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PathophysI_MDO_October1_2012_CaseDiscussion_Class (1)

Hypothalamic pituitary ovarian hpo axis evaluation

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Hypothalamic-pituitary-ovarian (HPO) axis evaluation Ovaries: lack of/early loss of ovarian follicles; genetic abnormalities; toxins Anterior pituitary: prolactin-secreting adenoma; thyroid releasing hormone contributing to increased prolactin levels Hypothalamus: reduction in GnRH (eating disorders, extreme endurance activities)
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Menorrhagia Definition: menstrual blood loss greater than 80 mL per cycle Contributing factors / pathophysiology Systemic disorders: pregnancy, ectopic pregnancy, miscarriage Uterine abnormalities: fibroids, endometrial polyps Bleeding abnormalities: vonWillebrand’s disease; idiopathic thrombocytopenic purpura Cirrhosis Clinical manifestations / course
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Anovulatory Bleeding Definition: dysfunctional or irregular uterine bleeding NOT related to an anatomic lesion of the uterus. 70% of cases are due to PCOS Etiology: immature HPO axis (no LH surge); declining ovarian function; hyperprolactinemia; high thyroid stimulating hormone (TSH); high FSH; hyperandrogenism Clinical manifestations / course
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PCOS Definition Hyperandrogenism and chronic anovulation in cases in which secondary causes have been excluded Presence of polycystic ovaries is a sign; is a nonspecific finding Etiology Selective insulin resistance
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PCOS: Clinical Manifestations / Course Specific to PCOS Hirsutism, enlarged ovaries, infertility, amenorrhea, obesity, dysmenorrhea, persistent anovulation Chronic anovulation, obesity, hyperinsulinemia, and decreased sex hormone binding globulin all associated with endometrial cancer Insulin resistance and associated conditions
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Acanthosis Nigricans
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Hypothalamic pituitary ovarian HPO axis evaluation Ovaries...

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