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64 Cards in this Set
- Front
- Back
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LH/FSH - low
Estrogen - low defect? |
ovary
hypergonadotropic hypogonadism |
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LH/FSH - low
Estrogen - low defect? |
Hypothalamus/Pituitary
Hypogonadotropic Hypogonadism |
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LH/FSH - normal
Estrogen - normal defect? |
- PCOS
- ovarian tumor - excess production of androgens in adrenals Eugonadotropic eugonadism |
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3 classifications of abnormal bleeding
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anatomic defects
ovarian failure chronic anovulation |
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chronic anovulation withOUT estrogen
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hypogonadotropic hypogonadism
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chronic anovulation WITH estrogen
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eugonadotropic eugonadism
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anatomic defects
congenital |
imperforate hymen
transverse vaginal septum mullerian agenesis |
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anatomic defects
acquired |
fibroids
polyps asherman's (from surgery or curettage) |
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32 yo female
two elevated FSH levels (>40) drawn 4 months apart cause? |
chromosomal
fragile X Infectious Iatrogenic Autoimmune Enzymatic Galactosemia Idiopathic premature ovarian failure |
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loss of negative feedback by ovarian horones and inhibin causes what?
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HYPERgonadotropic hypogonadism (high FSH)
Premature Ovarian Failure |
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gonadal dysgenesis
short webbed neck shield chest CV defects cause? |
deletion of material on X chromosome
- 45, X (Turners) |
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premature ovarian failure
types of chromosomal defects |
45,X (Turners)
45,X/46, XX - mosaicism |
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menstrual bleeding in chromosomal premature ovarian failure
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90% ABSENT
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premature ovarian failure
type associated w/ gonadal malignancies tx? |
45,X/46,XY - mosacism w/ Y chromosome
remove streak gonad - risk of developing a germ cell tumor |
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X-linked
>200 CGG repeats silenced gene expression increased risk of what in females? |
premature ovarian failure
Fragile X syndrome |
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POF
infectious source, process? |
mumps oophoritis -> inflammation -> destruction of ovary
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POF
iatrogenic source |
surgical removal of ovaries
radiation to pelvis chemotherapy |
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adrenal insufficiency
hypothyroidism SLE parathyroid disease labs for what? |
anti-ovarian antibodies
autoimmune POF |
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primary amenorrhea
sexual infantilism HTN |
17-hydroxylase deficiency
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primary amenorrhea
sexual infantilism no HTN |
17,20 desmolase deficiency
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neonatal death
ataxic neurological disease cognitive disabilities cataracts defect? |
impaired GALT
enzymatic POF |
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female pt
needed hormone therapy to ovulate |
chronic anovulation
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chronic anovulation
defect? |
ovaries do not secrete estrogen in a normal cyclic pattern
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how do you categorize chronic anovulation?
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whether they bleed after withdrawal of progesterone therapy
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chronic anovulation w/ estrogen low or absent
type of hypogonadism? |
hypogonadotropic
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chronic anovulation
thin endometrium cause? |
functional
hypothalamic/pituitary hyperprolactinemia thyroid disease chronic illness |
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chronic anovulation
functional causes? |
stress (hypercortisol)
anorexia (decreased leptin -> ^ neuropeptide Y) intense exercise (^ B-endorphins) all generate abnormal pulse of GnRH |
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chronic anovulation
inherited hypothalamic and pituitary abnormalities |
idiopathic hypo hypo
Kallman Syndrome |
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can't smell
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Kallman syndrome
inherited hypothalamic form of chronic anovulation |
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chronic anovulation
hypothalamic lesion indicators? |
p53 mutation
CNS trauma or radiation deficiencies in secretion of GH, ACTH, TSH |
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chronic anovulation
anterior pituitary lesions |
infiltrative, infection, trauma, radiation
Sheehan syndrome Benign pituitary tumors |
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woman just had a baby
low BP losing lots of blood can't lactate lose of sexual and axiallary hair how are her adrenal hormones? |
low
Panhypopituitarism from Sheehan syndrome |
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how can benign pituitary tumors cause chronic anovulation
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compress gonadotrophs
compress pituitary stalk (prolactin will ^) trying to radiate them may destroy gonadotrophes |
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how does chronic anovulation arise from a small prolactioma?
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hyperprolactinemia -> reflexive rise in dopamine -> effects dopamine receptors on GnRH neurons -> abnormal pulsatile release of LH/FSH
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amenorrhea
galactorrhea treat w/ what? worry about what? |
treat adenoma w/ bromocriptidine or cabergolin (dopamine agonist)
then surgery then radiation worry about osteoporosis from low estrogen levels |
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how does primary hypothyroidism cause chronic anovulation
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low T3/T4 -> reflex rise in TRH -> stimulates PRL -> reflex increases dopamine -> affects GnRH neurons
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chronic anovulation
chronic illness sources |
ESRD
malignancy malabsorption |
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chronic anovulation WITH estrogen
causes |
polycystic ovarian syndrome (PCOS)
ovarian tumors adrenal production of excess androgen |
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how do ovarian tumors cause chronic anovulation WITH estrogen
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secrete excess estrogen or androgens
disrupt normal feedback of ovarian-hypothalamic axis |
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things to note on physicial exam for amenorrhea
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sexual maturation
uterus present? estrogen status (hypo vs. hyper) FSH (ovarian vs. hypothalamic problem) PRL & TSH hCG (pregnant) |
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signs of normal vagina mucosa
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moist and rugated
cervical mucus stretchy epithelial cells look mature on smear |
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bleeds after removal of progesterone
dx? |
chronic anovulation w/ estrogen present (PCOS)
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LH/FSH levels in ovarian failure
why? |
high
loss of follicles = less estrogen/inhibin production = less negative feedback to pituitary = more secretion of LH/FSH |
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30 yo female
oligo-amenorrhea hot flashes vaginal dryness infertility |
premature ovarian failure/insufficiency
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POF therapy
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estrogen
- treat hot flashes - prevent osteoporosis progesterone - prevent hyperplasia |
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chronic anovulation w/ estrogen absent
etiologies? |
hypothalamus
anterior pituitary functional chronic illness |
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hypothalamic lesions
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craniopharyngioma
germinoma pinealoma glioma teratoma CNS trauma/radiation |
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isolated GnRH deficiency -> low LH/FSH
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Idiopathic hypothalamic hypogonadism (IHH)
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fetal GnRH secreting neurons fail to migrate from the olfactory placode to the medial basal hypothalamus
type of inheritance? |
X-linked, autosomal dom/rec
Kallmans Syndrome |
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delayed puberty
unilateral renal agenesis |
Kallman's syndrome
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space occupying lesions in pituitary?
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empty sella syndrome
arterial aneurysm |
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pituitary gland disorders
inflammatory/infiltrative |
sarcoidosis
hemochromatosis |
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pituitary gland disorders
tumors |
prolactinoma
other hormone secreting craniopharyngioma (non function) metastatic carcinoma |
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pituitary gland disorders
infection |
TB
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pituitary gland disorders
necrosis |
port-partum hemorrhage (Sheehans syndrome)
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pituitary gland disorders
iatrogenic |
surgery
radiation |
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bitermporal hemianopsia
amenorrhea milky discharge from breasts |
prolactinoma
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what is classically associated with?
amenorrhea menorrhagia |
hypothyroidism
hyperthyrodism - increased SHBG -> low normal free estradiol and diminished LH surge |
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^ cortisol
^ neuropeptide Y ^ opioids low T3 |
anorexia nervosa
bulemia |
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functional hypothalamic amenorrhea
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eating disorders
exercise - ^ cortisol and B-endorphins (GnRH modulators) stress - ^ cortisol |
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what is bleeding after progresterone withdrawal a sign of?
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estrogen presence (thickens endometrium)
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chronic anovulation with estrogen ABSENT is almost always
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hCG
PRL TSH |
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Etiologies of Chronic Anovulation WITHOUT estrogen present
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a. Functional
b. Inherited hypothalamic-pituitary abnormalities c. Hypothalamic-pituitary lesions d. Hyperprolactinemia e. Thyroid disease f. Chronic illness |
