Ovulatory disorders Flashcards by Sheryl O'Hare

Ovulatory disorders subtypes (3)

Hypothalamic pituitary failure
Hypothalamic pituitary dysfunction
Ovarian failure

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Hypothalamic pituitary failure - definition

Hypogonadotrophic hypogonadism
Absence of GnRh so no LH or FSH can be produced.
Therefore, no ovulation takes place

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Hypothalamic pituitary failure - endocrine function

Decreased LH and FSH (due to decreased GnRh) 
Decreased oestrogen (as there is no LH or FSH to produce it)

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Hypothalamic pituitary failure - causes

Stress
Excessive exercise
Low BMI: anorexia 
Pituitary tumours 
Head trauma 
Kallman's syndrome

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Hypothalamic pituitary failure - clinical features

Amenorrhoea

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Hypothalamic pituitary failure - investigations

Progesterone challenge test

in normal patients, this triggers a period
in these patients, the patient will not have a period (i.e. negative progesterone challenge test)

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Hypothalamic pituitary failure - management

Stabilise weight
Pulsatile GnRh pump given and there is pulsatile administration of GnRh every 90 mins
FSH and LH daily injections

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Hypothalamic pituitary dysfunction - definition

Normogonadotrophic hypogonadism

Gonadotropins (LH and FSH) are normal but the signals are not ready in the ovary

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Hypothalamic pituitary dysfunction - endocrine function

Normal LH and FSH

Normal oestrogen levels

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Hypothalamic pituitary dysfunction - investigations

Progesterone challenge test

- when patient stops taking progesterone tablets and progesterone levels fall, then the patient should menstruate

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Hypothalamic pituitary dysfunction - PCOS - definition

Polycystic ovarian syndrome

Ovaries that contain many small cysts (egg containing follicles that have not developed properly)

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Hypothalamic pituitary dysfunction - PCOS - endocrine functions

Increased LH 
Increased testosterone 
Increased insulin
Normal oestrogen
Decreased progesterone 
Decreased SHBG

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Hypothalamic pituitary dysfunction - PCOS - cause

Weight gain

Inherited condition

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Hypothalamic pituitary dysfunction - PCOS - clinical features

Obesity 
Hirsutism 
Acne
Menstrual cycle abnormalities 
Subfertility

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Hypothalamic pituitary dysfunction - PCOS - investigations

Pregnancy test
Progesterone challenge test
Transvaginal US
Check testosterone levels (increased)

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Hypothalamic pituitary dysfunction - PCOS - diagnosis

Presence of at least 2 of:

menstrual irregularity
polycystic ovaries on US (12 or more, 2-9mm mottled purple follicles)
hyperandrogenism (hirsutism, acne) due to elevated free testosterone levels (i.e. above 5mmol/L)

Hypothalamic pituitary dysfunction - PCOS - management

Weight loss 
Folic acid supplements 
Ensure patient is immune to rubella 
Ovulation induction 
Oral contraceptive pill 
Anti-androgens (cyproterone acetate)

PCOS sufferers commonly have insulin resistance?

True

Ovulation induction - components

Anti - oestrogens 
Gonadotropin daily injections 
Laparoscopic ovarian diathermy 
Aromatase inhibitor 
Metformin

Ovulation induction - risks

Ovarian hyperstimulation
Multiple pregnancies
Ovarian cancer

Hypothalamic pituitary dysfunction - hyperprolactinaemia - definition

Abnormally high levels of prolactin in the blood

Hypothalamic pituitary dysfunction - hyperprolactinaemia - endocrine functions

Normal LH
Normal FSH
Low oestrogen

Hypothalamic pituitary dysfunction - hyperprolactinaemia - investigations

Raised serum prolactin

MRI scan

Hypothalamic pituitary dysfunction - hyperprolactinaemia - management

Dopamine agonist

Ovarian failure - definition

Hypergonadotrophic hypogonadism | Ovaries don't work

Ovarian failure - endocrine function

Increased LH and FSH | Decreased oestrogen

Premature ovarian failure - definition

Menopause before the age of 40 resulting in loss of ovarian function

Premature Ovarian failure - cause

Turners syndrome Fragile X Autoimmune disease

Premature Ovarian failure - clinical features

``` Amenorrhoea Hirsutism Acne Galactorrhoea Headaches Visual symptoms Hot flushes Atrophic vaginitis ```

Premature Ovarian failure - investigations

``` Pregnancy test Check progesterone levels Progesterone challenge test Check serum FSH, LH, testosterone Transvaginal US Auto-antibody bone screen Bone density scan ```

Premature Ovarian failure - management

HRT | Egg or embryo donation

Progesterone challenge test

5 day course of progesterone. If patient gets period after this 5 day course then oestrogen levels are normal. If patient doesn't get period after this 5 day course then oestrogen levels are abnormal.

Which syndrome is this: loss of GnRH secretion + anosmia

Kallman's syndrome

Turner's syndrome only affects females. True or false?

True

Turner's syndrome Normal/reduced/increased pubic hair development Normal/reduced/increased breast development

Normal pubic hair development | Reduced breast development