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27 Cards in this Set
- Front
- Back
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Amenorrhea
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absence of menses
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When do many teenage girls usually experience intervals of amenorrhea?
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2-12mo during 1st 2 yrs after menarche
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How early can spontaneous menopause occur in women?
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mid 30s
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Classification of Amenorrhea
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eugonadotropic - congenital/acquired anomalies
hypergonadotropic - primary amenorrhea hypogonadotropic - secondary amenorrhea |
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__ is failure of menarche by age 15 in presence of normal growth and secondary sexual development/ by age 13
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Primary amenorrhea
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Causes of primary amenorrhea
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Mayer-Rokitansky-Kuster-Hauser Syndrome (mc vagina/uterus agenesis with renal abnormalities)
Androgen Insensitivity Syndrome(testicular feminization) Mullerian dysgenesis (Turner's syndrome) Imperforate hymen Transverse vaginal septum Hypogonadotrophic hypogonadism(Kallmann's syn) Primary hypothyroidism (chronic autoimm thyroiditis) Infection/pelvic radiation/TB |
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__ is absence of menses for 6 consecutive mo in women with normal menstruation has been established OR >3 cycle intervals in woman with oligomenorrhea
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Secondary amenorrhea
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Types of secondary amenorrhea
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uterine (Asherman's syndrome)
pituitary (galatorrhea syndrome, empty sella syndrome, hyperprolactinemia, pituitary adenoma, Sheehan's syndrome) hypothalamic dysfunction (nutritional deficiency, chronic illness, histiocytosis, lymphoma, meds, overtraining, emotional stress) adrenal (CAH, Cushing's syndrome) ovarian (Halban's syndrome, premature ovarian failure, PCOS) physiologic (pregnancy) |
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What is the MCC of secondary amenorrhea causing infertility and synechiae/adhesions as well?
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Asherman's syndrome
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What is the prevalence of women on OC that have amenorrhea once stopping the pill?
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<1%
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What labs are important in evaluating amenorrhea?
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serum hCG, prolactin levels, thyroid function tests, gonadotropin levels (LH/FSH)
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Tx of amenorrhea
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counseling and education
estrogen therapy progesterone therapy gonadotropins (Clomid) bromocriptine endocrine meds surgery |
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__ is excessive growth of non-sexual hair
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hypertrichosis
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__ is increased growth of male-like hairs on midline of body, face, chest, abdomen, and inner thigh associated with anovulatory amenorrhea, dysfunctional uterine bleeding, or infertility
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hirsutism
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__ is hirsutism associated with increased muscle mass, clitoromegaly, temporal balding, voice deepening, increased libido, and possible de-feminization
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virilization
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__ are steroids that promote development of masculine secondary sex characteristics with transformation occurring in the liver and skin
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androgens
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What are the 3 sources of androgens in women?
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adrenal gland (0-30%)
ovary (5-20%) preandrogens peripheral transformation/DHEA(50-70%) |
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What is the most important androgen that mostly circulates bound to albumin/binding globulin in the blood and small portion found in free form?
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testosterone
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classification of hirsutism
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ovarian (PCOS, hyperthecosis, tumors)
adrenal (CAH,adenoma, carcinoma) primary endocrinopathy (Cushing's, acromegaly) drugs (danazol, phenothiazine, diazoxide, minoxidil) idiopathic hyperprolactinemia/ menopause |
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What is the most important treatment goal for hirsutism and what are the serious complications of hirsutism?
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goal: stop virilizing process
complications: infertility, DM, HTN, heart dz *significant weight loss is only long-term soln to obesity-related hirsutism |
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medical tx of hirsutism
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combo OC
medroxyprogesterone acetate (Depo-Provera) spironolactone flutamide (hepatotoxic comp) finasteride (5alpha reductase inhib; teratogenic) glucocorticoids cimetidine, metformin eflornithine (vaniqua) - hair reduction |
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T/F: Combo of hormonal suppression and supportive measure offers best long-term results for hirsute patients
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True
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MC endocrinopathy in women of reproductive age and MCC of androgen excess and hirsutism
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polycystic ovary syndrome (PCOS)
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Who 1st described PCOS and was the prior name?
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Stein and Leventhal
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sx of PCOS
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menstrual irregularities, chronic anovulation, acne, hirsutism, infertility, enlarged polycystic ovaries, obesity, acanthosis nigricans (common skin fold), inc testosterone/DHEAS, inc fasting insulin levels, Ferrin Galloway score>6, LH-FSH ratio>2, norm-inc serum prolactin, norm serum 17-hydroxyprogesterone, norm TSH level
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dx of PCOS
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chronic anovulation, hyperandrogenism, hyperandrogenemia, US polycystic ovaries
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tx of PCOS
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OC (mc)
medroxyprogesterone weight reduction diet clomiphene citrate flutamide spironolactone GnRH agonists (Lupron, Viadur, Synarel) hair removal metformin thiazolidinedione |
