Female Hypogonadism

Question 1

What is female hypogonadism?

Answer 1

Impairment of ovarian function

Question 2

Give 2 causes of PRIMARY female hypogonadism

Answer 2

Gonadal dysgenesis (chromosomal abnormalities e.g. Turner's syndrome)  
Gonadal damage (e.g. AI, chemotherapy, radiotherapy)

Question 3

Describe the epidemiology of female hypogonadism

Answer 3

Secondary hypogonadism is a more common cause of anovulation/ amenorrhoea
Turner’s syndrome occurs in ~1.5% of conceptions

Question 4

List 6 symptoms of female hypogonadism

Answer 4

Symptoms of oestrogen deficiency:  
Night sweats  
Hot flushing  
Vaginal dryness  
Dyspareunia  
Decreased libido  
Infertility  
Symptoms of the underlying cause

Question 5

Give 2pre-pubertal signs of female hypogonadism

Answer 5

Delayed puberty (primary amenorrhoea, absent breast development, no secondary sexual characteristics)  
Eunuchoid (long legs, arm span greater than height)

Question 6

List 4 causes of SECONDARY female hypogonadism

Answer 6

Functional (e.g. stress, weight loss, excessive exercise, eating disorders)
Pituitary/ Hypothalamic Tumours + Infiltrative Lesions (e.g. pituitary adenomas, haemochromatosis)
Hyperprolactinaemia (e.g. due to prolactinoma)
Congenital GnRH deficiency: Kallmann’s syndrome, idiopathic

Question 7

Give 2 post-pubertal signs of female hypogonadism

Answer 7

Regression of secondary sexual characteristics (e.g. loss of secondary sexual hair, breast atrophy)
Perioral + periorbital fine facial wrinkles

Question 8

List signs of an underlying cause in female hypogonadism

Answer 8

Visual field defects (Hypothalamic/ Pituitary disease)
Anosmia (Kallmann’s syndrome)
Turner’s syndrome signs

Question 9

What other signs may be present in female hypogonadism?

Answer 9

AI primary ovarian failure; may have signs of other AI diseases (e.g. vitiligo)

Question 10

Describe serum oestradiol, FSH and LH in primary and secondary hypogonadism

Answer 10

Low serum oestradiol
Serum FSH/LH
Primary hypogonadism = HIGH
Secondary hypogonadism = LOW

Question 11

List 3 investigations performed in Primary Hypogonadism

Answer 11

Karyotype (look for chromosomal abnormalities)  
Pelvic imaging (US or MRI): in primary amenorrhoea to check for structural defects (e.g. androgen insensitivity)  
Screen for FMR1 gene in pts with unexplained pre-mature ovarian failure

Question 12

List 5 investigations performed in Secondary Hypogonadism

Answer 12

Pituitary function tests (e.g. 9 am cortisol, TFTs, prolactin)
Visual field testing
Hypothalamic-pituitary MRI
Smell tests for anosmia
Serum transferrin saturation (check for haemochromatosis)

Question 13

What investigations may be used in female hypogonadism for associated conditions?

Answer 13

Turner’s Syndrome: periodic echo, renal US

AI Oophoritis: check AI adrenal insufficiency

Question 14

List 7 signs of Turners syndrome

Answer 14

Short statue
Low posterior hair line  
High arched palate  
Widely spaced nipples  
Wide carrying angle  
Short fourth and fifth metacarpals  
Congenital lymphoedema