ovaries Flashcards
Premature ovarian failure - definition / presentation and endocrine profile
premature atresia of ovarian follicles in women of reproductive age
- signs of menopause after puberty but before 40
endocrine profile: low estrogen, high LH, FSH
Polysystic ovarian (Stein-Leventhal) syndrome - mechanism
hyperinsulinemia and/or insulin resistance is hypothesized to alter hypothalamic hormonal feedback response –> high LH/FSH –> increased androgen production from theca cells (LH) (–> hirsutism) but low estrogen (no FSH on granulosa), low rate of follicular maturation –> unruptured follicles (cysts) + anovulation
Polysystic ovarian (Stein-Leventhal) syndrome - estrogen levels (mechanism)
- low 17β -estradiol (low FSH –> no aromatization granulosa cells)
- high estrone (aromatization of androgen on adiposse tissue)
Polysystic ovarian (Stein-Leventhal) syndrome - increased risk of … (and mechanism)
- endometrial cancer 2ry to unopposed estrogen from repeated anovulatory cycles
- Ovarian neoplasm
Ovarian cysts - types (MC?)
- follicular cysts (mc)
2. Theca lutein cyst
ovarian follicular cysts / associated with
distention of unruptured graafian follicle
associated with: 1. hyperestrogenism 2. endometrial hyperplasia
ovarian follicle cyst may be associated with
- hyperestrogenism
2. endometrial hyperplasia
Theca-lutein cyst - definition/mechanism / associated with
often bilateral/multiple due to gonadotropin stimulation
- choriocarcinoma / hydatidiform moles
increased risk for ovarian neoplasm
- advanced age
- infertility
- endometriosis
- Polysystic ovarian syndrome
- genetics (BRCA1/2 Lynch syndrome, family history)
decreased risk for ovarian neoplasm
- previous pregnancies
- history of breastfeeding
- OCPs
- tubal ligation
Benign ovarian neoplasms (MC?)
- serous cystadenoma
- mucinous cystadenoma
- endometrioma
- mature cystic teratoma (dermoid cyst)
- Brenner tumor
- fibromas
- thecoma
MC ovarian tumor in females 10-30
Mature teratoma of ovary (dermoid cyst)
Thecoma - characteristic, presentation
like granulosa cell tumors –> may produce estrogen
usually presents as abnormal uterine bleeding in postmenopausal women
malignant Ovarian neoplasms (MC?)
- Granulosa cell tumor
- serous cystednocarcinoma (MC)
- Mucinous cystedonacarcinoma
- immature teratoma
- yolk sac (endodermal sinus) tumor
- Krukenber tumor
- dysgerminoma
granulosa tumor - pathogenesis - histology
sex cord-stromal tumore
high estradiol and inhibin
- histology: Call-Exner bodies (cells in rosette pattern)
Granulosa cell tumor - clinical features
- complex ovarian mass
jevenile subtype: precocious puberty
adult: brest tenderness, abnormal uterine bleeding
postmenopausal bleeding
granulosa cell tumor - management
endometrial biopsy (endometrial cancer) surgery (tumor staging)
how to check the quality of ovaries
measure FSH at day 3
infertility due to diminished ovarian reserve - characteristics
regular menstrual cycles and decreased oocyte number + quality
ovarian cancer - screening
there is no screening
ovarian torsion - treatment
laparoscopy with detorsion
ovarian cystecomy
oophorectomy if nerosis or malignancy
ovarian torsion - RF
- ovarian mass
- reproductive age
- infertility treatment with ovulation induction
Causes of hyperandrogenism in pregnancy - types and risk for fetal virilization
- Luteoma –> high
- theca luteum cyst –> low
- Krukenberg tumor –> high
Causes of hyperandrogenism in pregnancy - Krukenberg tumor - maternal clinical features
bilateral solid ovarian masses on U/S
metastases from GI tract ca
Causes of hyperandrogenism in pregnancy - Luteoma - maternal clinical features
- yellow or yellow brown masses (often with areas of hemorrhage) of large lutein cells
- solid ovarian masses on U/S (50% are bilateral)
- regress spontaneously after delivery
- 30% symptoms of hyperandrogenism
Causes of hyperandrogenism in pregnancy - theca luteum cyst - maternal clinical features
- bilateral cysts on U/S
- associated with molar pregnancy + multiple gestation
- regress spontaneously after delivery
ruptured ovarian cyst - clinical presentation / US findings
sudden onsetm severe, unilateral lower abd pain immediately followgin strenuous or sexual activity
U/S: pelvic free fluid
ovarian mass in postemeupausal patients is investigated by
pelvic U/S and CA-124 –> IF NO MALIGNANT FEATRUES ON u/s AND NO HIGH ca-125 –> –> OBSERVATION WITH U/S
- IF 1 OF THEM IS SUSUCPICIOUS –> MRI or CT
PCOS - levels of FSH, GNRH, estrogen
- increased estrogen
- increased GnRH
- normal FSH
INCREASED LH:FSH
Polycystic ovarian syndrome - symptoms
Symptoms in women of reproductive age:
- amenorrhea or irregular menses
- Hisrutism and obesity
- acne
- DM2
Polycystic ovarian syndrome - diagnosis
pelvic US: bilaterally enlarged ovaries with multiple cysts present
free testosterone elevated (2ry to high androgens)
LH to FSH RATIO MORE THAN 3:1
Polycystic ovarian syndrome - treatment
- Weigh loss (decrease insulin resistance)
- OCP control the amounts of estrogn and progestin that are in the body –> control androgens and prevent endometrial hyperplasia (ONLY if they do not want children)
- Clomiphene and metformin (if they want to conceive)
- ketoconazole / spironolactone
rupture ovarian cyst - fever
NO
just diffuse abd pain
epithelial ovarian Ca - management
exploratory laparotomy
ruptured ovarian cyst - clinical presentation / US findings
sudden onsetm severe, unilateral lower abd pain immediately followgin strenuous or sexual activity
U/S: pelvic free fluid
teratoma in U/S
calcifications
hyperechoic
