Amenorrhea

Question 1

List a general differential diagnosis for amenorrhea in the following situations:

1. Breasts absent/uterus present
2. Breasts present/uterus absent
3. Breasts absent/uterus absent

Answer 1

1. Gonadal failure, defects in estrogen biosynthesis, hypothalamic failure/suppression
2. AIS, Mullerian agenesis
3. 46XY w/ disorder of testosterone biosynthesis or testicular regression

Question 2

What three laboratory investigations would you order to work up secondary amenorrhea in a non-pregnant woman?

Answer 2

FSH
TSH
PRL

Question 3

How would you treat functional hypothalamic amenorrhea in a woman who does not desire pregnancy? What about in a woman who desires pregnancy?

Answer 3

OCPs or HRT (also some evidence for CBT)

Ovulation induction

Question 4

What blood test is useful in diagnosing late-onset CAH?

Answer 4

17-OHP level (elevated in CAH)