Primary Amenorrhea Flashcards by Clyde Silverio

Primary amenorrhea is diagnosed when ___

Absence of menses by age 15 years old
No menstruation within 5 years of breast development, if occuring by age 10
No breast development occuring by age 13

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[Sequence of prepubertal changes]

Breast development should happen at age

10-11

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[Sequence of prepubertal changes]

appearance of pubic and axillary hairs

10.5 to 11.5

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[Sequence of prepubertal changes]

maximal growth velocity

11-12 years old

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[Sequence of prepubertal changes]

menarche

11.5 to 13 years old

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What is the first sign of puberty

breast budding

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What is the last sign of puberty

menarche

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What is the most relevant factor for onset of puberty and menstruation?

Ratio of fat to lean BW and tbw

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What hormone produced by adipocytes that directly affects LH pulsatility and restore menstrual cycle

Leptin

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[Stage of breast growth]

breast budding

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[Stage of breast growth]

breast enlargement without separation of breast contours

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[Stage of breast growth]

secondary mound

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[Stage of pubic hair growth]

labial hair present

PH2

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[Stage of pubic hair growth]

labial hair spreads over mons pubis

PH3

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[Stage of pubic hair growth]

slight lateral spread

PH4

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Delayed menarche is defined as ______

delayed up to 15 years old, if involved in strenuous exercise before menarche

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[Diagnose: Primary amenorrhea]

No breast development, uterus well developed

Hypothalamic failure - insufficient GnRH
Pituitary failure - pituitary adenoma
gonadal failure (Turners)

ovaries never secreted estradiol

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[Diagnose: Primary amenorrhea]

breast well developed
no uterus

Androgen resistance

2. Uterovaginal agenesis

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[Diagnose: Primary amenorrhea]

breast and uterus not present

17,20 desmolase deficiency
Agonadism
17a-OHase deficiency with 46XY

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[Diagnose: Primary amenorrhea]

beast and uterus present, no menarch

Secondary ammenorrha

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[Diagnose: Primary amenorrhea]

anosmia
normal height
increase growth of long bones
greater wingspan to height ratio

Kallman Syndrome

Hypogonadotropic Hypogonadism is associated with what disease condition?

Thalassemia major

2. Retinitis pigmentosa

Viral infection that can cause pituitary failure?

Mumps encephalitis

What is the second most common cause of congenital absence of uterus?

Mayer-Rokitansky-Kuster-Hauser

[Diagnose] 46XY no internal male/female geintalia lack pubic or axillary hair, breast present

Androgen Resistance (Testicular feminization) Remove gonads, create neovagina

[Diagnose] ``` 46XX present breast absent mullerian ducts present pubic hair Testosterone is female level ```

Uterovaginal Agenesis uterine transplant; create neovagina

Secondary amenorrhea is diagnosed when there is absence of menses _____

longer than 6 months to 12 years

[Cause of Secondary Amenorrhea] Hypergonadotropic hypogonadism

from ovary

[Cause of Secondary Amenorrhea] Hypoestrogenic amenorrhea

from the pituitary gland

___ syndrome can happen due to hypotensive episode during pregnancy resulting to pituitary cell destruction

Sheehan Syndrome

____ disease is a damage to pituitary gland unrelated to pregnancy

Simmonds disease

___ refers to menopause before age 40

premature ovarian failure/ premature ovarian insufficiency

[Diagnose] obliteration of endometrial cavity refers to what syndrome

Asherman Syndrome

What is the most frequent antecedent factor for intrauterine adhesions?

endometrial curettage

Precocious puberty is diagnosed when there is appearance of any signs of secondary sexual maturation at an age

<8 years old

True precocious puberty is GnRH ____ (dependent/independent)

GnRH dependent if GnRH independent, its incomplete

What are the primary concerns of parents with children having precocious puberty?

1. Social stigma | 2. Diminished ultimate height

What is the Lh value that is diagnostic for true precocious puberty?

LH > 5mIU/Ml

Lesions located at which sites at the brain is associated with GN

1. Hypothalamus near 3rd ventricle 2. Tuber cinereum 3. Mamillary

___ syndrome refers to increase TSH and gonadotophin with primary hypothyroidism

Van wyk-Grumbach syndrome Unique: Bone age is retarded

What is the most common cause of GNRH independent precocious puberty?

Ovarian tumor from Granulosa cell tumor >8cm

___ syndrome cafe au lait sponts polyostotic fibrous dysplasia cyst of skull and long bones

McCune Albright Tx: Fulvestrant

Premature thelarche is diagnosed when ___

isolated unilateral or bilateral breast development, no axillary or pubic hair development

___ refers to early isolated development of pubic hair, non-progressive, no clitoral hypertophy, bone age not advanced

Premature pubarche

____ refers to isolated early development of axillary hair which may evolve to PCOS

Premature Adrenache

What is one of the earliest features of precocious puberty?

Acceleration of growth

What test differentiates incomplete from true precocious puberty?

GnRH agonist stimulation test

What are the indications for medical treatment of precocious puberty?

1. menarche at <8 years old 2. Progressive thelarce and pubarch 4. Bone age >2 years of chronological age

What is the DOC for true precocious puberty?

GnRH agonist (Leuprolide)

____ refers to aromatase inhibitor used to treat precocious puberty

Letrozole

___ drug is an estrogen receptor antagonist used to treat McCune Albright

Fulvesterant