Hormonal alterations Flashcards
1
Q
Primary amenorrhea- Eti
A
- Failure of menses to appear
- Eval at 14 if amenarche and no breasts and height in lowest 3%
- Amenarche at 16
- HP causes- delayed puberty
- Hyperandrogenism- polycystic ovaries
- Ovarian- Turner syndrome
- Pseudohermaphroditisim- Androgen insensitivity
- Absence of uterus
2
Q
Primary amenorrhea- Sx
A
- HA, visual field abnormalities
- BP, hirsuitism & acne
- Short stature
3
Q
Primary amenorrhea- Dx
A
- FSH, LH, PRL, Testosterone, TSH, FT4 & hCG
- Pituitary MRI
4
Q
Primary amenorrhea- Tx
A
- Underlying cause
- Hormone replacement therapy
5
Q
Secondary amenorrhea- Definition
A
- Absence of menses for 3 consecutive months passed menarche
6
Q
Secondary amenorrhea-Sx
A
- Vasomotor instability
- Fatigue, insomnia, headache, decreased libido
7
Q
Secondary amenorrhea-Dx
A
- hCG (pregnancy)
- PRL, FSH, LH & TSH
- MRI of pituitary
- Kidney & liver fxn test
8
Q
Secondary amenorrhea-Tx
A
- Estrogen therapy
- Gabapentin (hot flash)
- HRT decreases mortality under 60
9
Q
Secondary amenorrhea due to pregnancy
A
Most common cause
10
Q
Secondary amenorrhea- Hypothalamic- pituitary
A
- Low or normal FSH
- low GnRH pulses
- Stress, dieting, exercise, anorexia, illnes
11
Q
Secondary amenorrhea- Hyperandrogenism
A
- Low to normal FSH
- Elevated testosterone
- Hirsutism, virilization & amenorrhea
- Ovarian & adrenal malignancy
- Anabolic steroids
- Cushing
12
Q
Secondary amenorrhea- Uterine
A
- Spontaneous or following delivery
- Endometriosis: Tb or schisto
13
Q
Secondary amenorrhea- Early & premature menopause
A
- Ovarian failure before 45
- 5% women
- Premature = <40
- Radiation, hysterectomy, oophorectomy, familial
14
Q
Secondary amenorrhea- Normal menopause
A
- Ovarian failure >45
- Climacteric over 10 yrs
- USA: 48-55 (ave: 51.5)
- Low serum estradiol
- High FSH
15
Q
Turner syndrome- Eti
A
- x chromosome disorder
- Spontaneous abortion, hypogonad, short stature
- 1-2% fetuses, 10% spontaneous abortions
16
Q
Turner syndrome- Sx
A
- Severe lymphedema in young girls
- Short stature
- Risk of aortic coarctation, bicuspid and aortic valves
- Webbed neck
- Hypogonadism
- High arched palate
- Wide spaced nipples
- HTN
- Renal abn
- Primary amenorrhea (80%)
- Emotional & autoimmune disease (thyroiditis, IBD, celiac)
17
Q
Turner syndrome- Dx
A
- Hypogonadism: High FSH, LH
- Blood karyotyping
- US/ MRI of chest/ abd- cardiac/ vasc. abn
18
Q
Turner syndrome- Tx
A
- Growth hormone & androgens
- Estrogen & progestin after growth stops
19
Q
Menopause- Dx
A
- Dx after 6 months of amenorrhea
20
Q
Menopause- Tx
A
- Eval for osteoporosis & tx if appropriate
- HRT w or w/o progestin
- Both have risks and benefits
