Which option best supports the scenario for hypothalamic amenorrhea?

Question

You are a first-year medical student and in class today you are listening to a lecture on reproductive abnormalities. Your professor begins by discussing hypothalamic amenorrhea, which occurs when the release of GnRH slows or stops completely.

While on your clinical rotation the following morning, you decide to start the day with a chart review of a young female, Lou, who comes to you frustrated in that she and her husband have been trying to get pregnant for a year with no luck. After running some bloodwork, you are surprised to find that Lou has hypothalamic amenorrhea. The attending would like for you to draft a write up overviewing the diagnosis, elaborating on the possible outcomes and treatments for Lou to understand.

Of the following options, choose the one that accurately supports the above scenario. Reject all the rest. Also provide an explanation for each case. Defend the correct choice with adequate justification. For those that are false, explain why they are incorrect.

Accept/Reject: Despite this diagnosis, Lou is still able to ovulate because the multiplying granulosa cells will continue to secrete LH.

Accept/Reject: On possible treatment is to put Lou on hormone replacement therapy, which would involve daily oral progesterone pills to stimulate ovulation.

Accept/Reject: If Lou’s blood where to be taken multiple times in a month, you would find consistent blood readings of LH each time.

Accept/Reject: Lou probably experiences heavy menstrual bleeding due to low levels of GnRH.

Accept/Reject: Because her ovaries are still producing follicles, an alternative treatment for Lou to consider is in vitro fertilization wherein follicles produced in her ovaries are medially harvested, fertilized outside of the body and implanted into her uterus.

Answer 1

1.reject - Lou is still able to ovulate because the multiplying granulosa cells will continue to secrete LH.

Granulosa cells can not be multiply without FSH(follicular stimulating hormone) which is produce by GnRH. Because of hypothalamic amenorrhea GnRH can not be secrete. second thing is granulosa cell secrete estrogen NOT LH.

2 reject - .On possible treatment is to put Lou on hormone replacement therapy, which would involve daily oral progesterone pills to stimulate ovulation.

Progesterone is not a hormone that induce ovulation. progesterone is required for maintenance of pregnency in early weeks. For ovulation LH surge is necessary

3.accept - If Lou’s blood where to be taken multiple times in a month, you would find consistent blood readings of LH each time.

because Lou's hypothalamus is not working properly, mid cycle surge of FSH and LH never happen.so you will find consistent blood reading of LH each time during month.

4.reject- Lou probably experiences heavy menstrual bleeding due to low levels of GnRH.

Main cause of heavy menstruation is HIGH level of estrogen. Lou is not producing GnRH. GnRH act on pituitary to produce FSH that act on ovary to produce estrogen from granulosa cells. so NO heavy menstruation without estrogen.

5 reject- Because her ovaries are still producing follicles, an alternative treatment for Lou to consider is in vitro fertilization wherein follicles produced in her ovaries are medially harvested, fertilized outside of the body and implanted into her uterus.

Lou's ovary is not producing follicles because of lack of FSH, but she can become pregnant by IVF through stimulation of follicles of ovary by medication