Amenorrhea Clinical

  1. T/F: Amenorrhea during pregnancy is pathologic, indicative of ovarian failure
    False; it is physiologic during pregnancy and lactation
  2. Absence of spontaneous menses during reproductive years is known as ______
  3. What defines primary amenorrhea?
    • No menses by age 13 or 14 in the absence of secondary sexual development
    • Or no menses by age 15 or 16 regardless of secondary sexual characteristics
  4. What is the most common cause of primary amenorrhea
    Turner Syndrome which leads to Gonadal failure
  5. How is secondary amenorrhea defined?
    Lack of menses for 6 months or 3 cycles after establishing regular menses (in the absence of pregnancy, lactation, cyclic suppression by contraceptives or menopause)
  6. What is the most common cause of secondary amenorrhea?
  7. In non-pregnant women, secondary amenorrhea causes include:
    • Ovarian
    • Hypothalamic
    • Pituitary
    • Uterine
  8. T/F: Turner syndrome is the most common cause of secondary amenorrhea in non-pregnant people
    False; turner syndrome is the most common cause of primary amenorrhea. Secondary amenorrhea in non-pregnant causes include ovarian, hypothalamic, pituitary and uterine causes
  9. What are the imagining techniques used to evaluate for amenorrhea?
    • Ultrasound (cheapest)
    • MRI
    • HSG (hysterosalpingogram)
    • IVP (intravenous pyelography)
  10. What is an HSG?
    Hysterosalpingogram, an x ray procedure used to see whether the fallopian tubes are patent and if the inside of the uterus is normal
  11. Which imagining modality is used to see whether the fallopian tubes are patent and if the uterine cavity is normal?
    HSG- hysterosalpingogram
  12. What is the first lab you would order to evaluate for amenorrhea (what would you want to rule out first)?
    • Pregnancy test
    • First and foremost, r/o pregnancy
  13. Ovarian failure is suspected when there is _____ level of FSH and LH, and this is when you would do a karyotype to look for ______
    • Elevated
    • Tuner Syndrome
  14. Which hormone could allow you to determined if there is hypogonadotropic or hypergonadotropic hypogonadism?
  15. Why is there elevated levels of FSH when there is gonadal failure?
    • High levels of FSH because the hypothalamus and pituitary are trying to get the ovaries to produce estrogen but ovaries is burnt so won’t budge
    • This is hypergonadotropic hypogonadism
  16. What is the clinical presentation when there is gonadal failure?
    Typically there is no breast development
  17. What does low levels of FSH tell you in a patient that experiences amenorrhea?
    • Problem lies at the level of the hypothalamus or pituitary
    • Still no breast development but FSH is normal
  18. What is missing in Turnery syndrome?
    • Ovarian determinant genes results in premature loss of germ cells
    • No estrogen or progesterone produced at puberty
  19. Defining characteristics of Turner syndrome:
    • Short stature
    • Shield shaped thorax
    • Widely spaced nipples
    • Fold of skin
    • Elbow deformity
    • Gonadal streak
  20. T/F: Pure gonadal dysgenesis occur in females with 45XO genotypes, and result in short stature women with infantile internal and external female genitalia
    False; 45XO is turner syndrome and results in short stature women with premature loss of germ cells. Pure gonadal dysgenesis is 46XX or 46XY individuals with abnormal development of the gonads that leads, in women leads to normal stature with infantile internal and external female genitalia
  21. Pure gonadal dysgenesis would result in ___ level of FSH, and on ultrasound their ovaries would be _____.
    • Elevated
    • Undetectable ovaries
  22. What is Swyer Syndrome?
    • 46XY pure gonadal dysgenesis
    • Associated with mutation in the SRY gene
  23. What is the physical characteristic of an individual with 46XY Swyer Syndrome?
    • Phenotypic female but genetically male
    • No testes formation, no testosterone
    • Normal Mullerian organs
  24. 46 XY Swyer Syndrome would have _____ FSH and LH levels, and estrogen is _______
    • Elevated
    • Not produced, so no breast development
  25. T/F: in Swyer syndrome, streak gonads must be removed at the time of diagnosis otherwise malignant transformation can occur at any age
  26. Describe GnRH, FSH, LH and estrogen hormone level changes in HPA dysfunction:
    • Hypothalamic GnRH secretion is affected, reduced pulsatile secretion of GnRH
    • FSH, LH and estrogen will subsequently reduce levels too
  27. Kallmann syndrome Is an example of _______ hypogonadism
  28. What is the Kallmann Syndrome triad?
    • Deficiency of GnRH
    • Anosmia
    • Amenorrhea
  29. Is function of the ovaries intact in individuals with Kallmann syndrome?
    Yes, ovaries are normal. Kallmann is a deficiency of GnRH
  30. CNS tumors such as _____, ______ and ______ are examples of ____ hypogonadism
    • Craniopharyngiomas
    • Adenomas
    • Meningiomas
    • Hypogonadotropic
  31. How does craniopharyngiomas lead to decreased GnRH amongst other hormones?
    The tumor compresses portal vessels lead to impede flow of GnRH
  32. Pituitary causes contributes to ____ amenorrhea, and the most common cause of pituitary dysfunction is _____
    • Primary
    • Prolactinoma (hyperprolactinemia)
  33. Inadequate caloric and fat intake would likely lead to _______ amenorrhea
    Hypothalamic/ Primary (hypogonadotropic hypogonadism)
  34. Constitutional delay is a _____ cause of primary amenorrhea
    Pituitary dysfunction
  35. Primary amenorrhea due to an anatomic cause would have _____ breast development
    • Normal
    • As opposed to other primary amenorrhea causes (gonadal failure and HPA dysfunction), would result in no breast development
  36. Mullerian duct is aka ______ which develops into ______ internal structures
    • Paramesonephric
    • Female
  37. Mullerian Agenesis presents as _____ amenorrhea due to lack of ______ development. With fully developed secondary sexual characteristics (functional ovaries)
    • Primary
    • Uterine
  38. Fusion failure of urogenital sinus and Mullerian Ducts is _____
    Transverse vaginal septum
  39. Transverse vaginal septum would result in what phenotypic defect?
    shortened vagina
  40. How would you treat a transverse vagina septum?
    Hysteroscopic resection
  41. Imperforate hymen is an ____ cause of primary amenorrhea, and this usually presents with _______
    • Anatomic
    • Presents with cyclic abdominal and pelvic pain with lower abdominal swelling, as well as hematocolpos (blood behind membrane)
  42. What is Congenital androgen insensitivity syndrome (CAIS)?
    • genotype male, phenotype female, X-linked recessive
    • Testicular feminization
    • (basically: boys that are girls)
  43. What is the difference between CAIS and Swyer syndrome, given that both are 46XY, genetically male, phenotypically female individuals?
    • CAIS has a mutation in androgen receptor, they still have testes that make androgen, just not receptors to respond to those androgen leading to failure of male sexual differentiation
    • Vs in swyer, there is no testes and therefore no testosterone production
  44. T/F: like turner syndrome, CAIS result in short stature females
    False; unlike turner, CAIS “girls” are taller than other girls
  45. Which condition would have genetically male with female appearance with testes in abdomen and no uterus?
    Congenital androgen insensitivity syndrome
  46. Is there breast development in individuals with CAIS?
    • yes there is
    • But limited pubic, axillary and upper lip hair
  47. In CAIS, there would be ____ level of FSH, and ____ level of LH and ____ level of testosterone and ____ level of estradiol
    • Normal FSH
    • Mild elevated LH
    • Normal testosterone
    • Mid elevated estradiol
  48. T/F: MRI is a good, safe, cost-effective first imagining test for evaluation of amenorrhea due to low radiation exposure
    False; MRI is never cost effective unless you’re Trump. Ultrasound is the good, safe, cost-effective first choice
  49. In progestin challenge (progesterone withdrawal test), if bleeding results, would suggest _____
  50. T/F: in progestin and estrogen challenge, if bleeding results it rules out abnormalities of outflow, which suggests lack of hormone to build endometrium
  51. What does it mean if there is no bleeding after progesterone withdrawal? (progestin challenge)
    • That amenorrhea is likely due to:
    • low serum estradiol
    • hypothalamic- pituitary dysfunction
    • nonreactive endometrium
    • problem with the uterine outflow tract
  52. You want to distinguish the cause of a no bleeding progestin challenge by administering estrogen followed by a course of progestin in order to induce withdrawal bleeding, and that resulted in bleed, what does this tell you?
    That the amenorrhea is likely due to low estrogen
  53. What is the FSH and LH level in menopause?
    Persistent increase of FSH, LH
  54. What is the most common cause of hyperandrogenic chronic anovulation?
    Polycystic ovary syndrome
  55. What is the leading cause of subfertility in women?
  56. PCOS is an example of _____ amenorrhea
  57. Anorexia, malnutrition and excessive exercise, CNS tumors and Sheehan syndrome are examples of _____ hypogonadism
  58. Low body fat and increased stress would have what effect to menstruation?
    Menstrual suppression due to decreased gonadotropins and leptin
  59. What is the female athlete triad?
    • Excessive exercise
    • Amenorrhea
    • Osteoporosis
  60. T/F: critical body fat level must be present for reproductive system to function normally
  61. Menopause, primary ovarian insufficiency are examples of _______ hypogonadism
  62. What is Asherman syndrome?
    • Endometrial destructions leading to adhesions
    • (a secondary amenorrhea cause)
  63. How to manage asherman syndrome?
    • Lysis of adhesions
    • Prevent recurrence
    • Pain management NSAIDs
    • Postoperative
  64. Cervical stenosis is a _____ amenorrhea due to _____
    • Secondary
    • Trauma, tumors, congenital, hypoestrogenic environment
  65. What is an imagining technique that diagnose and treat uterus things?
  66. How do you explain why there is breast development in male patients with androgen insensitivity?
    Because receptors don’t respond to androgen so they get converted peripherally
  67. Someone with a blind vaginal pouch and no cervix, most likely diagnosis is_____
    Mullerian agenesis
Card Set
Amenorrhea Clinical
Endo Exam 3