Amenorhea妇产科仁济临床医院.pptVIP

2006-11-15 七年制 Amenorrhea Amenorrhea Amenorrhea Amenorrhea is the absence of menstruation. Primary Secondary Events of Puberty Thelarche (breast development) Requires estrogen Pubarche/adrenarche (pubic hair development) Requires androgens Menarche Requires: GnRH from the hypothalamus FSH and LH from the pituitary Estrogen and progesterone from the ovaries Normal outflow tract Classification of amenorrhea hypothalamic amenorrhea pituitary amenorrhea ovarian amenorrhea uterine amenorrhea Etiology hypothalamic amenorrhea Psychological stress 5a-Reductase deficiency Anorexia nervosa, weight loss Increased exercise levels Kallmann syndrome drug-induced amenorrhea Space-occupying lesion of CNS Etiology pituitary amenorrhea tumor Empty sella syndrome Sheehan syndrome Etiology ovarian amenorrhea Gonadal dysgenesis Turner syndrome: low hair line, web neck, shield chest, and widely spaced nipples) Swyer syndrome resistant ovary syndrome Premature ovarian failure Tunner staging Acanthosis nigrans Striae Typical features of Turner Syndrome Etiology uterine amenorrhea Absence of uterus Asherman syndrome anatomic abnormalities of the reproductive tract Imperforate Hymen Imperforate Hymen Mayer-Rokitansky-Kuster-Hauser Syndrome (utero-vaginal agenesis) 15% of primary amenorrhea Normal secondary development external female genitalia Normal female range testosterone level Absent uterus and upper vagina normal ovaries Karyotype 46-XX 15-30% renal, skeletal and middle ear anomalies Androgen Insensitivity Normal breasts but no sexual hair Normal looking female external genitalia Absent uterus and upper vagina Karyotype 46, XY Male range testosterone level Treatment : gonadectomy after puberty + HRT Diagnosis History Physical examination Physical examination begins with vital signs, including height and weight, and with sexual maturity ratings Laboratory evaluation Treatment treatment varies depending upon the causes of