Week 5 - D - Ovulation disorders Flashcards

1
Q

What hormone made in the hypothalamus causes the release of GnRH and the sequence of events following?

A

The kisspeptin hormone causes the release of GnRH from the hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What hormone can be used to check if a female is ovulating or not? Checked on day 21 of the menstrual cycle

A

The hormone progesterone

Its levels rise after ovulation as the corpus luteum forms from the remnant follicular cells after ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the moment in which the developing oocyte is released? What is it known as when the period becomes and why does this happen?

A

Ovulation is when the developing oocyte is released

Menses is when the uterus lining sheds causing bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is defined as oligomenorrhea in woman?

A

reduction in frequency of periods to less than 9/year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the failure of menarche by age 16 known as?

A

Primary amenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is secondary amenorrhea defined as?

A

cessation of periods for >6 months in an individual who has previously menstruated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are two physiological causes of amenorrhea?

A

Pregancny and post-menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Primary amenorrhea is ually thought to be a congenital disorder (can be causes by something else eg prolactinoma from a young age) What are the two congenital disorders?

A

Turner’s syndrome

Kallman’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which congenital disorder is caused by having the 45X cromosome where there is a full missing Xchromosome? Is this disorder in males or females?

A

Tuner’s syndrome

Only in females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are features of tuner’s syndrome found in women?

A

Short stature

infertility – due to underdeveloped ovaries

Puberty failing to arrive

Congenital heart defects in 50% of females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

is a form of hypogonadotropic hypogonadism (HH). Congeneital condition that is a form of hypogonadotropic hypogonadism (HH) and therefore children cannot go through puberty?

A

Anosmia and isolated GnRH deficiency → Kallmann’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are four causes of secondary amenorrhea? what can cause hypothalamic dysfunction? this causes amenorrhea also

A

Polycyctic ovarian syndrome (PCOS)

Premature ovarian failure

Hyperprolactinaemia

Hypopituitarism

Hypothalamic dysfuntion - weigh loss, stress, over exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are symptoms of oestrogen deficicency? (give name for the difficult/painful sex)

A

Flushing

reduced Libido

Dysparenuia - difficult or painful sexual intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In all patients with amenorrhea, what hormone levels should be investigated?

A

LH, FSH

Prolactin

Oestradiol,

Testosterone

Thyroid function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should the patients karyotype be investigated?

A

In cases of primary amenorrhea or suspected turner’s syndroem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Primary hypogonadism causing amenorrhea is to do with a problem due to the ovaries What are the hormone levels in primary hypogonadism? (clue - it is hypergonadotropic hypogonadism)

A

the ovaries have stopped working characterized by a

high LH/FSH in combination with low oestogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Primary ovarian problem is the usual cause of hypergonadotropic hypogonadism What are the primary ovarian problem causes?

A

Premature ovarian failure

18
Q

What is secondary hypogonadism usually due to? WHat are the hormone levels in this? (LH,FSH and oestradiol levels)

A

Is a hypothalamic or pituitary problem

LH, FSH and oestradiol are all low

19
Q

What are three potential causes of secondary hypogonadism causing amenorrhea?

A

Kallman’s syndrome

Hyperprolactinaemia

Hypopituitarism

20
Q

Condition, with amenorrhea, oestrogen deficiency and elevated gonadotrophins <40 years of age as a result of loss of ovarian function What is this condition?

A

Premature ovarian failure

21
Q

Is premature ovarian failure a cause of primary or secondary hypogonadism? What are the FSH levels to diagnose premature ovarian failure? (2 readings)

A

Causes of primary hypogonadism as it is an ovarian problem that causes secondary amenorrhea

Also the high LH/FSH with low oestrogen

FSH >30 on 2 separate occasions > 1 month apart

Below the age of 40

22
Q

So, menopause before the age of 40 can indicate premature ovarian failure This condition is usually idiopathic however what are some causes? (congenital, gene mutations, autoimmune)

A

Congenital - Turner’s

Autoimmune - Addison’s and thyroid

Gene mutations - FSH/LH receptor mutation

Can also be iatrogenic due to radio or chemo therapy

23
Q

Hypothalamic dysfunction due to eg stress, weight loss causing amenorrhea is called functional hypothalamic amenorrhea What does this do to the GnRH? Why is amenorrhea associated with people who lose increase amounts of weight?

A

Causes loss of pulsatile GnRH decreasing the gonadotrophins

Basically the hypothalamus decreases gonadotrophic production decreasing gonad production as it is saying the body is an unsuitable environment to host a foetus

24
Q

What is is an upstream regulator of GnRH secretion produced in a specific subset of hypothalamic neurons ?

A

Kisspeptin

25
Q

A genetic disorder characterised by a loss of GnRH secretion + anosmia or hyposmia Normal rest of pituitary function What is this condition? Aka - idiopathic hypogonadotropin hypogonadism + anosmia

A

Kallman’s syndrome

26
Q

On MRI in kallmans, what bulbs may be absent accounting for the lack of smell?

A

The olfactory bulbs

27
Q

Syndrome where the pituitary gland shrinks or becomes flattened, filling the sella turcica, or “Turkish Saddle”, with cerebrospinal fluid on imaging instead of the normal pituitary? Where is the sella turcica depression?

A

Empty sella syndrome

Depression in the sphenoid bone

28
Q

Is pituitary dysfunction eg empty sella syndrome a cause of primary or secondary hypogonadism causing amenorrhea?

A

Cause of secondary hypogonadism

29
Q

What can metaclopramide cause that may cause secodnary hypogonadism?

A

Can inhibit dopamine receptors causing increased prolactin

Hyperprolactinaemia can cause secondary hypogonadism leading to amenorrhea

30
Q

Polycystic ovarian syndrome is another ovarian cause of amenorrhea What are the hormone levels in PCOS? What does the genetic predisposition cause the ovaries to produces in excess in PCOS leading to some of the associated features?

A

Excess LH, androgens/testosterone, oestrogen

Low FSH (remember oestrogen has a negative feedback on FSH (and prolactin) however stimulates secretion of LH)

Causes the production of excess androgen

31
Q

What is the rotterdam criteria for diagnosing PCOS?

A

2 of:

Menstrual irregularity

Hyperandrogenism (hirsutism, elevated free testosterone)

Polycystic ovaries

32
Q

What can the elevated free testosterone/oestrogen levels cause in PCOS?

A

The cystic appearance of the ovaries results from several follicles failing to mature properly without development of a dominant follicle.

The multiple follicles produce large amounts of estradiol, which inhibits FSH release thereby preventing further follicle development

33
Q

What are common laboratory findings in PCOS?

A

Common laboratory findings with PCOS include

elevated LH, androgens, and estrogen,

with normal or low FSH.

34
Q

What is the adrenal insufficiecny cause that can classically presents in childhood with virilization and low salt? WHat enzyyme causes this?

A

Congenital adrenal hyperplasia

Due to 21-OH deficiecny causing low aldosterone, cortisol and high androgen levels

35
Q

What is the form of congenitl adrenal hyperplasia that presents in adolescence with hirsituism and infertitility due to anovulatin?

A

Non-classic congenital adrenal hyperplasia (CAH)

Causes by a partial 21-OH deficiency

36
Q

As ACTH is driven to androgens by the diversion since there is a 21-OH deficiecny What enzyme is there a massive increase in?

A

Increase in 17alpha OH progesterone after synacthen test

37
Q

Hirsituism and menstraul irregularity are associated symptoms of acromegaly in women What other 4 conditions can hyperandrogenism be associated with?

A

Cushing’s syndrome

Addison’s disease

Congenital adrenal hyperplasia

Polycystic ovarian syndrome

38
Q

In the treatment of PCOS, it depends on the symptoms What is the first line treatment of PCOS? What can be given for the menstraul irregularity?

A

Weight loss - reduces hyperinsulinsim and hyperandrogenism

* For menstrual irregularity can give oral contriceptrive pill

* For the infertiity - give clompiphen citrate - 1st line

(Clomifene is a non-steroidal anti-oestrogen that inhibits oestrogen negative feedback on the hypothalamus/pituitary, which in turn leads to an increase in FSH secretion that may allow follicular maturation and ovulation)

39
Q

Diagnosis? (this is a female)

A

Turner’s syndrome

40
Q

Turner’s syndrome can cause different heart disease eg coarctation of the aorta or bicuspid aortic valve What is the tetralogy of fallot?

A
  1. Pulmonary Stenosis
  2. Hypertrophy of Right Ventricle
  3. VSD
  4. Over-riding Aorta