Axis clinical session

Question 1

What does irregular cycle and breastmilk production indicate?

Answer 1

Irregular cycles - anovulation
Breastmilk production - high prolaction

Anovation - can be due to damage to prolactin and dopamine

• Prolactin secreted by anterior pituitary is suppressed by dopamine (negative feedback)
• prolactin negatively feedsback to hypothalamus and affects pulsatile secretion of GNRH (after ovulation)

-however if damage to dopamine, then will get increased prolactin

What can cause this

• Anterior pituitary tumour - prolactinoma - tumour that produces prolactin, - can give dopamine agonist to reduce amount of progesterone, surgery
• drugs - anti psychotic drugs
• lactation
• stress

Question 2

Symptoms - headache, visual disturbance, very light infrequent menstrual cycles

Answer 2

• Could be prolactinoma or a tumour of the anterior pituitary
• causes pressing on optic chiam, also cannot get menstrual cycle due to increased prolactin being secreted - so will stop the gnrh being secreted (due to negative feedback) and cause decrease in LH and fsh drop - no oestrogen and progesterone

Question 3

What will we see if it is a hypothalamic problem?

Answer 3

Will see low lh, low fsh and low estrogen because the negative feedback of these is not working to stimulate the hypothalamus

• can be caused by anorexia
• management - counselling, hormone therapy COCP, review when considerign starting a famiy

Question 4

Premature ovarian insufficiencey

Answer 4

• will see how oestrogen and high fsh - this is because not enough oetrogen is being produced by the ovaries, and so the reduced negative feedback will stimulate more fsh to try and get oestrogen made
• less frequent menstruation and eventually ovulation stops
• need counselling, and fertility specialist

Question 5

Criteria for PCOS

Answer 5

2/3 of …
-oligo-ovulation or anvoulation
hyperandrogenism
-Polycistic ovaries on ultrasound

Question 6

Symptoms of PCOS

Answer 6

• high LH - high LH : fsh ratio
• testosterone high
• lots of androgen
• heavey irregular peridos, acne, facial hari, wieght fain, obesity

Question 7

Management of PCOS

Answer 7

lose weight, can get ovulation

• medicaiton to induce ovulation, clomiphene citrate
• surgery - to induce ovulation, remove androgen producing tissue
• metformin - for insulin resistance e

Question 8

consequences of anovulation

Answer 8

no ovultiaon - no LH surge, no rise in progesterone, no drop in progesterone to trigger next menses

• endometrium continues to proliferate - can lead to endometrial thickening/ hyperplasia –> cancer
• can take progesterone tables so get a bleed
• or prevent endometrial prolieration - overgrowth of lining of utereus, hormonal treaments e.g mirena