Amenorrhea - classification

• Anatomic Defects
• Ovarian Failure
• Chronic anovulation with estrogen present
• Chronic anovulation with estrogen absent

fem) I. Endometrial hypoplasia or aplasia – congenital J.Anatomic Defects (outflow tract) • Anatomic Defects A. Müllerian agenesis (Mayer-Rokitansky syndrome) H. Labial agglutination/fusion B. Imperforate hymen C. Complete androgen insensitivity (T. Cervical stenosis – iatrogenic F. Transverse vaginal septum D. Cervical agenesis – isolated E. Asherman’s syndrome (intrauterine synechiae) . Vaginal agenesis – isolated G.

Aromatase deficiency . 46.20-Lyase deficiency 3. Gonadal dysgenesis 1. Mosaicism 2. XY (Swyer’s syndrome) C. Gonadal dysgenesis 45. Ovarian enzymatic deficiency 1. Gonadal agenesis B. XX ii. Pure Gonadal dysgenesis i. Abnormal karyotype a. 17α-Hydroxylase deficiency 2.Ovarian failure (hypergonadotropic hypogonadism) A. X b. 17. Normal karyotype a. 46.

continued D. Injury a. Resistant ovary a. Galactosemia . Mutations of LH receptor 4. Mutations of FSH receptor c. Chemotherapy 3. Mumps oophoritis b. Idiopathic – premature aging 2. Radiation c.Ovarian failure • Ovarian failure . Premature ovarian failure 1. Autoimmune disease 5. Idiopathic b.

Cushing’s syndrome 2. Mucinous/serous cystadenomas 5. Thyroid disease 1. estrogen present • Chronic anovulation with estrogen present A. Adrenal disease 1. Hypothyroidism 2. Hyperthyroidism D. Krukenberg tumors . Cystic teratomas 4. Hyperthecosis B. Granulosa-theca cell tumors 2. Adult-onset CAH C. Brenner tumors 3.Chronic anovulation. PCOS 1. Ovarian tumors 1.

Encephalitis/meningitis d. Hand-Schüller-Christian disease e. Hypothalamic 1. Kallman’s syndrome f. Tuberculosis b.Chronic anovulation. Chronic debilitating disease . Metastatic carcinoma 2. Craniopharyngioma b. Germinoma c. Sarcoidosis e. Teratoma f. Hamartoma d. Syphilis c. Tumors a. Endodermal sinus tumors g. Infection and other disorders a. Idiopathic hypogonadotropic hypogonadism g. estrogen absent (hypogonadotropic hypogonadism) A.

Psychological eating disorders (anorexia nervosa. Functional a. Malnutrition d. Weight loss/diet c. bulimia) e.Chronic anovulation. Exercise f. estrogen absent A. Hypothalamic 3. Pseudocyesis . Stress b.

Space-occupying lesions a. Inflammatory/infiltrative a.Gonadotropin mutations (FSH) 6. Tumors a. Other hormone-secreting pituitary tumors (corticotropin. thyrotropin.GnRH receptor mutations growth . Empty sella syndrome b. hormone) c. Pituitary 1. Prolactinomas b. Nonfunctional tumors (craniopharyngioma) d. Sarcoidosis b. estrogen absent (hypogonadotropic hypogonadism) B. Metastatic carcinoma 2. Lymphocytic hypophysitis 5. Arterial aneurysm 3. Panhypopituitarism 4.Chronic anovulation. Sheehan’s syndrome b. Hemochromatosis c. Necrosis a.

R/O pregnancy 3. Progestin administration . TSH 4. prolactin. History and physical examination (clinical evaluation of estrogen status) 2. Measure plasma FSH.Initial workup of amenorrhea 1.