Ammenorrhea Flashcards
Order of Pubertal Changes
Growth Spurt, Thelarche, Adrenarche, Menarche
First sign of puberty
Appearance of breast buds
Last sign of puberty
Menarche
Most relevant factor for onset of puberty and menstruation
Ratio of fat to both TBW and lean BW
Hormone produced by adipocytes which affects LH pulpability and restore mens cycle
Leptin
Cut off to investigate if there is no thelarche yet
13
Menarche delayed up to ______
if involved in strenuous exercise before menarche
______ can inhibit GnRH axis as Corticotropin releasing hormone inhibits GnRH
Emotional stress
No mens by age 15
No mens within 5 years of breast development, if occurring by age 10
Primary amenorrhea
No menses due to anatomic disorders (Hematocolpos - blood at uterus)
Cryptomenorrhea
Secondary amenorrhea
Skipped menses longer than 6-12 hours
Hypothalamic failure -> Inadequate GnRH synthesis Hypogonadotropic, Hypogonadism Assoc with: Anosmia Inc growth in long bones Greater wingspan to height ratio
Kallman syndrome
Pituitary failure -> Pituitary neoplasia
Hypogonadotropic, Hypogonadism
Pituitary neoplasia
Gonadal Failure -> 45X Hypergonadotropic, Hypogonadism Assoc with: Short stature Webbed Neck Gonadal Streak
Turner’s Syndrome
Hypothalamic Failure
Kallmann Syndrome
Craniopharyngioma
Pituitary Failure
Chromophobe adenoma
Mumps/ Encephalitis
New Born Kernicterus
Ovarial Failure
Turner’s Syndrome
Gonadal dysgenesis
Lack of androgen receptor synthesis
46XY
No internal male/female genitalia
Normal External female genitalia
Androgen resistance (Testicular Feminization)
2nd most Common
46XX
Shortened or absent Vagina
Skeletal deformity - bones in middle ear (deafness)
Ureterovaginal Agenesis/ Muller
Mayer- Rokitansky- Kuster- Hauser
Management for Ureterovaginal Agenesis/ Muller
Mayer- Rokitansky- Kuster- Hauser
Surrogacy
Uterine transplantation
Creation of neovagina
Management for Androgen resistance (Testicular Feminization)
Removal of Gonads
Creation of Neovagina
Karyotype: Male
External Genitalia: Female
Internal Genitalia: Absent
(+) Testes, AMH - IMS
17a-OHase deficiency
Karyotype: Male
External Genitalia: Female
Internal Genitalia: Absent
(-) Gonads, Internal female genitalia
Agonadism (Vanishing testes syndrome)
Neoplastic Pituitary (Hypoestrogenic Amenorrhea): Most common non PRL secreting
Chromophobe adenoma
Non -Neoplastic Pituitary (Hypoestrogenic Amenorrhea):
Pituitary destruction due to hypotensive episode during pregnancy
Sheehan Syndrome
Non -Neoplastic Pituitary (Hypoestrogenic Amenorrhea): Not related to pregnancy
Simmonds disease
Ovarian (Hypergonadotropic, Hypogonadism)
Cystic degeneration - cystetcomies
Premature ovarian failure/insufficiency - Menopause before 40
Intrauterine adhesions or synechiae
Asherman syndrome
the most common antecedent factor of IUA
Endometrial curettage from pregnancy
