopped for 6months+

Question 2

causes of primary amenorrhoea with sexual characteristics present

Answer 2

constitutional delay
genitourinary malformation
androgen insensitivity syndrome
hyperprolactinaemia 
pregnant

Question 3

causes of primary amenorrhoea without sexual characteristics present

Answer 3

ambigous genitalia
hypothalamic failure
ovarian failure

Question 4

causes of secondary amenorrhoea with androgen excess

Answer 4

polycystic ovary syndrome
cushings syndrome
late onset congenital adrenal hyperplasia
adrenal/ovarian carcinoma

Question 5

causes of secondary amenorrhoea without androgen excess

Answer 5

pregnancy, menopause, lactation. contraception
premature ovarian failure
hypothalamic dysfunction
weight loss (BMI under 19)
hyperprolactinaemia
thyroid disease

Question 6

when would you investigate someone with primary amenorrhoea (age)

Answer 6

at 14 if no sexual characteristics

at 16 if sexual characteristics are present

Question 7

causes of ambiguous genitalia

Answer 7

androgen secreting tumour
CAH
androgen resistance syndrome

Question 8

causes of hypothalamic failure

causes 1y and 2y

Answer 8

chronic illness
excessive exercise - androgens suppress periods
stress
underweight
tumours, irradiation, infection, trauma
Kallmann’s syndrome - failure to secrete GnRH

Question 9

investigation of amenorrhoea

Answer 9

pregnancy test
FSH/LH - both up - ovarian failure (or if both up and short ?Turner's)
prolactin
testosterone 
TFTs
pelvic ultrasound 

karyotype
MRI/CT pituitary