Ovulatory disorders

Question 1

WHO classification of ovulatory disorders?

Answer 1

1: Hypogonadotrophic hypogonadism (10%)
2. HPO axis dysfunction (85%)
3. Ovarian insufficiency (5%)

Question 2

Primary hypogonadotrophic hypogonadism

Causes?
Investigation?
Mx?

Answer 2

• Idiopathic hypogonadotropic hypogonadism e.g. Kallmann syndrome
• panhypopituitarism e.g. Sheehan syndrome, autoimmune or infectious hypophysitis,
• pituitary adenomas

Ix:

• FSH and LH low
• MRI brain
• If panhypopituitarism suspected: TSH, ACTH, GH

Mx:

• Ovulation induction if required with GnRH analogues
• Hormone replacement - if pre puberty then start with increasing doses of oestrogen and add in progesterone once advanced tanner stage

Question 3

2: HPO axis dysfunction
Causes?
Ix?
Mx:

Answer 3

Causes:

• Extremes of BMI
• PCOS
• Endocrinopathies e.g. hyperprolactinaemia,

Ix: TFTs, PRL, DHEA, Testosterone, ?USS.

Mx: Lifestyle/weight loss advice if relevant, correct underlying cause

Question 4

3: Ovarian insufficiency

Cause:
Ix:
Mx:

Answer 4

Genetic: Most common is Turners XO, also: fragile X, specific gene mutations,
Acquired: Autoimmune e.g. autoimmine thyroiditis, T1 diabetes,
Endometriosis can also destroy ovarian tissue, smoking, infection
Iatrogenic: chemotherapy, radiotherapy

Ix: will have hypergonadotrophic hypogonadism

Mx: dependent on cause