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24 Cards in this Set
- Front
- Back
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Growth and pain at first menses ?
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No pain during first menses, and no growth after first menses
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Age of thelarchy, adrenarchy and menarche ?
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8-9,9-10,12-13. This is delayed in undeveloped countries by 2-3 years
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Function of LH and FSH in regulation of normal physiology ?
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LH theca cells androgens precursors for estrogens
FSH granulosa cells androgen precursors estradiol |
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Trigger of menstruation ?
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Rising estradiol levels by FSH stimulation provide positive feedback to the HY to cause midcycle LH elevation. This LH elevation causes a surge of progesterone and menstruation
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Ovarian estradiol vs progesterone ?
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Proliferative endometrium - estradiol
Secretory endometrium - progesterone |
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Normal cycle/duration
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21-35 days and can last 3-5 days
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Primary Amenorrhea
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No period by age 14 in the absence of growth or secondary sexual characteristics
No period by age 16 in the presence of normal growth and secondary sexual characteristics |
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Secondary amenorrhea
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Absence of menses for 3 consecutive cycles in a patient who previously had regular cycles
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Unique causes of amenorrhea ?
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Anatomical abnormalities
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Genetic causes ?
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45X - turners syndrome
46 XY - androgen insensitivity syndrome Peripheral blood karyotype can be used to diagnose |
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How would you treat the causes ?
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Genetic - 45X - egg donation, IVF
46XY - maintain female sex of rearing Anatomic - surgery |
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What are some other causes of amenorrhea ?
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Pregnancy ( HCG) - prenatal care can avoid this
Hypothyroidism (TSH) - thyroid hormone replacement |
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What is the amonorrhea progesterone challenge test ?
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Administer progesterone and withdrawal bleeding should occur within 7-14 days.
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What does a positive test mean ?
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Positive withdrawal bleeding implies hypothalamic-pituitary dysfunction, i.e. a milder disruption of the CNS-gonadal axis
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What can cause hypothalamic pituitary dysfxn
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Stress
Decreased weight Polycystic ovarian syndrome |
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What does a positive withdrawal to progesterone confirm ?
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An estrogen primed endometrium and that genital outflow tract is patent
The FSH serum concentration is normal, however testosterone or DHEAS may be elevated if patient has hirsutism |
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Treatment ?
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No desire for pregnancy - Withdraw with progesterone every 1 to 2 months
No need for contraception - Withdraw with progesterone every 1 to 2 months Needs contraception - Oral contraceptives Desires pregnancy - ovulation induction with clomiphene |
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Hypothalamic pit failure caused by ?
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Extreme stress accompanied by loss of body weight and body fat
Competitive gymnast Competitive ballerina Marathon runner Anorexia nervosa Pituitary tumor |
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How would you diagnose it ?
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No withdrawal to progesterone
Low FSH Presence of excess serum prolactin - do MRI |
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Treatment
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No desire for pregnancy - hormone replacement
Pregnancy - Ovulation induction with gonadotropins Pituitary microadenoma - bromocriptine |
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Char. features of ovairan failure. Key diagnostic feature s?
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Premature - < 35 years of age
Surgery Genetic – primarily 46, XX / 45, X mosaicism Menopause Key diagnostic feature is high FSH |
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Treatment for ovarian failure
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Premature – no desire for pregnancy - HRT
Premature – desire for pregnancy - donor eggs, IVF Menopause - hormone replacement |
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Ashermann's syndrome
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Etiology
Prior curettage IUD Diagnosis – failure to withdraw to progesterone, followed by HSG Treatment – excision of scar tissue |
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Normal sequence of pubertal development
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Normal sequence of pubertal development
Thelarche Adrenarche Pubarche Growth spurt Menarche |
