Disorders of Menstruation MCQs

Involution of the corpus luteum results in a decrease in progesterone and estradiol secretion. This occurs around day 24 of a 28-day menstrual cycle. The loss of hormonal support causes endometrial shedding. LH, FSH, GnRH and estrogen are not involved in this process. Estradiol is primarily responsible for endometrial proliferation during the earlier phases of menstrual cycle. Reference : Harrison's Principles of Internal Medicine 21 st edition Page 3035

The question says that the girl has normal ovaries which rules out. Turners syndrome where streak gonads are seen Noonan's syndrome Androgen insensitivity syndrome gonads are testis. So by exclusion our answer is Mayer-Rokitansky Kuster-Hauser Syndrome. Mullerian agenesis or mayer-okintansky-Kuster-hauser syndrome is a congenital malformation characterized by a failure of the Mullerian ducts to develop, resulting in absent uterus and variable malformations of the vagina, while both ovaries are intact and functioning. Ovaries are present and function normally so secondary sexual characteristics are normal. External genitalia are also normal as testosterone is absent. Reference : Speroff 7th/ed p 420-421.

The patient is presenting with primary amenorrhea along with well developed breast and scanty pubic hair and axillary hair -leave no doubt regarding Testicular feminisation syndrome as the diagnosis, which c/k/a AIS (Androgen Insensitivity Syndrome) Reference : Novak 14 th /ed, pg no: 1037-1038

This child is presenting with primary amenorrhea with: Negative progesterone challenge test - which rules out PCOD (which may sometimes manifest as primary amenorrhea) When next step was done i.e., estrogen, progesterone combined test - lt comes out to be positive i.e., compartment I system (uterus, endometrium and outflow tract) is normal if properly stimulated by estrogen which rules out mullerian agenesis and Ashermann's syndrome. Positive estrogen progesterone combined test means the defect is in the production of estrogen i.e., either ovaries, pituitary, or hypothalamus. So from the given options we have to look for a cause which involves either of the above sites, which in this case is prolactinoma. Reference : Dutta Gynae 6 th /ed pg no: 467.

Kallmann’s syndrome is due to hypothalamic dysfunction characterised by a deficiency of gonadotropin releasing hormone (GnRH) causing a hypogonadotropic hypogonadism. This is associated with anosmia. It can occasionally be associated with optic problems, such as color blindness or optic atrophy, nerve deafness, cleft palate, cryptorchidism, renal agenesis, and mirror movement disorder. MRKH syndrome, also known as Mullerian agenesis, is due to anatomical absence of the uterus. This is the second most common cause of primary amenorrhea Turner’s syndrome is a type of gonadal dysgenesis and is overall the most common cause of primary amenorrhea Sheehan’s syndrome is postpartum pituitary necrosis. It leads to secondary amenorrhea and not primary amenorrhea. Reference: Shaw 15 th /ed, Page no:96-97

The main hormone responsible for secondary sexual characteristics in females is estrogen. Estrogen leads to Breast development Growth spurt, i.e. height attained Production of cervical mucus Cornification of vaginal cells Menstruation (menstruation occurs due to withdrawal of progesterone in an oestrogen primed uterus). As far as hair growth is concerned – in females also the hormone responsible is Androgens (produced by adrenals and ovary) Reference: Williams Gynae 1st/ed p 315; Novak 14th/ed p 992, 15th/ed p 993

Spasmodic dysmenorrhoea is another name for primary dysmenorrhoea. The etiology of primary dysmenorrhea includes excessive amount of prostanoids secreted from the endometrium during menstruation. The prostanoids result in increased uterine contractions with a dysrhythmic pattern, increased basal tone, and increased active pressure. Pain is spasmodic in nature Pain of primary dysmenorrhea usually begins a few hours before or just after the onset of a menstrual period and may last 48 to 72 hours. Characteristics of spasmodic dysmenorrhoea Seen in adolescent girls Pain begins few hours before a rest of menstruation and lasts for 12–24 hours, but never 48 hours more than Management: NSAIDs, OCP’s can be used for management. Reference: Berek & Novak's gynecology 16th ed, p571

A height of 58 inches corresponds to approximately 147 cm. Which is short stature for a female of 16 years. Her FSH levels are rising, i.e., estrogen production is low i.e. there is an ovarian cause for 1° amenorrhea. Primary amenorrhea with short stature is seen in Turners syndrome. Turner syndrome (45 X) is the most common chromosomal abnormality causing gonadal failure, hence on histological examination their ovary should low oocyte count. These patients present with short stature. (Height They typically have many of the associated stigmata including lymph edema and sometimes large cystic hygromas of neck, webbed neck, coarctation of aorta, horseshoe kidneys. Reference: Novak's gynecology p 1038.