Hormonal Causes of Infertility Flashcards
define oligomenorrhea
less than 9 periods per yr
describe difference between primary and secondary amenorrhea
primary - failure of menarche by 16 yearhs
secondary- cessation of periods for more than 6 months in person who has previously menstruated
physiological causes of amenorrhea
pregnancy
postmenopausal
causes of primary amenorrhea
turners
kallmans
causes of secondary amenorrhea
PCOS POF uterine adhesions weightloss, over exercise, stress high prolactin, hypopituitrism
define primary hypogonadism and give example
problem with the ovaries such as POF
define secondary hypogonadism
problem with hypothalamus/pituitary eg high prolactin, hypopituitarism
define premature ovarian failure
amenorrhea, oestrogen deficiency and elevated gonadotrophins occurring at less than 40 years of age, as a result of loss of ovarian function
what measurements must be taken to diagnose POF
FSH more than 30 on 2 separate occasions more than 1 month apart
give causes of POF
turners, fragile x
gene mutations (FSH/LH receptors)
autoimmune disease eg addisons
iatrogenic (chemotherapy)
give causes of secondary hypogonadism
kallmans IHH pituitary problem prader willi haemochromatosis
what can cause functional hypothalamic amenorrhea
weight change stress exercise anabolic steroids systemic illness surgery recreational drugs head trauma sarcoidosis
key features of kallmans
loss of GNRH secreation +/- anosmia
50-75 percent have anosmia
normal pituitary function
what gender is kallmans more common in
men
4:1
what percentage of IHH cases are kallmans
60 percent
what proportion of kallmans is inheritied
one third
what mutations results in x linked inheritance of kallmans
KAL 1 gene
give causes of pituitary dysfunction
piturary macroadenoma empty sella pituitary infarct hyperprolactinaemia micro/macro-prolactinoma drugs (dopamine antagonists)
give the diagnostic criteria for PCOS
2 of three of:
menstrual irregularity
hyperandrogenism
polycystic ovaries
what is turners syndrome
45X0
clinical features of turners syndrome
short stature webbed nicek shield chest with wide spaced nipples cubitus algus no menstruation rudimentary ovaries
what other conditions are associated with turners
cardiovascular problems - coartication of aorta gi problems lymphaedema hypthyroidisms osteoporosis scoliosis otitis media renal anomalies
what is hirsuitism
excess hairs im a male pattern
what causes hirsuitism
androgen excess at the hair follicle
- due to excess circulating androgen
- due to increased peripheral conversion at the hair follicle
what is congenital adrenal hyperplasia
inherited group of disorders characterised by deficiency in one of the enzymes required for cortisol synthesis
usually 21 alpha hydroxylase
how Is cah inherited
autosomal recessive
If classic - will present in childhood
if non classic and only partial deficiency may present in adulthood
list causes of hyperandrogenism
PCOS CAH cushings acromegaly androgen secreting tumour
causes of male primary hypogonadism
klinefelters cryptochidims testicular trauma torsion orchiditis chemotherapy varicocoele
causes of secondary hypogonadism in males
same as female-kallmans, prader willi
hyperprolactinaemia
causes of gynaecomastia
physiological drugs eg spironolactone hypogonadism tumours endocrine- cushings systemic illness hereditary disorders
