Hypogonadism (female)

Question 1

def of female hypogonadism

Answer 1

impairment of ovarian function

Question 2

aetiology of female hypogonadism

Answer 2

PRIMARY HYPOGONADISM
-gonadal dysgensis (chromosomal abnormalities e.g. Turner’s syndrome)
-gonadal damage (autoimmune & iatrogenic)
SECONDARY HYPOGONADISM
-functional (stress, weight loss, excessive exercise, anorexia nervosa)
-pituitary/hypothalamic tumours & infiltrative lesions (pituitary adenomas)
-hyperprolactinaemia (prolactinoma/ tumour causing pituitary stalk compression)
-congenital GnRH deficiency (idiopathic/ Kallman’s)

Question 3

epi of female hypogonadism

Answer 3

secondary is a more common cause than primary for anovulation & amenorrhoea

Question 4

history of female hypogonadism

Answer 4

symptoms of oestrogen deficiency
-night sweats
-hot flush
-decreased libido
symptoms of underlying cause

Question 5

examination of female hypogonadism

Answer 5

pre-pubertal hypogonadism
-delayed puberty (primary amenorrhoea, absent breast development, no secondary sexual characteristics)
-eunuchoid proportions (long legs & increased arms spam for height)
post-pubertal hypogonadism
-loss of secondary sexual characteristics
-fine facial wrinkles
signs of underlying cause/associated symptoms
-hypothalamic/pituitary disease (visual field defects)
-kallmanns (anosmia)
-turners (short stature, low posterior hairline, widely spaced nipples)

Question 6

investigations for suspected female hypogonadism

Answer 6

• low serum oestradiol in primary & secondary
• high FSH & LH in primary (negative feedback inhibition by ovarian oestradial & inhibin)
• low or inappropriately normal FSH & LH in secondary

INVESTIGATIONS FOR AETIOLOGY
primary
-chromosomal abnormalities (turner's)
-pelvic imaging (primary amenorrhoea for presence or absence of uterus & vagina)
secondary
-pituitary function tests (9am cortisol, TFTs, cortisol)
-visual field testing
-smell tests for anosmia

Question 7

what would be found on chromosomal analysis of turners

Answer 7

complete/partial deletion of x chromosome

or presence of y chromosome