Infertility, Endocrinology, and Menstrual Dysfxn Flashcards
9 yo girl presents for evaluation of regular vaginal bleeding. Hx reveals thelarche at age 7 and adrenarche at age 8. Which of the following is the most common cause of this condition in girls?
a. Idiopathic
b. Gonadal tumors
c. McCune-Albright syndrome
d. Hypothyroidism
e. Tumors of CNS
a. Idiopathic
In North America, pubertal changes in girls before 8 and boys before 9 = precocious puberty. Most of the time, idiopathic
Osteoporosis
First line ppx?
Bisphosphonates
Raloxifene usage, risk factor
Used to reduce risk of vertebral fractures
Associated with inc. risk of thromboembolism
Primary dysmenorrhea tx
First line: NSAIDs
then OCPs (esp if sexually active)
An 18 yo pt presents for eval b/c she has not yet started her period. On physical exam, she is 5’7’’. Minimal breast development and no axillary or pubic hair. On pelvic exam, normally developed vagina. Visible cervix. Uterus is palpable as are normal ovaries. Which of the following is the next step in eval of this pt?
a. Draw blood for karyotype
b. Test her sense of smell
c. Draw blood for TSH, FSH, and LH levels
d. Order MRI of brain to evaluate pituitary gland
b. Test her sense of smell
b/c Kallmann Syndrome
In Turner, would see streak ovaries and short stature.
How to treat precocious puberty?
GnRH agonists to disrupt pulsatile activity of HPA (Leuprolide)
Woman with bicornuate uterus. Of the pt’s sx, which is most likely to be corrected by resection of uterine septum?
a. Habitual abortion
b. Dysmenorrhea
c. Menometrorrhagia
d. Dyspareunia
e. Chronic pelvic pain
a. Habitual abortion
Medical management for endometriosis?
Suppressive therapy following ablative surgery
Combined OCPs = mainstay of therapy.
GnRH agonists can be used if combined OCPs fail (produce medically induced and reversible menopause state)
Primary sx with Asherman syndrome
Amenorrhea
Condition where intrauterine adhesions are present –> adhesions can often cause sx such as amenorrhea or infertility
B/c of decreased amount of functional endometrium present in this setting, progressive hypomenorrhea (lighter menstrual flow) or amenorrhea is common
During the evaluation of secondary amenorrhea in a 24 yo woman, hyperprolactinemia is diagnosed. Which of the following conditions could cause increased circulating prolactin concentration and amenorrhea in this pt?
a. Stress
b. Primary hyperthyroidism
c. Anorexia nervosa
d. CAH
e. PCOS
a. Stress
Prolactin is under the control of prolactin-inhibiting factor (PIF), which is produced in hypothalamus. Stress decreases PIF.
In hypothyroidism, elevated TRH acts as prolactin-releasing hormone; hyperthyroidism is not associated with hyperprolactinemia.
A 36 yo morbidly obese woman presents to your office for evaluation of irregular, heavy menses occurring every 3 to 6 mo. An office endometrial biopsy shows complex hyperplasia of the endometrium without atypia. The hyperplasia is most likely related to excess formation in the patient’s adipose tissue of which of the following hormones?
a. Estriol
b. Estradiol
c. Estrone
d. Androstenedione
e. Dehydroepiandrosterone
c. Estrone
In premenopausal adult women, most of the estrogen in the body is derived from ovarian secretion of estradiol, but a significant portion also comes from peripheral conversation of androstenedione to estrone in adipose tissue.
When there is an increase in fat cells, as in obese persons, estrogen levels–particularly estrone–will. be higher, provoking anovulation and endometrial hyperplasia.
7 lb infant with normal-appearing male external genitalia. However, nonpalpable tests. At 6 mo of age, boy’s testes still have not descended. Pelvis U/S shows testes in pelvis, and there appears to be a uterus present as well. +uterus in an otherwise phenotypically normal male is caused by which of the following?
a. Lack of MIF
b. Lack of testosterone
c. Increased levels of estrogen
d. 46, XX karyotype
a. Lack of MIF
Male testes secrete MIF, which causes regression of Mullerian structures. Anything that prevents MIF secretion in genetic males will results in persistence of Mullerian structures into postnatal period. Persons who appear to be normal male but who possess a uterus and fallopian tubes have such a failure of MIF. Their karyotype is 46, XY, testes are present, and testosterone production is normal.
Pt with PCOS would like to get pregnant. Therefore, discontinued OCPs. Periods are very unpredictable. Usually occur every 3 to 6 mo. Most appropriate first line therapy to help her conceive?
a. Intrauterine insemination
b. IVF
c. Metformin
d. Clomiphene citrate
e. Laparoscopic ovarian drilling
d. Clomiphene citrate
First line therapy for anuovulatory women, including women with PCOS. Most women with PCOS will ovulate with clomiphene citrate, and approx 50% will conceive.
Metformin may improve ovulation and is sometimes used in combo with clomiphene citrate.
A 23 yo woman presents for evaluation of a 7 mo hx of amenorrhea. She has no other major medical problems. Exam discloses bilateral galactorrhea and normal breast and pelvic exams. Pregnancy test is negative. Serum prolactin is ordered and the result is elevated at 47 ng/mL.
What is the next step in mgmt?
a. Repeat serum prolactin in 1 mo.
b. Order MRI
c. Provide reassurance
d. Refer her to breast surgeon
a. Repeat serum prolactin in 1 mo.
Modest inc. in serum prolactin should be reevaluated at least once prior to ordering an imaging study, b/c prolactin can be transiently increased by many factors such as stress, breast stimulation, or eating. If persistently elevated, undergo MRI.
Menstrual migraine tx?
What to watch out for….?
OCP (Not NSAID b/c continuous use –> ulcers)
If before onset of menses, pt reports visual auras consisting of bright spots, estrogen should be avoided (migraine with visual aura associated with inc risk of stroke)
