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Questions and Answers
Which of the following is NOT a common clinical finding associated with prolactinoma?
Which of the following is NOT a common clinical finding associated with prolactinoma?
- Diarrhea (correct)
- Secondary amenorrhea
- Galactorrhea
- Visual disturbances
A microadenoma is defined as a tumor size greater than or equal to 1 cm.
A microadenoma is defined as a tumor size greater than or equal to 1 cm.
False (B)
What is the first-line medical treatment for symptomatic prolactinoma?
What is the first-line medical treatment for symptomatic prolactinoma?
Cabergoline
A patient with a macroadenoma may experience __________ due to pressure on surrounding structures.
A patient with a macroadenoma may experience __________ due to pressure on surrounding structures.
Match the following types of adenoma with their characteristics:
Match the following types of adenoma with their characteristics:
What is the maximum recommended dose of Enclomiphene for treatment?
What is the maximum recommended dose of Enclomiphene for treatment?
Intrauterine insemination (IUI) carries a high risk of teratogenicity.
Intrauterine insemination (IUI) carries a high risk of teratogenicity.
What is the drug of choice for managing elevated prolactin in all females?
What is the drug of choice for managing elevated prolactin in all females?
What is the typical duration for administering Enclomiphene?
What is the typical duration for administering Enclomiphene?
Elevated prolactin can lead to increased levels of estrogen in females.
Elevated prolactin can lead to increased levels of estrogen in females.
The half-life (T1/2) of Enclomiphene is approximately ______.
The half-life (T1/2) of Enclomiphene is approximately ______.
What are the common treatments for hypothyroidism mentioned in the content?
What are the common treatments for hypothyroidism mentioned in the content?
Match the adverse effects with their corresponding descriptions:
Match the adverse effects with their corresponding descriptions:
Elevated prolactin levels in males and females lead to infertility and decreased levels of ________ in females.
Elevated prolactin levels in males and females lead to infertility and decreased levels of ________ in females.
Match the following conditions to their respective effects on hormone levels:
Match the following conditions to their respective effects on hormone levels:
What is the minimum duration of absence of menstruation to be classified as secondary amenorrhea?
What is the minimum duration of absence of menstruation to be classified as secondary amenorrhea?
Lactation can cause secondary amenorrhea due to increased levels of Prolactin.
Lactation can cause secondary amenorrhea due to increased levels of Prolactin.
Name one investigation used to assess levels of prolactin in suspected cases of secondary amenorrhea.
Name one investigation used to assess levels of prolactin in suspected cases of secondary amenorrhea.
Absence of menstruation for ≥ 90 days in a previously menstruating female is referred to as __________.
Absence of menstruation for ≥ 90 days in a previously menstruating female is referred to as __________.
Match the following causes of secondary amenorrhea with their descriptions:
Match the following causes of secondary amenorrhea with their descriptions:
What is the first-line drug used for ovulation induction?
What is the first-line drug used for ovulation induction?
Clomiphene citrate is a steroidal medication used for inducing ovulation.
Clomiphene citrate is a steroidal medication used for inducing ovulation.
What is the typical rate of ovulation achieved with clomiphene citrate treatment?
What is the typical rate of ovulation achieved with clomiphene citrate treatment?
Clomiphene citrate can lead to ________ cervical mucus, which can be unfavorable for pregnancy.
Clomiphene citrate can lead to ________ cervical mucus, which can be unfavorable for pregnancy.
Match the management step with its respective treatment:
Match the management step with its respective treatment:
What is the primary indication for using glucocorticoids such as dexamethasone in the management of PCOS?
What is the primary indication for using glucocorticoids such as dexamethasone in the management of PCOS?
Laparoscopic ovarian drilling has a risk of multiple pregnancies associated with it.
Laparoscopic ovarian drilling has a risk of multiple pregnancies associated with it.
What is the purpose of using metformin in patients with clomiphene-resistant PCOS?
What is the purpose of using metformin in patients with clomiphene-resistant PCOS?
The recommended power for laparoscopic ovarian drilling is _____ watts.
The recommended power for laparoscopic ovarian drilling is _____ watts.
Match the following treatments with their indications in PCOS:
Match the following treatments with their indications in PCOS:
What is one of the advantages of using Oral Contraceptive Pills (OCPs) in the treatment of PCOS?
What is one of the advantages of using Oral Contraceptive Pills (OCPs) in the treatment of PCOS?
Medroxyprogesterone acetate (MPA) is considered the drug of choice for regularizing cycles in PCOS.
Medroxyprogesterone acetate (MPA) is considered the drug of choice for regularizing cycles in PCOS.
What is the duration of treatment for OCPs?
What is the duration of treatment for OCPs?
The primary hormone combination in OCPs for treating PCOS is _____ and _____ to facilitate ovarian suppression.
The primary hormone combination in OCPs for treating PCOS is _____ and _____ to facilitate ovarian suppression.
Match the treatment with its effect in PCOS:
Match the treatment with its effect in PCOS:
Which of the following statements accurately describes metformin's role in managing PCOS?
Which of the following statements accurately describes metformin's role in managing PCOS?
Oral contraceptives are indicated in all PCOS cases, including those resistant to clomiphene.
Oral contraceptives are indicated in all PCOS cases, including those resistant to clomiphene.
Name one drug that is contraindicated in the treatment of hirsutism.
Name one drug that is contraindicated in the treatment of hirsutism.
The condition caused by an androgen producing ovarian tumor is called ______.
The condition caused by an androgen producing ovarian tumor is called ______.
Match the following drugs to their respective characteristics regarding ovulation induction:
Match the following drugs to their respective characteristics regarding ovulation induction:
What is the primary mechanism of action of Clomiphene Citrate?
What is the primary mechanism of action of Clomiphene Citrate?
Letrozole is associated with a higher risk of multiple pregnancies compared to Clomiphene Citrate.
Letrozole is associated with a higher risk of multiple pregnancies compared to Clomiphene Citrate.
What is the starting dose of Letrozole for ovulation induction?
What is the starting dose of Letrozole for ovulation induction?
Clomiphene Citrate is the first-line treatment for __________ induction.
Clomiphene Citrate is the first-line treatment for __________ induction.
Match the drug with its corresponding side effect:
Match the drug with its corresponding side effect:
What is the most common symptom associated with Asherman syndrome?
What is the most common symptom associated with Asherman syndrome?
Hysteroscopic Adhesiolysis is a management technique used for Asherman syndrome.
Hysteroscopic Adhesiolysis is a management technique used for Asherman syndrome.
Name one investigation used to identify Asherman syndrome.
Name one investigation used to identify Asherman syndrome.
In Asherman syndrome, the hormone profile usually shows normal levels of _____ and _____ during investigations.
In Asherman syndrome, the hormone profile usually shows normal levels of _____ and _____ during investigations.
Match the type of test with its significance in Asherman syndrome:
Match the type of test with its significance in Asherman syndrome:
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Study Notes
Clomiphene Citrate (CC)
- Selective Estrogen Receptor modulator (SERM)
- Non-steroidal, centrally acting anti-estrogenic drug
- Blocks estrogen receptors in hypothalamus and pituitary
- Increases LH and FSH levels by falsely interpreting decreased estrogen levels
- Binds to peripheral estrogen receptors in the Endometrium, Cervix
- Causes endometrial thinning, thick cervical mucus, unfavorable for pregnancy
- Ovulation rate: 80%
- Pregnancy rate: 5-10%
- Used as a first-line ovulation induction drug
Second Line Management of Clomiphene Resistant PCOS
- Clomiphene Citrate + Glucocorticoids (Dexamethasone): indicated for clomiphene resistant PCOS with elevated androgens
- Clomiphene Citrate + Metformin: indicated for clomiphene resistant PCOS with insulin resistance
- Oral Contraceptives (OCPs): for 2 months, decreases LH levels and Androgen
- HMG: 75 IU LH + 75 IU FSH + impurities, indicated for hypogonadotropic hypogonadism, DOC for ovulation induction
- Recombinant Inj FSH: Purified form of FSH, expensive
- Laparoscopic ovarian drilling: burns ovarian stroma, destroys theca cells, decreases Androgens, no risk of multiple pregnancies or OHSS
- IVF in PCOS: indicated for women >35 years with other factors contributing to infertility
Mechanism of Action of OCPS
- Estrogen + Progesterone leads to ovarian suppression, causing anovulation and reduction in Androgens
- Endometrial thinning occurs due to progesterone
- Progesterone is used cyclically every 12-14 days in the second half of the cycle
- Medroxyprogesterone acetate (MPA) can be used for 5 days, facilitates withdrawal bleeding
Advantages of OCPS in PCOS
- Regularizes menstrual cycles
- Treats hirsutism
- Contraceptive benefit
- Protects against endometrial cancer
Disadvantages of MPA
- Does not regularize menstrual cycles
- No protective effect on endometrium, less than 12 days
Drugs Contraindicated in PCOS and Infertility
- Spironolactone: Anti-androgenic
- Oral Contraceptives (OCPs): Except in clomiphene resistant cases
Management of Insulin Resistance
- DOC: metformin
- Helps in weight loss
- Mild anti-hirsutism action
- Decreases the chance of gestational diabetes mellitus in PCOS
- Can be continued during pregnancy
- Decreases the risk of OHSS
Causes of Hirsutism
- PCOS: Most common cause
- Idiopathic hirsutism
- Androgen producing ovarian tumor
- Androgen producing adrenal tumor
- Cushing syndrome: Hirsutism + Diabetes/Hypertension
- Pregnancy luteoma: Hyperplastic mass of luteinized ovarian cells (not a true tumor)
- Theca lutein cysts: Due to ↑ hCG (similar to a subunit of LH)
- Hyper prolactinemia
Drugs Contraindicated in Hirsutism
- Danazol
- Gestrinone
Clomiphene vs Letrozole
Clomiphene
- SERM
- Centrally acting
- Blocks receptors in hypothalamus and pituitary
- Increases LH and FSH
- Starting dose: 50mg
- Maximum dose: 150mg
- T1/2: 2 weeks
- Follicular development: Multifollicular
- Risk of multiple pregnancies: 7-10%
- Effect on endometrium and cervix: Blocks estrogen receptors
- Live birth rate: ↑
- Side effects: Hot flushes, vaginal dryness
- Teratogenicity: No effect, increased chances of pregnancy
- Uses: DOC for ovulation induction, DOC for PCOS
- Pre-requisite: Intact HPO axis + Normal FSH levels
Letrozole
- Aromatase inhibitor
- Peripherally acting
- Decreases androgen aromatase
- Decreases estrogen
- Starting dose: 2.5 mg OD
- Maximum dose: 7.5 mg OD
- Follicular development: Monofollicular + Multifollicular
- Risk of Multiple Pregnancies: 3-7%
Asherman Syndrome
- Intrauterine adhesions and thin, defective endometrium
- Highest risk: Curettage done postpartum
- Causes: Excessive curettage, D&C (Dilation & Curettage)
- Symptoms: Menstrual irregularities, infertility, 2° Amenorrhea, Hypomenorrhea, 2° Dysmenorrhea, Recurrent abortions, Schistosomiasis, removal of retained tissue, genital TB
- Investigation: TVS or hormonal test, hysterosalpingography (moth-eaten appearance)
- 2° Amenorrhea Investigations: UPT, LH, FSH, Estrogen, Prolactin, TSH, Progesterone Challenge/withdrawal Test, Progesterone & Estrogen withdrawal Test
- Management: Hysteroscopic Adhesiolysis, Intra uterine insertion of Foley's catheter, Estrogen & Progesterone x 3 months
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