Female Repro pathophys

Question 1

Anorexia nervosa is a ______ generator defect

Answer 1

Acquired GnRH pulse generator defect (leading to amenorrhea)

• hardware is there, but no software coming down

Question 2

GnRH pulse generator alterations (leading to amenorrhea) can due to:

Answer 2

1. excessive exercise
   - no fat
2. eating disorders
3. stress
4. genetic?

Question 3

Infiltrative diseases that can lead to low estrogen and amenorrhea by affecting the pituitary

Answer 3

1. Hemochromatosis
2. Sarcoidosis
3. Lymphocytic hypophysitis

Question 4

Tx of prolactin elevation

Answer 4

dopamine agonists
- bromocriptine or
cabergoline

or change OCPs

Question 5

Fertility drugs

Answer 5

Clomiphene (SERM)
- tricks body

Gonadotropins
Pulsatile GnRH

Question 6

Autoimmune disorders that can cause premature ovarian failure

Answer 6

1. Autoimmune thyroid diseases
   - Hashimotos, or Graves
2. Pernicious anemia
   - B12 def
3. Addison’s disease
   - primary adrenal insuff
4. RA, Lupus, Myasth gravis, celiac sprue

Question 7

CAH 17OH levels

Answer 7

test: Give cosyntropin (ACTH) –> measure 17OH after 30 min > than 1000 ng/ml = CAH
tx: OCPs and antiandrogens

Question 8

Women with rapid onset of sx + sz in a women with nl menses. See Hirsutism and virilzation.

• temporal recession
• anabolic phenotype
• loss of breast tissue
• clitoromegaly >2.5 cm

Answer 8

Hyperandrogenic anovulation tumors (rare)

Question 9

Ovarian Hyperandrogenic anovulation tumors

Answer 9

Testosterone >200 ng/dl

Accounts for ~ 10% of ovarian tumors

• Sertoli-leydig cell tumor
• Hilar cell tumor
• Lipoid cell tumor

*there are also adrenal hyperandrogenic anovulation tumors

Question 10

Adrenal Hyperandrogenic Anovulation tumors

Answer 10

DHEAS > 8-900 ng/ml

1. Adrenocortical adenoma or r carcinoma
2. Virilizing T secreting tumor

Question 11

Is PCOS Hyper or Hypor androgenic?

Answer 11

Hyperandrogenic

• hirsutism
• acne
• insulin resistance
• acanthosis nigricans

Question 12

Tx for PCOS if pregnancy is desired vs not desired

Answer 12

Preggo desired:

• Clomiphene citrate (SERM) w/ metformin (hypoglycemic drug: halts weight gain)
• Letrozole (aromatase inhibitor)

No preggo:

• OCPs w/ less androgenic progestin or cyclic progesterone for regular menses
• Spirinolactone (antiandrogen) for hirsutism
• Metformin (insulin sensitizer)

Question 13

Fragile x show early menopause?

Answer 13

Yes. Can cause low E due to premature ovarian failure.

Make sure you screen if persons mom had early menopause.

• high FSH, LH, low E

Question 14

Premature menopause

Answer 14

cessation of menses before age 40

Question 15

Addisons disease

• what is it?
• blood levels
• tx

Answer 15

primary adrenal insufficiency/atrophy resulting in premature ovarian failure
- causes High ACTH

tx: glucocorticoids

Question 16

Do women with PCOS have oligo - or amenorrhea

What is the rotterdam criteria that is added to PCOS?

Answer 16

Either

• rotterdam criteria adds:
• multiple small cysts and/or ovarian volume on us