Puberty/menstrual disorders(Quiz 2 material)

tx hyperandrogenic disorders

-oral combo contraceptive-decrease LH, FSH, androgens

-spironolactone-decrease androgens

-eflornithine hydrochloride hair removal cream

Cushing syndrome

excess production of cortisol

-also hyperandrogenic state-obesity, moon facies, HTN, easy bruising, thinning skin, muscle wasting of upper legs and arms, purple abdominal striae, impaired glucose tolerance, osteoporosis

congenital adrenal hyperplasia

-enzyme deficiencies involved in steroidogenesis

-not able to synthesize cortisol, present with salt wasting, adrenal insufficiency, genital ambiguities

-most common cause 21 alpha dehydroxylase deficiency

PMS/PMDD

-cyclic, psychologic or behavioral changes

-both occur in luteal(postovulatory) phase

PMS/PMDD manifestations

depression, anger, irritability, fatigue

headache, weight gain, bloating, breast tenderness

PMS/PMDD tx

hormonal cycle regulation

SSRI

counseling

PMS/PMDD patho

multifactorial, interaction between serotonin and cyclic changes in ovarian steroids

-no pathology in HP ovarian axis or levels of estrogen/progesterone, may be abnormal response to normal hormonal changes

PMS

-symptoms exacerbated premenstrually

- psych symptoms, weight gain, hand swelling, breast tenderness, poor concentration, aches and pains, change in appetite, sleep disturbance

-dx only requires 1 symptoms, needs to be restricted to luteal phase and stop around beginning of period

PMDD

need 5 symptoms, 1 has to be depression, hopelessness, self deprecating thoughts, anxiety

-affective lability, anger, irritability, decreased interest in activities, difficulty concentrating, lethargy, change in appetite, hypersomnia, breast tenderness, headache

labs for PMS/PMDD

no specific tests

-r/o thyroid and anemia

-look for symptoms during luteal phase

what other disorders worsen during luteal phase w/ PMS

migraine

seizures

asthma

allergies

genital herpes

what psych disorders should be ruled out w/ PMS

depression

anxiety

panic disorder

bulimia

substance abuse

mania

chronic fatigue syndrome

fibromyalgia

IBS

non pharm PMS/PMDD tx

-changes in eating habits(limit caffeine, alcohol, tobacco, chocolate, eat small frequent meals high in carbs)

-decrease sodium to alleviate edema

-stress management, CBT, aerobic exercise

PMS/PMDD pharm tx

-calcium carbonate for bloating, food craving, pain

-magnesium for water retention

-spironolactone for cyclic edema

-bromocriptine for mastalgia

-mild anxiety w/ PMS- buspirone

-PMDD- fluoxetine, sertraline

-vitamins and supplements

hormonal interventions for PMS/PMDD

-oral contraceptives and transdermal estradiol patch to suppress ovulation

-GnRH agonists to cause temporary menopause(limitations are hypoestrogenic state, risk osteoporosis)