Day 4 Flashcards
phsyiologic states of amenorrhea
pregnancy and lactation
structural causes of primary amenorrhea
vaginal obstruction
cryptomenorrhea
imperforate hymen
Mullerian agenesis (missing uterus and upper vagina)
uterine absence or endometrial destruction
gonadal causes of primary amenorrhea
Dysgenesis, 17 alpha-Hydroxylase Deficiency, Resistant Ovary (Receptor abnormalities for FSH, LH**Hypergonadotrophic hypogonadism)
Chronic Anovulation,
Testicular Feminization
PREGNANCY!!!
3 criteria for PCOS
- Hyperandrogenism (elevated total or free testosterone, acne, hirsutism)
- Chronic anovulation
- on US looks like a string of pearls
(must meet 2 out of 3)
adrenal causes or primary amenorrhea
congenital adrenal hyperplasia
PCOS
Pituitary-Hypothalamic disorders that cause primary amenorrhea
Galactosemia (inherited deficiency of galactose converting enzymes)
Prolactin secreting pituitary tumor
Hypopituitarism
Aromatase deficiency
Delay in hypothalamic-pituitary maturation
enzyematic defect in cortisol pathway that causes a near blockage of cortisol depletion so there is a build-up precurosor hormone (17-hydroxy progesterone)
congenital adrenal hyperplasia
is the growth of hair in a typical male distribution. This hair may grow on the chin, upper lip, side of the face, breasts, lower abdomen and down medial thighs.
Hirsuitism
labs to get with hirsutism
Total vs. Free testosterone, Serum androstenedione, Urinary 17-ketosteroids, DHEA, DHEA-S, Prolactin, FSH, LH, Overnight Dexamethasone-Cortisol test
abdominal US for PCOS
most effective tx for PCOS
OCPs
if OCPs are working super well for PCOS what can you add
anti-androgens (spironolactone)
Discharge of milk or colostrom from nipple when not nursing
galactorrhea
how will most women w/ galactorrhea also present
amenorrhea
infertility
causes of galactorrhea with normal prolactin levels
OCPs
in primary hypogonadism what is LH level
low LH
