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25 Cards in this Set
- Front
- Back
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Primary
Absence of menses by...... with ..... Absence of menses by ..... without ..... |
-age 16,normal secondary sexual characteristics
-age 14, secondary sexual development |
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Secondary
Absence of menses for....... in a ..... |
- 6 months, previously menstruating female
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Events of Puberty
1. ...... (breast development) Requires .... 2. ........ (pubic hair development) Requires ...... 3. body countour 4. psychological attitude 5. ........ (last event) Requires: GnRH from the hypothalamus FSH and LH from the pituitary Estrogen and progesterone from the ovaries Normal outflow tract |
-Thelarche, estrogen
-Pubarche/adrenarche, androgens -Menarche |
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Primary Amenorrhea
Is there normal development of secondary sexual characteristcs? |
NO
Think hypogonadism or hypogonadotropism |
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Amenorrhea with Immature Secondary Characteristics
FSH Serum level -Low / normal -> ...... -High->...... |
-Hypogonadotropic
hypogonadism -Gonadal dysgenesis |
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Primary Amenorrhea
1......Hypogonadism ..... have genetic abnormality Gonadal dysgenesis, Turner’s syndrome, mosaicism 2........ 3........ 4...... 5....... 6.....Galactosemia |
Primary Amenorrhea
Hypogonadism 30% have genetic abnormality Gonadal dysgenesis, Turner’s syndrome, mosaicism Enzyme deficiencies Kallmann’s syndrome, CNS tumors Irradiation Chemotherapy Galactosemia |
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Primary Amenorrhea with Immature Sexual Characteristics
Hypogonadism (gonadal failure) dt..... Note: gonadotropins (FSH/LH) will be ...., similar to menopause |
-Gonadal dysgenesis, Irradiation, Chemotherapy, Galactosemia
-high |
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Gonadal Dysgenesis dt
Chromosomally abnormal - ......(45XO) -...... (45XO/46XX),(46X-abnormal X) -...... (45XO/46XY) Chromosomally normal - 46XX (.........) - 46XY (.........) |
-Classic turner’s syndrome
- Turner variants - Mixed gonadal dygenesis -Pure gonadal dysgenesis -Swyer’s syndrome |
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Primary Amenorrhea with Immature Sexual Characteristics
Hypogonadotropism dt...... |
- Hypothalamic dysfunction like
Kallmann syndrome Anorexia nervosa Space-occupying lesion of CNS Marijuana use -Pituitary damage (surgery/radiation) -Constitutional delay |
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Primary Amenorrhea
Is there normal development of secondary sexual characteristics? YES Think..... |
Pregnancy
Mullerian anomaly Androgen insensitivity |
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Primary Amenorrhea with Normal Secondary Characteristics
Mullerian Anomalies like..... |
-Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome)
-Imperforate hymen -Transverse vaginal septum |
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Mayer-Rokitansky-Kuster-Hauser Syndrome (.......)
-.....of primary amenorrhea -...... secondary development & external female genitalia -Normal female range ....... level -Absent ..... -Karyotype .... -15-30% ....... anomalies |
-utero-vaginal agenesis
-15% -Normal -testosterone -uterus and upper vagina & normal ovaries -46-XX -renal, skeletal and middle ear |
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Androgen Insensitivity
-Normal breasts but no ..... -...... looking female external genitalia -Absent..... -Karyotype ..... -......range testosterone level -Treatment : |
-sexual hair
-Normal - uterus and upper vagina -46, XY -Male -gonadectomy after puberty + HRT |
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Primary Amenorrhea Evaluation
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Pregnancy test
Physical exam to determine presence of uterus FSH Karyotype |
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Primary Amenorrhea Treatment
-Cyclic estrogen/progestin -Remove gonadal streaks if..... -..... for ovulation induction in selected patients -Surgical resection of..... |
- XY or mosaic dt Increased (52%) risk of gonadoblastomas, dysgerminomas, and yolk sac tumors
-Pulsatile GnRH - intrauterine, cervical, and vaginal adhesions/septa |
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Secondary Amenorrhea
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Pregnancy!
CNS disorders Pituitary gland Thyroid Ovary Uterus Systemic disorders-Renal failure, liver disorders, DM Medications: anti-psychotics, reserpine |
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Secondary Amenorrhea
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-CNS disorders
-Chronic hypothalamic anovulation-Stress, Increased exercise levels, Anorexia nervosa -Head trauma -Space-occupying lesions |
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Secondary Amenorrhea
1. Pituitary disorders -Hyperprolactinemia:....... -Hypoprolactinemia:........ 2. Thyroid disorders -........ |
- Prolactinoma, Medications, PCOS, Renal failure
- Pituitary resection, Sheehan’s syndrome -Hyper- or hypothyroidism |
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Secondary Amenorrhea
1. Ovulation disorders ......... 2. Uterine abnormalities ......... 3. Drug-induced amenorrhea ........... |
-Polycystic ovarian syndrome
Premature ovarian failure -Asherman’s syndrome Cervical stenosis -Hormonal contraceptives GnRH analogues |
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Secondary Amenorrhea
1. History ........... 2. Physical exam .......... 3. Laboratory .......... |
-Nutrition/exercise habits, weight change
Sexual/contraceptive practice History of uterine/cervical surgery -Height/weight Hirsutism Galactorrhea Estrogen status of tissues -BhCG ->PRL & TSH->progesterone challenge ->FSH -> if high ->karyotype |
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Negative Pregnancy.test ->
TSH ,PROLACTIN, Progesterone challenge test ->withdrawal bleeding ->...... |
anovulation
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Negative Pregnancy.test->
TSH ,PROLACTIN, Progesterone challenge test-> without withdrawal bleeding-> hypoestrogenic, +ve.est/progest challenge test-> FSH norm.-> Repeat+serum estrogen level-> ....... |
hypothalamic-pituitary failure
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Negative Pregnancy.test->
TSH ,PROLACTIN, Progesterone challenge test-> without withdrawal bleeding-> hypoestrogenic, +ve.est/progest challenge test-> FSH>30-40-> repeat-> ...... |
PreOvFailure
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Negative Pregnancy.test ->
TSH ,PROLACTIN, Progesterone challenge test-> without withdrawal bleeding -> compromised outflow tract , -ve.est/progest challenge test-> Normal FSH-> ...... |
HSG OR hysteroscopy Asherman’s
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Secondary Amenorrhea
Treatment goals |
-Discovery and treatment of underlying disorder
-Hormone replacement -Menses every 1-3 months to prevent endometrial hyperplasia and cancer -Pregnancy->Ovulation induction, GnRH pump, FSH/LH |
