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Sem 4 > Repro 3: Puberty And Abnormalities Of Mensturation > Flashcards

Repro 3: Puberty And Abnormalities Of Mensturation Flashcards

1
Q

What is thelarche?

A

Development of breast

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2
Q

What is puberache?

A

Development of axillary and pubic hair

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3
Q

What is menarche?

A

First menstrual period

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4
Q

What is adrenarche?

A

Onset of an increase in the secretion of androgens

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5
Q

When do girls and boys experience puberty on average?

A

Girls 8-13yrs
Boys 9-14 yrs
(Girls begin earlier than boys)

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6
Q

What is the ‘critical weight’ for menarche to begin?

A

47kg

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7
Q

How can pubertal development be staged?

A

Classified via the Tanner standard

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8
Q

What is precocious puberty?

A

Puberty before 8 years in girls, or before 9 years in boys.

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9
Q

What are different causes of precious puberty?

A

Gonadotropin dependent: tumour, CNS trauma, hydrocephalus

Gonadotropin independent: gonad matures without GnRH stimulation, testosterone and oestrogen elevated by LH and FSH low (negative feedback) could be due to congenital adrenal hyperplasia, gonad neoplasms, exogenous steroid exposure, testotoxicosis

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10
Q

What is testotoxicosis?

A

Autosomal dominant conditions causing precious puberty in males, rapid growth and sexually aggressive behaviour seen in first 2-3 years of life

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11
Q

What is Turner’s syndrome?

A 
Females with 45XO karyotype (or 46XX with defect)
Either only one normal X chromosome present
Short stature
Grandad dysgenesis
Dysmorphic face
Cardiac and kidney malformation
* no mental defect! *
Thereby is growth hormones
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12
Q

When would a child’s puberty be classed as delayed?

A

If there were no initial physical changes of puberty present by 13 years in females and 14 years in boys (or not primary amenorrhoea at 15.5-16 in girls)

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13
Q

What is an example of hypergonadotrophic hypogonadism that can cause delayed puberty?

A

Gonadal failure eg Turners syndrome, post chemotherapy/ radiotherapy

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14
Q

What could cause hypogoandotrophic hypogonadism?

A

Gonadal deficiency eg if mutation inactivated FSH and LH receptors, or hypothalamus or pituitary lesions eg tumours or post-radiotherapy

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15
Q

What do the Tanner’s stages looks at?

A

Girls: breast size, pubic hair, Axillary hair, menarche

Boys: testicular volume, spermarche, pubic hair, penis enlargement

Looks at 5 stages for each

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16
Q

What is the menopause?

A

Cessation of the menstrual cycle when all of the follicles in the ovaries have been depleted, occurs at around 50 years

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17
Q

How does the menopause affect levels of gonadal hormones?

A

Oestrogen and progesterone fall (high FSH and LH due to lack of -ve feedback, high FSH:LH ratio due to lack of inhibin)

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18
Q

What changes can result due to menopause?

A

Low gonadal hormone levels can lead to:

  • osteoporosis
  • regression of endometrium
  • involuted not of breast tissue
  • vascular changes ie hot flushes
  • loss of pelvic tone in bladder (leads to urinary incontinence)
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19
Q

How can the menopause be treated?

A

Hormone replacement therapy
Provides oestrogen orally or topically via a patch or gel
Relieves menopause symptoms by reducing hot flushes, osteoporosis etc

however, increased risk of malignancy esp in breast due to oestrogen stimulating tissue growth

20
Q

What is amenorrhoea?

A

Absence or stopping of menses

21
Q

What is menorrhagia?

A

Abnormally heavily periods

22
Q

What is dysmenorrhea?

A

Painful menstruation

23
Q

What is oligmenorrhoea?

A

Menses occurring at irregular intervals more than 35 days apart

24
Q

What could menorrhagia lead to?

A

Anaemia

25
Q

What may be some causes of menorrhagia?

A 
Fibroids
DUB (dysfunctional uterine bleeding)
Endometrial carcinoma
Pelvic inflammatory disease
Progesterone contraceptive
26
Q

How is an endometrial carcinoma treated?

A

Endometrial ablation where a laser internally burns the endometrium to thin it and reduce the bleeding

27
Q

What is the difference between primary and secondary amenorrhoea?

A

Primary: absence of menses with absence of secondary sexual characteristics by 14

Secondary: when established menstruation has ceased (for 3 months if regular or 9 months if history of irregular cycle)

28
Q

What are some causes of secondary amenorrhoea?

A 
Pregnancy
Menopause
Outflow tract obstruction
PCOS
Hypothalamus problems (stress, weight, exercise)
Thyroid problems
Pituitary problems 
Hyperprolactinaemia
29
Q

What are some causes of primary amenorrhoea?

A

Low body weight
Outflow tract issue (eg Müllerian agenesis, imperforated hymen, vaginal atresia)
Gonad disorders (turners, congenital adrenal hyperplasia, receptor abnormalities for LH or FSH)
Hypothalamus/ pituitary dysfunction (don’t develop properly)
Hyperprolactinaemia

30
Q

Why can hyperprolactinaemia cause amenorrhoea?

A

Prolactin inhibits oestrogen production
Prolactin may be high in stress, pregnancy, dopamine antagonists, prolactin secreting adenoma of pituitary, hypothyroidism

31
Q

What is PCOS?

A

Polycystic ovary syndrome
Causes irregular periods/ heavy
Hair growth, acne
Due to increased frequency of GnRH pulses so excess LH increase androgen secretions which are converted to testosterone a instead of oestrogen
Ovaries have multiple cysts and thickened capsules

32
Q

What are fibroids?

A

Benign tumours of smooth muscle in the myometrium
They are hormone dependent so regress after menopause
Cause menorrhagia

33
Q

What is congenital adrenal hyperplasia?

A

Group of autosomal recessive conditions that cause large adrenal gland
Associated with decreased cortisol and increased androgens

34
Q

Would you expect a girl to be shorter or taller as an adult as a result of precocious puberty?

A

Shorter
Growth spurt would begin earlier and is terminated earlier, so the epiphyseal growth plates close at an earlier stage of growth

35
Q

How much blood is usually lost in menses?

A

10-80 ml

36
Q

What is the physiology behind the menopause?

A

Reduced number of follicles means a reduced number of binding sites for LH and FSH, so the ovary becomes less sensitive and secretes less oestrogen

37
Q

Why do levels of LH and FSH increase in the menopause?

A

Due to a reduction in circulating oestrogen
Hence less negative feedback on the hypothalamus and pituitary
Also less inhibin released causes FSH to rise

38
Q

What are some clinical features of the menopause?

A

Peripheral vasodilation and transient rise in body temperature causes hot flushes
Atrophy of the vagina and thinning of the myometrium causes dryness, can result in pain during sex, urinary incontinence and more UTIs
Osteoporosis (as oestrogen reduces osteoclasts activity)
Ischaemic heart disease (as oestrogen offers a protective effect against heart disease)

39
Q

Which hormone is measured to diagnose the menopause?

A

FSH (will be increased)

40
Q

What is HRT?

A

Hormone replacement therapy, for women who can’t tolerate menopausal symptoms
Small daily doses of oestrogen and progesterone
Available as a tablet, transdermal patch of vaginal ring

41
Q

What are the risks of HRT?

A

Increased risk of breast cancer
Increased risk of endometrial and ovarian cancer if no hysterectomy
Increase risk of venous thromboembolism and stroke due to pro-thrombotic effects of oestrogen

42
Q

When is the menopause clinically defined?

A

Amenorrhoea for at least 12 months

43
Q

What is the first sign of puberty in girls?

A

Thelarche

44
Q

What is the first sign of puberty boys?

A

Increase in testicular size

45
Q

How can NSAIDs treat primary dysmenorrhea?

A

Reduce the production of prostaglandins (because excess prostaglandins from endometrial cells is thought to cause primary dysmenorrhea)

46
Q

After the corpus luteum regresses and there is a decline in oestrogen and progesterone, what actions does the release of prostaglandins from endometrial cells have?

A

Spiral artery vasospasm (leading to ischaemic necrosis and shedding of the superficial layer of the endometrium)
Increased myometrial contractions

Sem 4 (25 decks)

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