Menopause/Infertility/Virilization Flashcards
Hirsutism
mild masculinization = fat and hairy
Virilization
hirsutism +! = fat, hairy, enlarged clitoris, deep voice, amenorrhea + increase in muscle mass
where does DHEA come from?
Adrenals in response to ACTH
5 common causes of Hirsutism/virilization
- PCOS
- Sertoli-Leydig Tumor
- Adrenal Tumor
- CAH
- Familial hirsutism
explain why you get hirsutism in PCOS. how would you dx? labs?
lack of progest = elevated LH trying to produce progest but just making excess testosterone!
Labs: elevated test, norm DHEA, LH >FSH, bilateral ovary cysts on U/S
How do you tx PCOS? why?
- OCP = regulate cycle and prevent breakthrough bleeding
- Clomiphene if trying to get prego to stimulate ovulation(no progest no ovulation!)
- Metformin = helps w/ovulation(no idea why) + helps w/insulin resistance
- Spironolactone = antiandrogen fx
What labs would you see w/hirsutism caused by sertoli-leydig tumor? tx?
HIGH test, normal DHEA, unilateral ovarian mass on U/S. must resect
What labs would you see w/hirsutism caused by Adrenal Tumor? tx?
normal test, HIGH DHEAS, unilateral adrenal mass on CT scan. must resect
What labs would you see w/hirsutism caused by CAH? which one? tx?
normal test, elevated DHEA, bilateral adrenal enlargment on CT scan. Often 21 OH Prog. Tx: cortisol + fludrocortisone
What labs would you see w/hirsutism caused by familial hirsutim?
everything is normal but ur still fat in hairy bc ur genes suck
Whats the trick to figuring out the CAH’s? so whats 17, 11, 21?
1st number is mineralo/aldo, 2nd is sex.
- 17 = high aldo, no sex
- 21 = no aldo, high sex
- 11 = some aldo, high sex
elevation of —- is consitant with ovarian failure.
FSH
tx of vaginal atrophy
estrogen cream
tx of hot flashes
SSRI = venlafaxine
osteoporosis prophylaxis @ 50
Vit D3 + Ca
when do you do Osteoporosis screening?
dexa @ 65 or 60 if smoker
Osteoporosis tx
bisphosphonates
define Infertility
inability to conceive after 1 year
Which do you work up 1st in infertility M or F?
Male!
male workup for infertility includes…
- ED - look @ nighttime tumescence test. If psyc = counciling; If not = Sildenafil
- Semen analysis = look @ number + Motility
when should you advise a couple who wants to get pregnant to have sex?
5 days prior to ovulation and throughout the day of ovulation
ICSI vs IVD vs IUI
- Intracytoplasmic Sperm Injection(ICSI) = manual sperm + egg + implant
- In Vitro Fert(IVD) = Egg + sperm in dish, let fertilize nat + implant
- Intrauterine Injection(IUI) = sperm injected into uterus
Female causes of infertility workup
- hostile mucous 6cm this is good. tx Estrogen
2. Anovulation
What is a smush test? what is this used for?
tests infertility due to hostile cervical mucus = <6 cm on smush test = too thick =( idealy want >6cm this is good. tx Estrogen to thin mucus if too thick
Define Menopause
1yr w/o period
Primary ovarian insufficiency definition
Menopause(1yr w/o period) before age 40