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Week 25 (menstraul Cycle Disorders, PCOS) > Amenorrhoea > Flashcards

Amenorrhoea Flashcards

1
Q

Primary amenorrhea

A

Failure of menstruation by the age of 16 years in the presence of normal secondary sex characteristics
OR
14 yrs in the absence of other evidence of puberty

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2
Q

Secondary amenorrhea

A

Absent periods for at least 6 months in a woman who has previously had regular periods, or 12 months if she has previously had oligomenorrhoea

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3
Q

Group 1 Amenorrhoea

A

Low oestrogen, low FSH, no hypothalamic-pituitary pathology

Hypogonadotrophic hypogonadism

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4
Q

Group 2 Amenorrhoea

A

Normal oestrogen, normal FSH, normal prolactin

PCOS

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5
Q

Group 3 Amenorrhoea

A

Low oestrogen, high FSH

Gonadal failure

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6
Q

Tanner stage 1

A

Breast and pubic hair prepubertal

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7
Q

Tanner stage 2

A

Breast buds seen

Few hairs at labia majora

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8
Q

Tanner stage 3

A

Larger breast buds

Mainly central growth of pubic hair

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9
Q

Tanner stage 4

A

Mound formed

Triangular shaped area of pubic hair

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10
Q

Tanner stage 5

A

Fullly formed breasts

Adult shape pubic hair, spread to thighs

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11
Q

Causes of Amenorrhoea (subdivisions)

A 
Pregnancy
Haematocolpos 
Hypothalamic dysfunction (chronic illness, weight loss)
Hydrocephalus, empty sella syndrome, craniophayngioma
Prolactinoma
Thyroid disorders
Cushing syndrome
Consitutional delay
Genetic disorders (Turners)
Androgen secreting tumors
Premature ovarian failure
PCOS
Ashermans
Head injury
Sheehan’s syndrome
Chromosomal abnormalities (fragile x)
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12
Q

Most common causes of primary amenorrhoea

A

Gonadal dysgensis (43%)
Mullerian agenesis (15%)
Constitutional (14%)
PCOS (7%)

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13
Q

Hirsuitism virilisation

A

May be due to an androgen-secreting ovarian or adrenal tumor, or 5 alpha-reductase deficiency

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14
Q

History points for primary amenorrhoea

A 
Psychological dysfunction or emotional stress
Mother and sister gynae hx
Mother obs history with child
Fam hx (genetic disorders, diabetes, delayed puberty)
Pubertal development
Galactorrhoea
Hypothyroid symptoms
Weight loss or gain
Hirsuitism virilisation
Menopausal symptoms
Sexual activity
Headache or visual disturbance, Polaris, poldipsia
Anosmia
Chronic illness
RT or CT
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15
Q

Secondary amenorrhoea hx

A 
Irregular menstraul cycles
Hirsuitism
Acne
Malaise, fatigue, weight loss
Heterotopic ossification (following head injury)
Headaches
Galactorrhoea
PPH - ?sheehan’s
D&C ?asherman
Medications
Rapid virilisation
Hyperprolactinemia
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16
Q

Conditions with a blind vaginal pouch

A

Mullerian agenesis
Transverse vaginal septum
Androgen insensitivity syndrome

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17
Q

Testosterone >5

A

Androgen insensitivity
Androgen secreting tumors
Cushing syndrome
Late onset CAH

Test in both primary and secondary amenorrhoea

18
Q

Raised FSH/LH and secondary sexual characteristics

A

PCOS

19
Q

Primary amenorrhoea with normal FSH and secondary sexual characteristics

A

?obstructed outflow tract

Haematometra and haematocolpos

20
Q

High FSH and no secondary sex characteristics

A

17-alpha hydroxylase deficiency (with HTN)

If high LH, turner’s sndrome or male karyotype

21
Q

Low FSH and LH

A

Intracranial lesions and Craniopharyngioma if short stature

Normal height or normal FSH, weight loss, celiac diseae, type 1 DM, anorexia nervosa or exercise

22
Q

High FSH and secondary amenorrhoea

A

Premature ovarian failure if on 2 occasions >20

23
Q

Space occupying lesion of the hypothalamus pathophysiology

A

Tend to occur around the time of puberty
Cause amenorrhoea by disrupting the tonic inhibition of dopamine on prolactin release and/or compress and destroy hypothalamic and pituitary tissue

24
Q

Kallman’s syndrome

A

1:50000
Congenital absence of GnRH neurons whose cell bodies from the olfactory area to the arcuate nucleus of the hypothalamus
May be sporadic or inherited
AD or X-linked recessive
Associated with anosmia and colour-blindness

25
Q

Prolactin level 700-2500

A

Hypothyroidism/PCOS

Check TSH, T4, FSH/LH, testosterone, SHBG

26
Q

Prolactin <3000

A

Non-functioning macroadenoma

MRI or CT head (if >1500 x 2 occasions)

27
Q

Prolactin 1500-4000

A

Functioning microadenoma

Image

28
Q

Symptoms of hyperprolacinaemia

A

Oestrogen deficiency
Galactorrhoea (30%)
Visual field defects (5%)

29
Q

Bromocriptine treatment for hyperprolactinaemia

A

1.25mg nocte for 5 nights
Gradually uptitrate to 7.5mg daily in 2 or 3 divided doses over three weeks

SE: nausea, vomiting, headache, postural hypotension, Raynauds, constipation, psychiatric hanged (aggression)

30
Q

Cabergoline for treatment of hyperprolactinameia

A

0.25-1mg twice weekly
Up to 1mg daily

Longer acting and better tolerated but still second line due to adverse psychiatric effects and not Licensed for pregnancy

31
Q

Quinagolide for treatment of hyperprolactinaemia

A

25-150mcg daily in divided doses

Longer acting and better tolerated but still second line due to adverse psychiatric effects and not Licensed for pregnancy

32
Q

Prolactinomas and pregnancy

A

80% achieve pregnancy on dopamine agonist treatment
No increase in miscarriage, ectopic or other complications of pregnancy
Can BF

Some develop signs of tumor growth in pregnancy, <2% for micro, 15% macro

Bromocriptine ok in pregnancy

33
Q

Empty sella syndrome (cause, consequence and treatment)

A

Benign congenital absence or following surger or RT

Extension of the subarachnoid space into the pituitary fossa flattens the pituitary separating it from the hypothalamus; usually get hyperprolactinaemia

Bromocriptine

34
Q

Sheehan’s syndrome (cause consequence and treatment)

A

Acute infarction and necrosis of pituitary due to PPH and shock

Hypopituitarism; failure of lactation and loss of pubic hair; deficiencies in GH, gonadotrophins, adrenocorticotrophin, Thyroid hormone

To: pituitary hormone replacement and oestrogen and progesterone

35
Q

uterine causes of secondary amenorrhoea

A

Asherman syndrome

Cervical stenosis

36
Q

Ovarian causes of secondary amenorrhoea

A 
PCOS
POF (genetic, autoimmune, infective, RT/CT)
37
Q

Hypothalamic causes of secondary amenorrhoea (hypogonadotrophic hypogonadism)

A 
Weight loss
Exercise
Chronic illness
Psychological distress
Idiopathic
38
Q

Pituitary causes of secondary amenorrhoea

A

Hyperprolactinaemia
Hypopituitarism
Sheehan syndrome

39
Q

Hypothalamic/pituitary damage (hypogonadism)

A 
Tumour
Cranial irradiation
Head injury
Sarcoidosis
TB
40
Q

Systemic causes of secondary amenorrhoea

A

Chronic illness
Weight loss
Endocrine disorders (Thyroid disease, Cushing)

Week 25 (menstraul Cycle Disorders, PCOS) (5 decks)

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