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REPRODUCTIVE ENDOCRINOLOGY . . . CONT.

Notes

Etiology ovarian failure • hypergonadotropic hypogonadism • +/– abnormal karyotype (e.g. Turner syndrome 45 X0) hypothalamic, pituitary failure • hypogonadotropic hypogonadism • reversible: physiological delay, weight loss/anorexia • irreversible: GnRH deficiency, hypopituitarism outlet sydromes • eugonadism • vaginal septum, imperforate hymen

Diagnosis history previous height and weight charts pubertal milestones of siblings and parents physical (including height and weight) Tanner staging rule out anatomical abnormalities (i.e. U/S) serum gonadotropins bone age skull films

AMENORRHEA

APPROACH TO AMENORRHEA

Primary Amenorrhea? absence of menses by age 15

OR

Secondary Amenorrhea? absence of menses for >6 months after documented menarche

History and Physical Tanner staging breasts present? uterus present? r/o possibility of pregnancy

Investigations (see Figure 3)

Table 2. Anatomic • pregnancy • adhesion • gonadal dysgenesis (absent uterus, ovaries present) • imperforate hymen • vaginal septum • GTN Ovarian Failure • menopause • chromosomal • Turner Syndrome (XO) • Androgen Insensitivity Syndrome (XY) • Resistant Ovary Syndrom • surgery, radiation, chemotherapy Causes of Primary and Secondary Amenorrhea e • hypothyroidism • Cushing Disease • hyperprolactinemia Endocrine • hypothalamic/pituitary tumours • isolated gonadotropin deficiency • hyperandrogenism • PCOD • Ovarian/adrenal tumour • Testosterone injections

Other

  • stress

  • anorexia

  • post OCP

  • illness

  • exercise

Gynecology 10

MCCQE 2000 Review Notes and Lecture Series

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