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Y2 ENDOCRINOLOGY > Reproduction and Ovulatory Disorders > Flashcards

Reproduction and Ovulatory Disorders Flashcards

1
Q

Define oligomenorrhoea

A

Reduced frequency of periods (less than 9/year)

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2
Q

Define primary amenorrhoea

A

Failure of having a period before the age of 16

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3
Q

Define secondary amenorrhoea

A

Cessation of periods for greater than 6mths in someone who has previously had a period

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4
Q

What is the main cause of primary amenorrhoea?

A

Congenital abnormality

Turner’s, Kallman’s

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5
Q

List ovarian causes of secondary amenorrhoea

A

Polycystic ovarian syndrome

Ovarian failure

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6
Q

List pituitary causes of secondary amenorrhea?

A

High prolactin

Hypopituitarism

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7
Q

What triad of symptoms are classic of amenorrhoea/oestrogen deficiency?

A

Flushing
Lack of libido
Dyspareunia (painful sex)

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8
Q

List investigations that all patients with oligo-/amen- orrhoea get

A

LH, FSH, oestradiol leves
Thyroid function tests
Prolactin levels

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9
Q

List additional investigations for oligo-/amen- orrhoea

A

Ovarian USS, endometrial thickness
Testosterone levels if hirsutism
Pituitary function/ MRI
Karyotype

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10
Q

In primary hypogonadism in females, the problem is arising from where?

A

Ovaries

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11
Q

In secondary hypogonadism in females, the problem is arising from where?

A

Pituitary/hypothalamus

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12
Q

Describe LH and FSH levels in primary hypogonadism

A

High LH
High FSH
Low oestraidol
i.e. hypergonadotrophic hypogonadism

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13
Q

Describe LH and FSH levels in secondary hypogonadism

A

Low LH
Low FSH
High oestradiol
i.e. hypogonadotrophic hypogonadism

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14
Q

Give an example of a condition where primary hypogonadism occurs

A

Premature ovarian failure

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15
Q

What happens in premature ovarian failure?

A

Loss of ovarian function causes amenorrhoea, low oestrogen and elevated gonadotrophins

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16
Q

What is idiopathic hypogonadotrophic hypogonadism?

A

Absent/delayed sexual development assoc. with low levels of gonadotrophins in the absence of anatomical/functional defect in the H-P-gonadal axis

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17
Q

Which syndrome is like idiopathic hypogonadotrophic hypogonadism but includes anosmia (inability to smell)?

A

Kalmann’s syndrome

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18
Q

What is the major defect/identified cause of idiopathic hypogonadotrophic hypogonadism?

A

Mutated GnRH receptor (thus inability to sense GnRH from hypothalamus)

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19
Q

What is the function of kisspeptin?

A

Regulates GnRH secretion and thus pubertyRegulates fertility

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20
Q

What is Kallman’s syndrome? What is the characteristic sign on imaging?

A

Genetic disorder of loss of GnRH secretion characterised by anosmia and hyposmia
Absence of olfactory bulbs

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21
Q

Males are more affected by Kallman’s syndrome. True/False?

A

True

4:1

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22
Q

What causes hirsutism?

A

Excess androgen at the hair follicle

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23
Q

What is the most common cause of hirsutism?

A

Polycystic ovarian syndrome

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24
Q

Which chromosome is missing in Turner syndrome?

A

X

so women only have one X

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25
Q

List clinical features of Turner syndrome

A 
Short stature
Failure/delayed puberty
Coarctation of aorta
Poor breast formation
Infertility
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26
Q

Define primary hypogonadism in males in terms of testosterone and LH/FSH levels

A

Low testosterone

High FHS/LH

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27
Q

Define secondary hypogonadism in males in terms of testosterone and LH/FSH levels

A

Low testosterone

Low FSH/LH

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28
Q

What is the most common congenital form of primary hypogonadism?

A

Klinefelter’s syndrome (XXY)

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29
Q

List clinical features of Klinefelter’s syndrome

A

Reduced testicular volume
Gynaecomastia
Eunuchoidism (lack of reproductive organ development)

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30
Q

Infertility risk increases with chlamydia infections. True/False? How is it diagnosed and managed?

A

True
Endocervical swab
Azithromycin 1st line, doxycycline if allergic

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31
Q

List some male factors contributing to infertility

A

Decreased quality sperm
Increased testicular cancer
Cryptoorchidism
Hypospadias

32
Q

Define infertility

A

Failure to achieve pregnancy after 12 months of regular unprotected sex in a couple who have never had a child

33
Q

What is the difference between primary + secondary infertility?

A

Primary: never conceived
Secondary: unsuccessful pregnancy

34
Q

List factors increasing the chance of conception

A 
Women less than 30yrs
Less than 3yrs trying to conceive
Intercourse during 6 days before ovulation
Women BMI 20-30
Non-smokers
Low caffeine intake
35
Q

What are the main causes of female infertility?

A 
Ovulation failure (50%)
Tubal damage (25%)
Endometriosis (10%)Misc. (15%)
36
Q

List hypothalamic causes of anovulatory infertility

A

Anorexia, bulimia

Excessive exercise

37
Q

List pituitary causes of anovulatory infertility

A

Hyperprolactinaemia
Sheehan syndrome
Tumours

38
Q

What is a hydrosalpinx?

A

Fallopian tube dilation by fluid (due to blockage)

39
Q

What is endometriosis?

A

Condition where endometrial tissue grows outside of the womb/uterus

40
Q

What is the characteristic sign of endometriosis on USS?

A

Chocolate cysts on ovary

41
Q

What is the most common cause of male infertility?

A

Varicocele

42
Q

What is a varicocele?

A

“varicose veins” of the testis

43
Q

List endocrine disorders that can cause male infertility

A 
Hypogonadotrophic hypogonadism (Kallman's)
Testicular failure
Klinefelter's syndrome (XXY)
Hyperprolactinaemia
Acromegaly
Cushing's
44
Q

List investigations for causes of infertility in females

A 
Endocervical swab (chlamydia)
Cervical smear
Pelvic USS
Bloods (rubella)
Mid-luteal progesterone
Hormone levels (PRL, FSH, LH)
Hysterosalpingiogram (tubal patency)
45
Q

List causes of WHO group I ovulatory disorders

A 
FSH/ LH REDUCED (hypothalamic causes)
Hypogonadotrophic hypogonadism
Kallman's syndrome
Anorexia, bulimia
Excessive exercise
46
Q

List causes of WHO group II ovulatory disorders

A

NORMAL FSH/ LH (pituitary dysfunction)
Normogonadotrophic hypogonadism
Polycystic ovarian syndrome
Hyperprolactinaemia

47
Q

List causes of WHO group III ovulatory disorders

A

FSH/ LH INCREASED
Hypergonadotrophic hypogonadism
Ovarian failure

48
Q

List causes of amenorrhea

A 
PHYSIOLOGICAL (pregnancy, post-menopause)
CONGENITAL
OVARIAN
UTERINE (adhesions)
HYPOTHALAMUS 
PITUITARY
49
Q

List hypothalamic causes of secondary amenorrhea

A

Weight loss
Over-exercise
Stress

50
Q

What age is the typical onset of premature ovarian failure?

A

<40 yo

51
Q

How long is the normal menstrual cycle?

A

28-35 days

52
Q

If someone has oligomenorrhoea, how long do menstrual cycles last?

A

Greater than 35 days

53
Q

What is another name for an ovulatory disorder caused by hypothalamic pituitary failure?

A

Hypogonadotrophic hypogonadism

54
Q

Outline management of hypogonadotrophic hypogonadism

A 
Pulsatile GnRH
Gonadotrophin injections
Stabilise weight (BMI over 18.5)
55
Q

What is the most common ovulatory disease caused by hypothalamic pituitary dysfunction?

A

Polycystic ovarian syndrome

56
Q

What is the criteria for diagnosing polycystic ovarian syndrome?

A

2/3: Oligo/amen -orrhoea
Polycystic ovaries on USS (12+ 2-9mm follicles)
Hyperandrogenism

57
Q

Insulin resistance is commonly seen alongside polycystic ovarian syndrome. True/False?

A

True

58
Q

Outline management of polycystic ovarian syndrome

A 
Ovulation induction
Lifestyle modification (smoking, alcohol)
Ovulation induction
Folic acid 400mcg/5mg if BMI over 30
Check if rubella immunity
59
Q

By what 3 methods can ovulation be induced in polycystic ovarian syndrome?

A

Clomifene citrate/tamoxifen/letrozole
Gonadotrophin injection
Laparoscopic ovarian diathermy

60
Q

What type of drugs are clomifene citrate and tamoxifen?

A

Anti-oestrogens (thus help stimulate FSH)

61
Q

Is metformin useful in ovulation induction? If so, why?

A

Yes

Improves insulin resistance, thus reducing androgen production

62
Q

What are the main risks of ovulation induction?

A

Ovarian hyperstimulation
Multiple pregnancy
Possible ovarian cancer

63
Q

What is another name for ovarian failure?

A

Hypergonadotrophic hypogonadism

64
Q

Oestrogen levels are low in ovarian failure. True/False?

A

True

65
Q

List some causes of premature ovarian failure (menopause before age of 40)

A

Turner syndrome
XX gonadal agenesis
Autoimmunity

66
Q

What is involved in a progesterone challenge test?

A

Should menstrual bleed in response to a 5-day course of progesterone to indicate normal oestrogen levels

67
Q

List clinical features of polycystic ovarian syndrome

A 
Hirsutism
Acne/oily skin
Alopecia
Central obesity
Amenorrhoea/ infertility
68
Q

What do aromatase inhibitors do? Give an example of one

A

Letrozole

Inhibit ovarian aromatase enzyme to inhibit oestrogen

69
Q

In PCOS, oestrogen levels are ___

A

Normal

70
Q

List clinical features of premature ovarian failure

A

Hot flushes
Night sweats
Atrophic vaginitis

71
Q

What is the diagnostic criteria for premature ovarian failure?

A

FSH/LH >30u/l on two occasions 2 months apart

72
Q

List causes of tubal disease

A

INFECTIVE: PID (chlamydia, gonorrhea, anerobes, syphillus, TB), trans-peritoneal spreas (appendicitis, abscess), following procedure

NON-INFECTIVE: endometriosis, surgical, fibroids, polyps, congenital

73
Q

List the clinical features of endometriosis

A 
Dysmenorrhea
Dysparenuia
Menorrhagia
Defecation pain
Chronic pelvic pain
74
Q

Outline management for premature ovarian failure/menopause

A

Counselling
Oocyte donation
Prevention of OP via HRT
Cryopreservation of ovarian tissue

75
Q

List the differential diagnoses of infertility from most to least likely

A 
Pregnancy
PCOS
Premature ovarian failure
PID (secondary to STI)
Hyperprolactinaemia
Anorexia/ bulimia
76
Q

What are the clinical signs of hyperprolactinaemia?

A

Amenorrhea
Galactorrhea
Visual field defect (BTH)

77
Q

Outline the drug used to manage hyperprolactinaemia

A

Dopamine antagonist (cabergoline)

Y2 ENDOCRINOLOGY (19 decks)

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