Endo - amenorrhoea

Question 1

Differentials for secondary amenorrhoea

Answer 1

• pregnancy
• menopause / POF
• PCOS
• hyperprolactinaemia (pituitary adenoma or anti-psychotics)
• Thyrotoxicosis: Graves, or toxic thyroid nodule(s)

Question 2

How might you investigate amenorrhoea?

Answer 2

LH/FSH, oestradiol (raised in menopause, POF, PCOS)
TFTs
Prolactin
MRI pituitary
Thyroid US
Pelvis US scan if ?PCOS

Question 3

What symptoms does a prolactinoma cause?

Answer 3

Amenorrhoea + galactorrhoea
Headache + VF changes (BT hemianopia)

Question 4

What is the management of prolactinoma?

Answer 4

DA-agonist: bromocriptine/cabergoline

May need referral to fertility specialist

Question 5

What is Multiple Endocrine Neoplasia -1

Answer 5

Autosomal dominant inheritance:
1. Parathyroid hyperplasia (raised Ca)
2. Pituitary adenoma (50% prolactinaoma, or GH+ acromegaly)
3. Pancreas endocrine tumour: gastrinoma, insulinoma.

Question 6

What is MEN-2?

Answer 6

Autosomal dominant inheritance:
1. Parathyroid hyperplasia, fewer have raised Ca than MEN1
2. Phaeochromocytoma
3. Medullary thyroid carcinoma (100%)