PCOS
Pituitary
Uterus
Hypothalamus
Ovary
100
This % age of patients with PCOS is NOT obese.
What is 20%
100
The most common cause of hyperprolactinemia
What is Prolactinoma or lactotroph adenoma
100
The most common cause of secondary amenorrhea?
What is Pregnancy
100
Definition of secondary Amenorrhea
What is Absence of menses for 3 cycles or 6 months and/or Oligomenorrhea <9 cycles/year in a woman who previously had MENSES.
100

What is the definition of primary ovarian insuffiency?

What is cessation of menses by age 40 

200
The primary treatment for menstrual disorders in a PCOS patient
What is Combination low dose hormonal contraceptives
200
What is the cutoff value for an abnormal prolactin level.
What is 20ng/ml A PRL level >200ng/ml is very suspicious for a MACROademona (>1cm)
200
This disease is diagnosed by visualizing scarring of the endometrial lining, often as a result of PPH, endometrial infection, and/or D&C.
What is Asherman's Syndrome
200
This is one of the most common causes of hypogonadotropic hypogonadism, and by definition EXCLUDES pathologic disease.
What is functional hypothalamic amenorrhea, characterized by a decrease in GnRH secretion, and found commonly in patients with anorexia nervosa, excessive exercise, and high stress.
200
What lab do you order to confirm the dx?
What is FSH and estradiol level. FSH >30mIU/ml x2 @ least 1 month apart Estradiol <50 pg/ml
300
The Rotterdam criteria consists of...
What is Must have 2 of 3: Hyperandrogenism Oligomenorrhea or Amenorrhea Polycystic ovaries by US
300
This syndrome is caused by a PPH, and characterized by hypotension, failure to lactate, extreme fatigue, n/v, and amenorrhea
What is Sheehan Syndrome
300
This bacillus is responsible for a rare cause of amenorrhea.
What is Tuberculosis
300
These drugs can affect the hypothalamus and cause amenorrhea.
What is Phenothiazines (compazine/prochlorperazine & thorazine/chlorpromazine) Reserpine Alkylating agents
300
The most common causes of POF?
What is Chromosomal abnormalities, Turners/XO Premutation for Fragile X (most common cause of inherited mental retardation) Damage from chemo &/or XRT
400
What laboratory work up is necessary?
What is 2 hr GTT Free testosterone (or total testosterone & SHBG) Fasting lipid & lipoprotein level TSH Prolactin 17 hydroxyprogesterone +/- 24hr urinary free cortisol excretion test or low dose dexamethasone suppression test
400
This extrapituitary tumor has a bimodal age distribution, causes bitemporal hemianopsia, headache, and amenorrhea
What is Craniopharyngioma
400
Describe the progesterone withdrawal test.
What is Give oral progesterone/Provera 10mg daily for 5-10 days. Patients with adequate endogenous estrogen will bleed within 3-5 days of cessation of the medication. Progesterone induces secondary changes in the endometrium, which will inevitably cause withdrawal bleeding if there is endogenous estrogen present.
400
What is the female athletes triad? And what do you have to be concerned about?
What is Amenorrhea, eating disorder, and osteoporosis or osteopenia. The biggest concern is bone density.
400
This is an uncommon cause of secondary amenorrhea with increased androgen secretion
What is Androgen secreting ovarian tumor (sertoli-leydig tumor and granulosa theca tumor). Serum testosterone >150-200ng/dl. Do a pelvic US
500
Dx of the Metabolic Syndrome
What is Elevated BP >/= 130/85 Increased waist circumference >/= 35 in or 88cm Elevated fasting glucose >/= 100mg/dl HDL </= 50mg/dl AND Trigs >/= 150mg/dl
500
Treatment options for a prolactinoma
What is Medications: Dopamine AGONISTS: bromocriptine or cabergoline (achieves desired fertility, improves galactorrhea, and reduces mass effect) Transphenoidal resection
500
What to do if there is no uterus... What are the common diagnoses?
What is Mullerian agensis or Mayer-Rokitansky-Kuster-Hauser syndrome Androgen Insensitivity In both cases you will have a NORMAL appearing female without a uterus. Get a KARYOTYPE: Mullerian agenesis XX w/ pubic & axillary hair, and AIS XY with NO pubic or axillary hair.
500
Treatment for exercise-induced/hypo hypo amenorrhea.
What is Increase caloric intake Estrogen therapy/OCPs Ca++ 1200-1500mg/day + Vitamin D 400IU/day If infertile, then will need exogenous gonadotropins (FSH + LH/injectables)
500
What other tests are necessary once POF is diagnosed?
What is DEXA TSH and thyroid peroxidase Ab (20% of POF patients have hypothyroidism) CBC with peripheral smear (r/o pernicious anemia) 2hr GTT Adrenal Ab (pts have a 50% chance of developing adrenal insufficiency) Referral to REI and psychologist
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