Gynaecology

Question 1

What is primary amenorrhoea?

Answer 1

Never starting menstruation:

1) by 13 years if no other evidence pubertal development
2) by 15 years if other signs of puberty, eg breast bud development

Question 2

What is the normal age for puberty in girls?

Answer 2

8-14

Question 3

What is hypogonadism?

Answer 3

Lack of sex hormones, oestrogen and testosterone

Question 4

What are the two main mechanisms of hypogonadism?

Answer 4

1. HYPOgonadotropic hypogonadism: deficiency of LH and FSH

2. HYPERgonadotropic hypogonadism: lack of response to LH and FSH by gonads

Question 5

Which hormone is responsible for the release of LH and FSH from the anterior pituitary?

Answer 5

Gonadotropin releasing hormone (GnRH)

Question 6

What is HYPOgonadotropic hypogonadism?

Answer 6

Deficiency of LH and FSH due to abnormal functioning of the hypothalamus or anterior pituitary

Question 7

Give 4 causes of HYPOgonadotropic hypogonadism

Answer 7

Chronic conditions (eg CF/IBD) |
Excessive exercise/dieting |
Endocrine disorders (eg hypothyroidism) |
Kallman syndrome |
Damage to hypothalamus/pituitary (eg radioRx/surgery)

Question 8

What is HYPERgonadotropic hypogonadism?

Answer 8

Gonads fail to respond to LH and FSH

Question 9

Give 3 causes of HYPERgonadotropic hypogonadism

Answer 9

Previous damage to gonads (torsion, cancer, infections e.g.mumps) |
Congenital absence of ovaries |
Turner’s syndome (XO)

Question 10

What is Kallman syndrome?

Answer 10

Genetic condition causing HYPOgonadotropic hypogonadism, with failure to start puberty (assoc w/ anosmia)

Question 11

What is congenital adrenal hyperplasia?

Answer 11

Deficiency of 21-hydroxylase enzyme -> underproduction of cortisol and aldosterone and overproduction of androgens

Question 12

When does congenital adrenal hyperplasia present?

Answer 12

1. If severe: presents at birth with electrolyte disturbances and hypoglycaemia
2. If mild, females can present later in childhood/puberty

Question 13

In mild cases of congenital adrenal hyperplasia, female patients can present in childhood/puberty with what features? (5)

Answer 13

Tall for age |
Facial hair |
Primary amenorrhoea |
Deep voice |
Early puberty

Question 14

What is androgen insensitivity syndrome?

Answer 14

Tissues unable to respond to androgen hormones -> typical male characteristics do not develop -> female phenotype (other than internal pelvic organs)