Amenorrhea

Front 1

Primary Vs Secondary Amenorrhea ?

Back 1

Primary amenorrhea, in which menarche (the first menses) has not occurred, and secondary amenorrhea, where menses has been absent for 6 months or more.

Front 2

The presence of normal breast development confirms ?

Back 2

Gonadal secretion of estrogen.

Front 3

The presence of pubic and axillary hair confirms ?

Back 3

Gonadal secretion of androgens as well as the presence of functional androgen receptors.

Front 4

When is the diagnosis of primary amenorrhea made ?

Back 4

No spontaneous uterine bleeding has occurred by the age of 16 years, no evidence of breast development (thelarche) by age 14 years or if the patient has failed to menstruate spontaneously within 2 years of thelarche.

Front 5

Differential diagnosis of primary amenorrhea with sexual infantilism ?

Back 5

- Hypogonadotropic hypogonadism
- Gonadal agenesis/dysgenesis

*Patients with hypogonadotropic hypogonadism have low FSH levels, whereas patients with gonadal dysgenesis have elevated FSH levels in the menopausal range (>40 IU/L).

Front 6

Primary amenorrhea, breast development, and Müllerian anomalies ?

Back 6

- Complete androgen insensitivity syndrome (46 XY)
- Karyotype of 46 XX with anatomical anomalies.

* Patients with complete androgen insensitivity syndrome have male levels of testosterone.

Front 7

Meyer-Rokitansky-Küster-Hauser syndrome ?

Back 7

Failure of the müllerian ducts to develop, resulting in a missing uterus and fallopian tubes and variable malformations of the upper portion of the vagina.

Front 8

Asherman's syndrome ?

Back 8

Characteristic intrauterine synechiae.

Front 9

The empty sella syndrome ?

Back 9

Herniation of the subarachnoid membrane into the pituitary sella turcica through a defective or incompetent sella diaphragm and may coexist with prolactin-secreting pituitary adenomas.

Front 10

Treatment of Hyperprolactinemia&Galactorrhea ?

Back 10

- As long as the galactorrhea is not socially embarrassing and the patient has regular menses (confirming normal estrogen levels), there is no need to institute treatment. Because the growth rate of microadenomas is slow, an annual measurement of serum prolactin is appropriate in patients with normal estrogen levels.
- Anovulatory patients without demonstrable tumors by MRI, for whom the only issues are prevention of osteoporosis and cycle regulation, may be treated with combination oral contraceptives. The ergot compounds, bromocriptine and cabergoline, act as dopamine agonists to reduce prolactin secretion and allow for the restoration of cyclic, physiologic estrogen secretion.
- Surgery should be performed for patients with significant visual field defects or symptoms that cannot be relieved by medical therapy.

Front 11

Mild form of hypothalamic anovulation caused by ?

Back 11

Nutrition/exercise mismatch, psychological stress, previous use of Depo-Provera, recent pregnancy, or lactation.

Front 12

Hirsutism ?

Back 12

More apparent facial and chest hair caused by conversion to the dark, thick terminal hair form

Front 13

Virilism ?

Back 13

Severe hirsutism with temporal balding, deepening of the voice or clitoromegaly

Front 14

Androgen Metabolism ?

Back 14

Figure 33-1

Front 15

Hyperandrogenic disorders ?

Back 15

Box 33-2

Front 16

PCOS most common symptoms ?

Back 16

- Hirsutism (90%)
- Menstrual irregularity (90%)
- Infertility (75%).

Front 17

PCOS pathophysiology ?

Back 17

- Patients with PCOS exhibit increased LH pulse frequency, resulting in higher circulating levels of LH.
- The increased LH level promotes androgen secretion from ovarian theca cells, leading to elevated levels of intraovarian-derived androgens.
- This then leads to atresia of developing follicles and interferes with the normal development of a dominant ovarian follicle. The normal secretory pattern of estrogen is disrupted and the midcycle LH surge does not occur, resulting in anovulation and lack of progesterone production.
- The excessive amounts of androgen are peripherally converted to estrogen. The unopposed estrogens may cause adenomatous hyperplasia of the endometrium or rarely endometrial carcinoma.
- An association exists between abnormal androgen production and insulin resistance with hyperinsulinism.
- Increased androgens as well as insulin generally reduce hepatic production and secretion of SHBG.

Front 18

Functional disorders Vs Neoplastic disorders ?
(Hyperandrogenic)

Back 18

- Functional disorders often first appear during puberty and tend to progress slowly
- Neoplastic disorders can occur at any time.