Revision 4

Question 1

At what age is 1ary amenorrhoea defined?

Answer 1

13 y/o with NO signs of pubertal development

or

15 y/o with signs of pubertal development

Question 2

How many years from start of puberty do menstrual periods typically begin?

Answer 2

Approx 2 years

Question 3

Give some causes of hypogonadotropic hypogonadism

Answer 3

1) Excess diet & exercise

2) Stress

3) Kallman syndrome

4) Damage to hypothalamus/pituitary e.g. radiotherapy, surgery

5) Endocrine disorders e.g. Cushing’s, hypothyroidism, GH deficiency, hyperprolactinaemia

6) Hypopituitarism (nder production of pituitary hormones)

Question 4

What is Kallman syndrome?

Answer 4

Hypogondaotropic hypogonadism

+

Absent sense of smell

Question 5

Give some causes of hypertrophic hypogonadism

Answer 5

1) Turner’s syndrome

2) Congenital absence of ovaries

3) Previous damage to the gonads (e.g. torsion, cancer or infections such as mumps)

Question 6

Which condition is associated with hypogonadotrophic hypogonadism and anosmia?

Answer 6

Kallman syndrome

Question 7

What is congenital adrenal hyperplasia?

Answer 7

Deficiency of 21-hydroxylase enzyme.

This enzyme is response for conversion of androgens into cortisol & aldosterone.

This results in high levels of androgens, and reduced cortisol & aldosterone.

Question 8

Inheritance of CAH?

Answer 8

Autosomal recessive

Question 9

In severe cases of congenital adrenal hyperplasia, how will the neonate present?

Answer 9

Severely unwell shortly after birth, with hypoglycaemia and electrolyte abnormalities.

Question 10

In milder cases, when will congenital adrenal hyperplasia present?

What symptoms?

Answer 10

Female patients can present later in childhood or at puberty with typical features:

• tall
• facial hair
• absent periods (1ary amenorrhoea)
• deep voice
• early puberty

Question 11

What is IGF-1 used as a screening test for?

Answer 11

GH levels - can affect menstruation

Question 12

Imaging in possible Kallman syndrome?

Answer 12

MRI to assess olfactory bulbs

Question 13

In patients with hypogonadotrophic hypogonadism, what can be used to induce ovulation and menstruation where:

a) fertility is wanted?

b) fertility is not wanted?

Answer 13

a) Pulsatile GnRH

b) Replacement sex hormones e.g. COCP

Question 14

How does hyperprolactinaemia cause amenorrhoea?

Answer 14

Prolactin reduces the secretion of GnRH.

Question 15

What is the most common cause of hyperprolactinaemia?

Answer 15

Pituitary adenoma –> get CT/MRI of brain

Question 16

Treatment for hyperprolactinaemia?

Answer 16

Often no treatment

Can give dopamine agonists e.g. bromocriptine, cabergoline

Question 17

What can be used to stimulate a withdrawal bleed in women with PCOS?

(2)

Answer 17

1) COCP

2) 14 days of Medroxyprogesterone

Question 18

When do women with amenorrhoea require management to reduce risk of osteoporosis?

Answer 18

> 12m

Question 19

If patients are clinically anaemic, what investigation can be done?

Answer 19

Ferritin

Question 20

How can the thyroid affect periods?

Answer 20

Hypothyroidism can cause menorrhagia

Hyperthyroidism can cause amenorrhoea

Question 21

What is the treatment for vaginal vault prolapse?

Answer 21

Sacrocolpopexy

This procedure suspends the vaginal apex to the sacral promontory. This support is usually afforded by the uterosacral ligaments.