Gynaecology

Question 1

What are the typical causes of ambigious (female genitalia) [4]

Answer 1

Typical causes include congenital adrenal hyperplasia, androgen insensitivity syndrome, 5-alpha reductase deficiency, and certain forms of gonadal dysgenesis.

Question 2

List 5 causes of primary amenorrhoea [5]

Answer 2

• gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
• testicular feminisation
• congenital malformations of the genital tract
• functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
• congenital adrenal hyperplasia
• imperforate hymen

Question 3

List 5 causes of secondary amenorrhoea [5]

Answer 3

• pregnancy
• hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
• polycystic ovarian syndrome (PCOS)
• hyperprolactinaemia
• premature ovarian failure
• thyrotoxicosis
• Sheehan’s syndrome
• Asherman’s syndrome (intrauterine adhesions)

Question 4

Describe the differences between primary and secondary amenorrhoea [2]

Answer 4

primary: defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development), or by 13 years of age in girls with no secondary sexual characteristics

secondary:
- cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea

Question 5

Describe the initial investigations for amenorrhoea [5]

Answer 5

exclude pregnancy with urinary or serum bHCG

full blood count, urea & electrolytes, coeliac screen, thyroid function tests

gonadotrophins
- low levels indicate a hypothalamic cause where as raised levels suggest an ovarian problem (e.g. Premature ovarian failure)
raised if gonadal dysgenesis (e.g. Turner’s syndrome)

prolactin

androgen levels
- raised levels may be seen in PCOS

oestradiol

Question 6

Define what is meant by precocious puberty in boys and girls [2]

What are the two types? [2]

Answer 6

Precocious puberty is characterised by the onset of secondary sexual characteristics before the age of 8 in girls and 9 in boys

central precocious puberty (CPP):
- resulting from premature activation of the hypothalamic-pituitary-gonadal axis

peripheral precocious puberty (PPP):
- due to excessive sex steroids independent of gonadotropin secretion.

Question 7

Tx for CPP and PPP? [2]

Answer 7

GnRH analogues are first-line treatment for CPP while PPP requires targeted therapy depending on underlying cause.