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Endocrine- Sex Hormones > Ovulation Disorders- Type 1 > Flashcards

Ovulation Disorders- Type 1 Flashcards

1
Q

What is the definition of oligomenorrhoea?

A

Reduction in the frequency of periods to < 9/year or a cycle of > 35 days

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2
Q

What is the definition of primary amenorrhoea?

A

Failure of menarche by age 16

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3
Q

What is the definition of secondary amenorrhoea?

A

Cessation of periods for > 6 months in an individual who has previously menstruated

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4
Q

If there is anatomical or congenital problems, which type of amenorrhoea will this cause?

A

Primary

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5
Q

What are the physiological causes of amenorrhoea?

A

Pregnancy or post-menopausal

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6
Q

What should always be checked for first in an individual with amenorrhoea?

A

Pregnancy test

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7
Q

What diagnoses should be considered in an individual with primary amenorrhoea?

A

Congenital disorders such as Turner’s or Kallman’s

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8
Q

What are some causes of secondary amenorrhoea?

A

Ovarian or uterine problems, hypothalamic or pituitary dysfunction

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9
Q

What are some causes of hypothalamic dysfunction?

A

Weight loss, excessive exercise, stress, infiltrative disease

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10
Q

What are two examples of pituitary problems which can cause hypogonadism?

A

Prolactinoma, hypopituitarism

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11
Q

Give 3 symptoms of oestrogen deficiency?

A

Flushing, decreased libido, dyspareunia

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12
Q

Anosmia is a feature of which condition?

A

Kallman’s

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13
Q

Why is it so important to ask about drug history in a patient with amenorrhoea?

A

Many drugs are associated with raised prolactin

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14
Q

All patients with oligo/amenorrhoea should have what hormones measured?

A

LH, FSH, oestrogen, thyroid function, prolactin

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15
Q

What are some additional investigations which may/may not be used for oligo/amenorrhoea?

A

Karyotyping, testosterone levels, pituitary levels and MRI ovarian ultrasound

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16
Q

Low LH and FSH suggests the problem is where?

A

Pituitary

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17
Q

High LH and FSH suggests the problem is where?

A

Ovaries

18
Q

What defines hypogonadism in females?

A

Low levels of oestrogen

19
Q

Primary hypogonadism is a problem where? What type of hypogonadism is it?

A

Ovaries- hypergonadotrophic hypogonadism

20
Q

Secondary hypogonadism is a problem where? What type of hypogonadism is it?

A

Hypothalamus/pituitary- hypogonadotrophic hypogonadism

21
Q

Give 3 examples of primary hypogonadism?

A

Premature ovarian failure, PCOS, congenital ovarian problems

22
Q

What is group 1 of the WHO classification of ovarian disorders?

A

Hypothalamus/pituitary failure

23
Q

Give 5 key features of group 1 ovulatory disorders?

A

Hypogonadotrophic hypogonadism, amenorrhoea, low LH/FSH, oestrogen deficiency, normal prolactin

24
Q

How is oestrogen deficiency proven?

A

Progesterone challenge test

25
Q

Describe what would happen in a progesterone challenge test on a normal individual?

A

There would be a menstrual bleed in response to a 5 day course of progesterone

26
Q

Give some causes of group 1 ovarian failure?

A

Hypothalamic disease, hypothalamic/pituitary tumours, Kallmanns, idiopathic, drugs

27
Q

What drugs can cause group 1 ovarian failure?

A

Steroids, opiates

28
Q

What is the first step in management of group 1 ovarian failure?

A

Stabilise weight (if that is an issue)

29
Q

If a patient is hypo/hypo, what medications need to be given?

A

Pulsatile GnRH (SC or IV) and daily injections of FSH and LH

30
Q

What treatment for hypogonadotrophic hypogonadism comes with a risk of multiple pregnancies?

A

FSH and LH daily injections

31
Q

Treatment for hypogonadotrophic hypogonadism requires what monitoring?

A

Regular ultrasound monitoring of response

32
Q

What are 3 rarer causes of hypogonadotrophic hypogonadism?

A

Idiopathic, Prader-Willi, haemochromatosis

33
Q

How is idiopathic hypogonadotrophic hypogonadism (IHH) identified?

A

Absent/delayed sexual development with low levels of gonadotrophin and sex hormone in the absence of any anatomical/functional problem

34
Q

What is the major defect in IHH?

A

Inability to activate pulsatile GnRH secretion during puberty

35
Q

A mutation where has been associated with IHH?

A

The GPCR KISS1R

36
Q

KISS1R produces the ligand for what?

A

Kisspeptin, a potent stimulator of GnRH secretion

37
Q

What is Kallmann’s syndrome?

A

Isolated GnRH deficiency

38
Q

What are some features which may/may not be associated with Kallmann’s syndrome?

A

Anosmia, cleft palate, colour blindness

39
Q

How is Kallmann’s syndrome inherited? What gene is affected?

A

X-linked, KAL-1 gene

40
Q

Is fertility possible in Kallmann’s?

A

Yes

41
Q

Kallmann’s is more common in which sex?

A

Males (4:1)

Endocrine- Sex Hormones (5 decks)

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