3 AMENORRHEA, PRIMARY General Discussion Primary amenorrhea is defined as the absence of menses by 16 years of age in the presence of normal growth and secondary sexual characteristics or lack of menses by 14 years of age in the absence of secondary sexual characteristics. In the classification of primary amenorrhea, hypogonadism refers to gonads that are not functioning and is associated with a hypoestrogenic state. Eugonadism refers to gonads that maintain normal steroidogenesis and is associated with a well-estrogenized state. An evaluation of breast development can be used to determine a patient’s estrogen status. The pelvic examination then further narrows the potential causes by determining the presence or absence of a normal mullerian system. The most common cause of primary amenorrhea is primary ovarian failure due to gonadal dysgenesis, most commonly as a result of Turner’s syndrome. The second most common cause of primary amenorrhea is congenital absence of the uterus and vagina (CAUV), followed by idiopathic hypogonadotropic hypogonadism (IHH). Eating disorders such as anorexia and bulimia have the highest incidence during the adolescent years. Anorexia nervosa has a prevalence of 1% in the United States. The Female Athlete Triad overlaps with eating disorders and is characterized by disordered eating, osteoporosis or osteopenia, and amenorrhea in the setting of excessive exercise. The first step in the evaluation of primary amenorrhea is a history and physical examination. If secondary sexual characteristics are not present, FSH and LH levels should be measured. FSH and LH <5 IU/L indicates hypogonadotropic hypogonadism. If FSH is >20 IU/L and LH >40 IU/L, hypergonadotropic hypogonadism is present. If hypergonadotropic hypogonadism is present, karyotype analysis is indicated. If secondary sexual characteristics are present, ultrasonography of the uterus should be performed. If the uterus is absent or abnormal, karyotype analysis is indicated. If the uterus is present and normal, the patient should be examined for evidence of an outflow obstruction. Medications Associated with Amenorrhea Butyrophenones Contraceptive medications Divalproex Domperidone Haloperidol H2 blockers Methyldopa Metoclopramide Opiates Phenothiazine Psychotropic medications Reserpine Risperdone Sulpiride Verapamil Causes of Primary Amenorrhea Eugonadism • Androgen insensitivity • CAUV • Cervical atresia • Imperforate hymen • Polycystic ovarian syndrome • Transverse vaginal septum • 17-ketoreductase deficiency Hypergonadotropic hypogonadism • Ovarian failure (due to chromosomal abnormality, previous radiation, or previous chemotherapy) • Pseudo-ovarian failure Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on AMENORRHEA, PRIMARY Full access? Get Clinical Tree
3 AMENORRHEA, PRIMARY General Discussion Primary amenorrhea is defined as the absence of menses by 16 years of age in the presence of normal growth and secondary sexual characteristics or lack of menses by 14 years of age in the absence of secondary sexual characteristics. In the classification of primary amenorrhea, hypogonadism refers to gonads that are not functioning and is associated with a hypoestrogenic state. Eugonadism refers to gonads that maintain normal steroidogenesis and is associated with a well-estrogenized state. An evaluation of breast development can be used to determine a patient’s estrogen status. The pelvic examination then further narrows the potential causes by determining the presence or absence of a normal mullerian system. The most common cause of primary amenorrhea is primary ovarian failure due to gonadal dysgenesis, most commonly as a result of Turner’s syndrome. The second most common cause of primary amenorrhea is congenital absence of the uterus and vagina (CAUV), followed by idiopathic hypogonadotropic hypogonadism (IHH). Eating disorders such as anorexia and bulimia have the highest incidence during the adolescent years. Anorexia nervosa has a prevalence of 1% in the United States. The Female Athlete Triad overlaps with eating disorders and is characterized by disordered eating, osteoporosis or osteopenia, and amenorrhea in the setting of excessive exercise. The first step in the evaluation of primary amenorrhea is a history and physical examination. If secondary sexual characteristics are not present, FSH and LH levels should be measured. FSH and LH <5 IU/L indicates hypogonadotropic hypogonadism. If FSH is >20 IU/L and LH >40 IU/L, hypergonadotropic hypogonadism is present. If hypergonadotropic hypogonadism is present, karyotype analysis is indicated. If secondary sexual characteristics are present, ultrasonography of the uterus should be performed. If the uterus is absent or abnormal, karyotype analysis is indicated. If the uterus is present and normal, the patient should be examined for evidence of an outflow obstruction. Medications Associated with Amenorrhea Butyrophenones Contraceptive medications Divalproex Domperidone Haloperidol H2 blockers Methyldopa Metoclopramide Opiates Phenothiazine Psychotropic medications Reserpine Risperdone Sulpiride Verapamil Causes of Primary Amenorrhea Eugonadism • Androgen insensitivity • CAUV • Cervical atresia • Imperforate hymen • Polycystic ovarian syndrome • Transverse vaginal septum • 17-ketoreductase deficiency Hypergonadotropic hypogonadism • Ovarian failure (due to chromosomal abnormality, previous radiation, or previous chemotherapy) • Pseudo-ovarian failure Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on AMENORRHEA, PRIMARY Full access? Get Clinical Tree
