Primary Amenorrhea Flashcards
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
[Sequence of prepubertal changes]
Breast development should happen at age
10-11
[Sequence of prepubertal changes]
appearance of pubic and axillary hairs
10.5 to 11.5
[Sequence of prepubertal changes]
maximal growth velocity
11-12 years old
[Sequence of prepubertal changes]
menarche
11.5 to 13 years old
What is the first sign of puberty
breast budding
What is the last sign of puberty
menarche
What is the most relevant factor for onset of puberty and menstruation?
Ratio of fat to lean BW and tbw
What hormone produced by adipocytes that directly affects LH pulsatility and restore menstrual cycle
Leptin
[Stage of breast growth]
breast budding
B2
[Stage of breast growth]
breast enlargement without separation of breast contours
B3
[Stage of breast growth]
secondary mound
B4
[Stage of pubic hair growth]
labial hair present
PH2
[Stage of pubic hair growth]
labial hair spreads over mons pubis
PH3
[Stage of pubic hair growth]
slight lateral spread
PH4
Delayed menarche is defined as ______
delayed up to 15 years old, if involved in strenuous exercise before menarche
[Diagnose: Primary amenorrhea]
No breast development, uterus well developed
- Hypothalamic failure - insufficient GnRH
- Pituitary failure - pituitary adenoma
- gonadal failure (Turners)
ovaries never secreted estradiol
[Diagnose: Primary amenorrhea]
breast well developed
no uterus
- Androgen resistance
2. Uterovaginal agenesis
[Diagnose: Primary amenorrhea]
breast and uterus not present
- 17,20 desmolase deficiency
- Agonadism
- 17a-OHase deficiency with 46XY
[Diagnose: Primary amenorrhea]
beast and uterus present, no menarch
- Secondary ammenorrha
[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?
- 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
- Hypothalamus near 3rd ventricle
- Tuber cinereum
- 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?
- menarche at <8 years old
- Progressive thelarce and pubarch
- 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
