Ovulation Disorders- Type 1 Flashcards
What is the definition of oligomenorrhoea?
Reduction in the frequency of periods to < 9/year or a cycle of > 35 days
What is the definition of primary amenorrhoea?
Failure of menarche by age 16
What is the definition of secondary amenorrhoea?
Cessation of periods for > 6 months in an individual who has previously menstruated
If there is anatomical or congenital problems, which type of amenorrhoea will this cause?
Primary
What are the physiological causes of amenorrhoea?
Pregnancy or post-menopausal
What should always be checked for first in an individual with amenorrhoea?
Pregnancy test
What diagnoses should be considered in an individual with primary amenorrhoea?
Congenital disorders such as Turner’s or Kallman’s
What are some causes of secondary amenorrhoea?
Ovarian or uterine problems, hypothalamic or pituitary dysfunction
What are some causes of hypothalamic dysfunction?
Weight loss, excessive exercise, stress, infiltrative disease
What are two examples of pituitary problems which can cause hypogonadism?
Prolactinoma, hypopituitarism
Give 3 symptoms of oestrogen deficiency?
Flushing, decreased libido, dyspareunia
Anosmia is a feature of which condition?
Kallman’s
Why is it so important to ask about drug history in a patient with amenorrhoea?
Many drugs are associated with raised prolactin
All patients with oligo/amenorrhoea should have what hormones measured?
LH, FSH, oestrogen, thyroid function, prolactin
What are some additional investigations which may/may not be used for oligo/amenorrhoea?
Karyotyping, testosterone levels, pituitary levels and MRI ovarian ultrasound
Low LH and FSH suggests the problem is where?
Pituitary
High LH and FSH suggests the problem is where?
Ovaries
What defines hypogonadism in females?
Low levels of oestrogen
Primary hypogonadism is a problem where? What type of hypogonadism is it?
Ovaries- hypergonadotrophic hypogonadism
Secondary hypogonadism is a problem where? What type of hypogonadism is it?
Hypothalamus/pituitary- hypogonadotrophic hypogonadism
Give 3 examples of primary hypogonadism?
Premature ovarian failure, PCOS, congenital ovarian problems
What is group 1 of the WHO classification of ovarian disorders?
Hypothalamus/pituitary failure
Give 5 key features of group 1 ovulatory disorders?
Hypogonadotrophic hypogonadism, amenorrhoea, low LH/FSH, oestrogen deficiency, normal prolactin
How is oestrogen deficiency proven?
Progesterone challenge test
Describe what would happen in a progesterone challenge test on a normal individual?
There would be a menstrual bleed in response to a 5 day course of progesterone
Give some causes of group 1 ovarian failure?
Hypothalamic disease, hypothalamic/pituitary tumours, Kallmanns, idiopathic, drugs
What drugs can cause group 1 ovarian failure?
Steroids, opiates
What is the first step in management of group 1 ovarian failure?
Stabilise weight (if that is an issue)
If a patient is hypo/hypo, what medications need to be given?
Pulsatile GnRH (SC or IV) and daily injections of FSH and LH
What treatment for hypogonadotrophic hypogonadism comes with a risk of multiple pregnancies?
FSH and LH daily injections
Treatment for hypogonadotrophic hypogonadism requires what monitoring?
Regular ultrasound monitoring of response
What are 3 rarer causes of hypogonadotrophic hypogonadism?
Idiopathic, Prader-Willi, haemochromatosis
How is idiopathic hypogonadotrophic hypogonadism (IHH) identified?
Absent/delayed sexual development with low levels of gonadotrophin and sex hormone in the absence of any anatomical/functional problem
What is the major defect in IHH?
Inability to activate pulsatile GnRH secretion during puberty
A mutation where has been associated with IHH?
The GPCR KISS1R
KISS1R produces the ligand for what?
Kisspeptin, a potent stimulator of GnRH secretion
What is Kallmann’s syndrome?
Isolated GnRH deficiency
What are some features which may/may not be associated with Kallmann’s syndrome?
Anosmia, cleft palate, colour blindness
How is Kallmann’s syndrome inherited? What gene is affected?
X-linked, KAL-1 gene
Is fertility possible in Kallmann’s?
Yes
Kallmann’s is more common in which sex?
Males (4:1)
