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Endocrine- Sex Hormones > Ovulation Disorders- Types 2 and 3 > Flashcards

Ovulation Disorders- Types 2 and 3 Flashcards

1
Q

What is the main type 2 ovulation disorder?

A

PCOS

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2
Q

What type of gonadotrophin gonadism is type 2?

A

Normogonadotrophic hypogonadism

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3
Q

Do type 2 ovulation disorders present with amenorrhoea, oligomenorrhoea or either?

A

Can be either

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4
Q

What are the oestrogen levels like in type 2 ovulation disorders?

A

Normal

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5
Q

PCOS is an inherited syndrome, exacerbated by what?

A

Weight gain

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6
Q

PCOS is diagnosed by having 2/3 of the Rotterdam criteria, what are these?

A

Oligo/amenorrhoea, polycystic ovaries, biochemical or clinical signs of hyperandrogenism

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7
Q

What are the two main clinical signs of hyperandrogenism?

A

Acne, hirsutism

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8
Q

What test is most useful to visualise ovarian cysts?

A

Ultrasound

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9
Q

What defines polycystic ovaries?

A

Increased ovarian volume (> 10ml), more than 12 follicles between 2-8mm in diameter, unilateral or bilateral

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10
Q

What are the levels of testosterone in PCOS? This feeds back on the pituitary which can lead to what?

A

High testosterone, can lead to insulin resistance

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11
Q

What are the levels of insulin in PCOS? What effect does this have on sex-hormone binding globulin?

A

High insulin- decreases SHBG

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12
Q

Decreased SHBG in PCOS results in what?

A

Increased free testosterone and hyperandrogenism

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13
Q

What are the 5 main symptoms of PCOS?

A

Obesity, hirsutism, acne, cycle abnormalities, infertility

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14
Q

Symptoms of PCOS get worse as weight increases. What are the first line treatments?

A

Weight loss and metformin

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15
Q

What are the levels of LH/FSH in PCOS?

A

High LH, normal FSH

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16
Q

What will the levels of progesterone be in PCOS?

A

Low

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17
Q

What are some ways to manage symptoms in a patient with PCOS?

A

Anti-androgens, contraceptive pill

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18
Q

When can anti-androgens cause a problem?

A

If the patient gets pregnant and the foetus is male

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19
Q

What should be given to women with PCOS who do not want to get pregnant?

A

Endometrial protection 4 times a year

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20
Q

What lifestyle modifications are used for pre-treatment to aid fertility in women with PCOS?

A

Weight loss, stop smoking, decrease alcohol

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21
Q

What supplement should be given in women with PCOS trying to get pregnant? What should you make sure they are immunised against?

A

Folic acid 5mg. Immunise against rubella.

22
Q

What is the first line treatment for ovulation induction in PCOS?

A

Clomifene citrate: 50/100/150mg tablets day 2-6

23
Q

If clomifene citrate treatment fails in PCOS, what can be used instead?

A

Metformin, gonadotrophin therapy, laparoscopic ovarian diathermy

24
Q

What is given as gonadotrophic therapy if required in PCOS? What are the risks of this?

A

Daily injections of recombinant FSH. Risks include multiple pregnancy and ovarian hyper stimulation.

25
Q

What is the main risk of laparoscopic ovarian diathermy? What is the advantage of this?

A

Ovarian destruction. The main advantage is singleton pregnancies.

26
Q

Along with lifestyle modification, what are the advantages of metformin in PCOS?

A

Improve insulin resistance, reduced androgen production, restore menstruation and ovulation

27
Q

What are the downsides of metformin in PCOS?

A

Does not help weight loss and may increase pregnancy rate

28
Q

What are the 3 main risks of ovarian induction?

A

Hyperstimulation, multiple pregnancies and increased risk of ovarian cancer

29
Q

When are you more likely to have ovarian hyper stimulation?

A

< 35 or if you have PCOS

30
Q

What are the main risks associated with multiple pregnancies?

A

Increased risk of maternal complications, increased risk of foetus complications, risk of disability, increased postnatal depression, twin twin transfusion syndrome

31
Q

When is the risk of ovarian cancer greatest in ovarian induction?

A

If fertility treatment is used for more than 12 months

32
Q

If the problem is pituitary dysfunction, what will be the levels of LH/FSH/oestrogen?

A

LH and FSH = low/normal, oestrogen = low

33
Q

What are some causes of loss of LH/FSH stimulation?

A

Non-functioning pituitary adenoma, empty sella or pituitary infarction

34
Q

What will be the main presenting features of hyperprolactinaemia?

A

Amenorrhoea and galactorrhoea

35
Q

What is a really important cause of hyperprolactinaemia which should be considered?

A

Drugs

36
Q

What exams/tests should be done in a case of hyperprolactinaemia?

A

Visual fields, hormone levels and pituitary MRI

37
Q

What will be the levels of LH/FSH/oestrogen in hyperprolactinaemia?

A

LH/FSH = normal, oestrogen = low

38
Q

How should hyperprolactinaemia be managed? When should this be stopped?

A

Dopamine agonist- stop if patient becomes pregnant

39
Q

What type of gonadotrophic gonadism is type 3 ovarian disorder?

A

Hypergonadotrophic hypogonadism

40
Q

What is the main issue in group 3 ovarian disorders?

A

Premature ovarian failure

41
Q

What are group 3 ovarian disorders?

A

Ovarian failure

42
Q

What will the level of oestrogen be in premature ovarian failure?

A

Low

43
Q

What will the levels of LH/FSH be in premature ovarian failure?

A

High

44
Q

What is premature ovarian failure?

A

The menopause aged < 40

45
Q

What FSH is diagnostic of premature ovarian failure?

A

> 30 on two separate occasions, more than 1 month apart

46
Q

What are some causes of premature ovarian failure?

A

Idiopathic, chromosomal, autoimmune, iatrogenic

47
Q

How can a mosaic of Turner’s syndrome present?

A

Secondary amenorrhoea (premature ovarian failure)

48
Q

What are some symptoms of premature ovarian failure?

A

Hot flushes, night sweats, atopic vaginitis

49
Q

As well as hormone levels, what are some other tests which may be useful in premature ovarian failure?

A

Karyotyping, DEXA scan, pituitary MRI

50
Q

How do you treat premature ovarian failure?

A

Counselling, hormone replacement, oocyte donation, prevention of osteoporosis

51
Q

Group 3 ovarian disorders can also be caused by what, as well as premature ovarian failure? Give examples.

A

Congenital problems: absence of a uterus or vaginal atresia. Also Turner’s, CAH, testicular feminisation.

Endocrine- Sex Hormones (5 decks)

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