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WH > anovulation and hormonal irregularities > Flashcards

anovulation and hormonal irregularities Flashcards

1
Q

what can the main causes of anovulation be divided into ?

A

physiological causes

pathological causes

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2
Q

what is the definition of an-ovulation ?

A

not a disease but rather a sign that indicates the failure to achieve the normal cyclic ovulation

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3
Q

what are the types of an-ovulation ?

A

sporadic

chronic

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4
Q

what are the physiological causes of an-ovulation ?

A

before puberty
menopause
pregnancy
lactation

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5
Q

what are the pathological causes of an-ovulation ?

A 
hypothalamic causes 
pituitary causes 
ovarian causes 
endocrinal causes 
drug induced
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6
Q

what are the hypothalamic causes of an-ovulation?

A

emotional stress
excessive stressful exercise
marked weight gain or loss
kallman’s syndrome

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7
Q

what is kallmannn’s syndrome ?

A

form of hypogonadotropic hypogonadism, a condition characterized by delayed or absent puberty and an impaired sense of smell
congenital deficiency of GnRh receptors

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8
Q

what are the pituitary causes of an-ovulation?

A

pituitary adenomas
empty sella syndrome ( hyperprolactinemia)
pituitary insufficiency

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9
Q

what is sheehan’s syndrome ?

A

when a mother loses a lot of blood after delivery , hypoxic damage occurs in the pituitary and causes pituitary insufficiency

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10
Q

what are the ovarian causes of an-ovulation ?

A

polycystic ovarian syndrome
premature ovarian failure
bilateral surgical removal or destruction by irradiation

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11
Q

what are the endocrinal causes of an-ovulation ?

A 
thyroid causes ( hypothyroidism)
adrenal disorders ( cushing disease)
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12
Q

what are the drug induced causes of an-ovulation?

A 
OCPs 
progestins therapy 
Progestin drugs ( Danzol )
GnRh Agonists 
drug induced hyperprolactinemia 
antihypertensive drugs
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13
Q

which drugs induce hyperprolactinemia ?

A

psychotropic agents
anti-emetics
anything that is a dopamine blocker

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14
Q

which anti-hypertensive drug can cause an-ovulation?

A

alpha methyl dopa

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15
Q

what are the methods for detection of ovulation?

A 
basal body temperature 
Urinary LH kit 
Ultrasound folliculometry
Mid Luteal Serum Progesterone 
Premenstrual endometrial biopsy
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16
Q

how is a mid luteal serum progesterone level test done?

A

blood sample is taken mid luteal phase according top the patients cycle to measure progesterone levels
less than 5 means an-ovulation
more than 10 means ovulation
between 5-10 luteal phase defect

17
Q

what do the different results of premenstrual endometrial biopsies indicate ?

A

proliferative endometrium: an-ovulation
secretory endometrium: ovulation
poor secretory changes: luteal phase defect

18
Q

what is the pathology in the luteal phase defect ?

A

inadequate secretion of progesterone from the corpus leuteum
leading to inadequate secretory changes of the endometrium

19
Q

how does the luteal phase defect present ?

A

manifests by spotting during the second half of the menstrual cycle
infertility
recurrent pregnancy loss

20
Q

what is the criteria for the diagnosis of PCOS ?

A

menstrual irregularities
evidence of hyperandrogegism
ultrasound cystic changes of the ovary

21
Q

what labs results are required fore the diagnosis of PCOS ?

A

increased triad of :
LH
Insulin
Androgen

22
Q

which enzyme is inhibited inn PCOS ?

A

aromatase enzyme

aromatase converts androgens into oestrogen

23
Q

what is the effect of high levels of androgens ?

A
  1. the high level of androgens is stimulated by the high levels of LH
  2. an increase in androgens stimulates the secretion of estrone
  3. this causes endometrial hyperplasia due to the unopposed effect of oestrogen
  4. increases the risk of endometrial carcinomas
24
Q

what is the diagnostic appearance of PCO on ultrasound ?

A

pearl necklace appearance , no dominant follicle present

25
Q

with laparoscopy what is the diagnostic image of PCO?

A

oyster shell ovary

26
Q

what is the long term risk of PCOS ?

A

risk for type 2 DM
hyperlipidemia
higher risk of endometrial hyperplasia

27
Q

what is the management for PCOS ?

A

life style modification
hormonal therapy ( OCPs, cyclic gestagens)
insulin sensitizing drugs : Metformin
Induction of ovulation ( if fertilization is the main concern )

28
Q

what are the causes of hyperprolactinemia ?

A 
pregnancy and lactation
severe stress
hypothyroidism 
pituitary adenoma 
hypothalamic tumors
antipsychotics - TCA
29
Q

what is the management for hyperprolactinemia ?

A

stop the causative drug
treat underlying cause
use cabergoline ( dopaminergic drug)
bromo-ergo-cryptin ( inhibits pituitary prolactin )
surgical removal in cases of pituitary adenoma

30
Q

what is primary ovarian failure ?

A

early exhaustion of ovarian primordial follicles before the age of 40 years , causing premature menopause

31
Q

what are the causes of premature ovarian failure ?

A

autoimmune ovarian destruction
Mosaic turner
Mumps
radiation or chemotherapy

WH (68 decks)

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