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Endocrine SOH > Ovulatory disorders > Flashcards

Ovulatory disorders Flashcards

1
Q

Ovulatory disorders subtypes (3)

A

Hypothalamic pituitary failure
Hypothalamic pituitary dysfunction
Ovarian failure

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2
Q

Hypothalamic pituitary failure - definition

A

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

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3
Q

Hypothalamic pituitary failure - endocrine function

A 
Decreased LH and FSH (due to decreased GnRh) 
Decreased oestrogen (as there is no LH or FSH to produce it)
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4
Q

Hypothalamic pituitary failure - causes

A 
Stress
Excessive exercise
Low BMI: anorexia 
Pituitary tumours 
Head trauma 
Kallman's syndrome
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5
Q

Hypothalamic pituitary failure - clinical features

A

Amenorrhoea

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6
Q

Hypothalamic pituitary failure - investigations

A

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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7
Q

Hypothalamic pituitary failure - management

A

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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8
Q

Hypothalamic pituitary dysfunction - definition

A

Normogonadotrophic hypogonadism

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

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9
Q

Hypothalamic pituitary dysfunction - endocrine function

A

Normal LH and FSH

Normal oestrogen levels

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10
Q

Hypothalamic pituitary dysfunction - investigations

A

Progesterone challenge test

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

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11
Q

Hypothalamic pituitary dysfunction - PCOS - definition

A

Polycystic ovarian syndrome

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

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12
Q

Hypothalamic pituitary dysfunction - PCOS - endocrine functions

A 
Increased LH 
Increased testosterone 
Increased insulin
Normal oestrogen
Decreased progesterone 
Decreased SHBG
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13
Q

Hypothalamic pituitary dysfunction - PCOS - cause

A

Weight gain

Inherited condition

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14
Q

Hypothalamic pituitary dysfunction - PCOS - clinical features

A 
Obesity 
Hirsutism 
Acne
Menstrual cycle abnormalities 
Subfertility
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15
Q

Hypothalamic pituitary dysfunction - PCOS - investigations

A

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

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16
Q

Hypothalamic pituitary dysfunction - PCOS - diagnosis

A

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)
17
Q

Hypothalamic pituitary dysfunction - PCOS - management

A 
Weight loss 
Folic acid supplements 
Ensure patient is immune to rubella 
Ovulation induction 
Oral contraceptive pill 
Anti-androgens (cyproterone acetate)
18
Q

PCOS sufferers commonly have insulin resistance?

A

True

19
Q

Ovulation induction - components

A 
Anti - oestrogens 
Gonadotropin daily injections 
Laparoscopic ovarian diathermy 
Aromatase inhibitor 
Metformin
20
Q

Ovulation induction - risks

A

Ovarian hyperstimulation
Multiple pregnancies
Ovarian cancer

21
Q

Hypothalamic pituitary dysfunction - hyperprolactinaemia - definition

A

Abnormally high levels of prolactin in the blood

22
Q

Hypothalamic pituitary dysfunction - hyperprolactinaemia - endocrine functions

A

Normal LH
Normal FSH
Low oestrogen

23
Q

Hypothalamic pituitary dysfunction - hyperprolactinaemia - investigations

A

Raised serum prolactin

MRI scan

24
Q

Hypothalamic pituitary dysfunction - hyperprolactinaemia - management

A

Dopamine agonist

25
Q

Ovarian failure - definition

A

Hypergonadotrophic hypogonadism

Ovaries don’t work

26
Q

Ovarian failure - endocrine function

A

Increased LH and FSH

Decreased oestrogen

27
Q

Premature ovarian failure - definition

A

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

28
Q

Premature Ovarian failure - cause

A

Turners syndrome
Fragile X
Autoimmune disease

29
Q

Premature Ovarian failure - clinical features

A 
Amenorrhoea 
Hirsutism 
Acne 
Galactorrhoea 
Headaches 
Visual symptoms 
Hot flushes 
Atrophic vaginitis
30
Q

Premature Ovarian failure - investigations

A 
Pregnancy test 
Check progesterone levels 
Progesterone challenge test 
Check serum FSH, LH, testosterone 
Transvaginal US 
Auto-antibody bone screen
Bone density scan
31
Q

Premature Ovarian failure - management

A

HRT

Egg or embryo donation

32
Q

Progesterone challenge test

A

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.

33
Q

Which syndrome is this: loss of GnRH secretion + anosmia

A

Kallman’s syndrome

34
Q

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

A

True

35
Q

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

A

Normal pubic hair development

Reduced breast development

Endocrine SOH (25 decks)

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