Female Hypogonadism Flashcards
What is female hypogonadism?
Impairment of ovarian function
How is female hypogonadism classified?
Primary: condition of ovaries (primary ovarian insufficiency/ hypergonadotrophic hypogonadism)
Secondary: failure of hypothalamus/ pituitary (hypogonadotrophic hypogonadism)
Give 3 causes of congenital PRIMARY ovarian insufficiency
Chromosomal abnormalities e.g. Turner’s syndrome
Ovarian dysgenesis/ agenesis
Congenital adrenal hyperplasia
List 4 causes of acquired primary ovarian insufficiency
Medications
Radiotherapy
AI disease
Viral infection e.g. Mumps
Bacterial infection e.g. Shigella
Name 1 cause of congenital secondary hypogonadism
Gonadotrophin deficiency due to genetic mutation e.g. Kallmann syndrome
Give 5 causes of acquired secondary hypogonadism
Intracranial SOL
Infiltrative disease e.g. sarcoidosis + haemochomatosis
Infection e.g. meningitis, TB
Pituitary apoplexy (bleeding into pituitary)
Trauma
Give 4 causes of gonadotrophin suppression
Chronic disease e.g. Anorexia, Obesity, Diabetes
Excessive exercise
Chronic opiate, glucocorticoid or anabolic steroid use
Hyperprolactinaemia
Give 3 features of oestrogen deficiency pre-puberty
Reduced growth
Absence of pubic hair
Primary amenorrhoea
Give 3 features of hypogonadism post-puberty
Secondary amenorrhea
Sx of peri-menopause
Infertility
List 6 symptoms of peri-menopause in female hypogonadism
Night sweats
Palpitations
Hot flushing + heat intolerance
Anxiety, depression, irritability
Vaginal dryness
Decreased libido
What signs may indicate an underlying cause in female hypogonadism?
Visual field defects (Hypothalamic/ Pituitary disease)
Anosmia (Kallmann’s syndrome)
Turner’s syndrome signs
Describe serum oestradiol, FSH and LH in primary and secondary hypogonadism
Low serum oestradiol
Serum FSH/LH
Primary hypogonadism = HIGH
Secondary hypogonadism = LOW
Give 2 investigations performed in Primary Hypogonadism
Karyotype (look for chromosomal abnormalities)
Pelvic imaging (US): in primary amenorrhoea to check for structural defects (e.g. androgen insensitivity)
List 5 investigations performed in Secondary Hypogonadism
Pituitary function tests (e.g. 9 am cortisol, TFTs, prolactin)
Visual field testing
Hypothalamic-pituitary MRI
Smell tests for anosmia
Serum transferrin saturation (haemochromatosis)
List 6 signs of Turners syndrome
Short stature
Low posterior hair line
High arched palate
Widely spaced nipples
Wide carrying angle
Congenital lymphoedema
