Female Hypogonadism

Question 1

what are the congenital causes of primary ovarian insufficiency?

Answer 1

• chromosomal (e.g. turner syndrome (45,X), fragile X syndrome, galactosaemia)
• ovarian dysgenesis/agenesis
• CAH (e.g. 17α-hydroxylase deficiency)

Question 2

what are the acquired causes of primary ovarian insufficiency?

Answer 2

• medication (e.g. chlorambucil, cyclophosphamide)
• radiotherapy
• autoimmune (e.g. autoimmune polyglandular syndrome type 1)
• viral (e.g. mumps, TB, malaria, VZV)
• iatrogenic

Question 3

what syndrome is a congenital cause of secondary hypogonadism?

Answer 3

kallmann

Question 4

what are the acquired causes of secondary hypogonadism?

Answer 4

• intracranial space-occupying lesion (e.g. tumour)
• infiltrative (e.g. sarcoidosis, haemochromatosis)
• infection (e.g. meningitis, TB)
• pituitary apoplexy
• trauma

Question 5

gonadotropins may be suppressed by what?

Answer 5

• chronic disease (e.g. diabetes, anorexia, obesity)
• excessive exercise
• critical illness
• chronic use of opiates, glucocorticoids, or anabolic steroids
• hyperprolactinaemia

Question 6

what are the symptoms of hypogonadism?

Answer 6

• secondary amenorrhoea
• climacteric (e.g. peri-menopause): palpitations, heat intolerance, flushing, night sweats, irritability, anxiety, depression, sleep disturbance, loss of libido, coarse hair, vaginal dryness, fatigue
• infertility

Question 7

what are the investigations for hypogonadism?

Answer 7

• hCG
• serum FSH
• serum LH
• oestradiol
• TSH
• serum prolactin
• ? karyotype

Question 8

what is the management of hypogonadism?

Answer 8

HRT (e.g. oestrogen, progesterone)