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Amenorrhea - Classification
Amenorrhea - Classification
• Anatomic Defects
• Ovarian Failure
A. Labial agglutination/fusion
B. Imperforate hymen
C. Transverse vaginal septum
D. Cervical agenesis – isolated
E. Cervical stenosis – iatrogenic
F. Vaginal agenesis – isolated
G. Müllerian agenesis (Mayer-Rokitansky syndrome)
H. Complete androgen insensitivity (T. fem)
I. Endometrial hypoplasia or aplasia – congenital
J. Asherman’s syndrome (intrauterine synechiae)
Ovarian failure
(hypergonadotropic hypogonadism)
A. Gonadal agenesis
B. Gonadal dysgenesis
1. Abnormal karyotype
a. Gonadal dysgenesis 45, X
b. Mosaicism
2. Normal karyotype
a. Pure Gonadal dysgenesis
i. 46, XX
ii. 46, XY (Swyer’s syndrome)
C. Ovarian enzymatic deficiency
1. 17α-Hydroxylase deficiency
2. 17,20-Lyase deficiency
3. Aromatase deficiency
Ovarian failure
• Ovarian failure - continued
A. PCOS
1. Hyperthecosis
B. Adrenal disease
1. Cushing’s syndrome
2. Adult-onset CAH
C. Thyroid disease
1. Hypothyroidism
2. Hyperthyroidism
D. Ovarian tumors
1. Granulosa-theca cell tumors
2. Brenner tumors
3. Cystic teratomas
4. Mucinous/serous cystadenomas
5. Krukenberg tumors
Chronic anovulation, estrogen absent
(hypogonadotropic hypogonadism)
A. Hypothalamic
1. Tumors
a. Craniopharyngioma
b. Germinoma
c. Hamartoma
d. Hand-Schüller-Christian disease
e. Teratoma
f. Endodermal sinus tumors
g. Metastatic carcinoma
2. Infection and other disorders
a. Tuberculosis
b. Syphilis
c. Encephalitis/meningitis
d. Sarcoidosis
e. Kallman’s syndrome
f. Idiopathic hypogonadotropic hypogonadism
g. Chronic debilitating disease
Chronic anovulation, estrogen absent
A. Hypothalamic
3. Functional
a. Stress
b. Weight loss/diet
c. Malnutrition
d. Psychological eating disorders (anorexia nervosa,
bulimia)
e. Exercise
f. Pseudocyesis
Chronic anovulation, estrogen absent
(hypogonadotropic hypogonadism)
B. Pituitary
1. Tumors
a. Prolactinomas
b. Other hormone-secreting pituitary tumors (corticotropin,
thyrotropin, growth hormone)
c. Nonfunctional tumors (craniopharyngioma)
d. Metastatic carcinoma
2. Space-occupying lesions
a. Empty sella syndrome
b. Arterial aneurysm
3. Necrosis
a. Sheehan’s syndrome
b. Panhypopituitarism
4. Inflammatory/infiltrative
a. Sarcoidosis
b. Hemochromatosis
c. Lymphocytic hypophysitis
5.Gonadotropin mutations (FSH)
6.GnRH receptor mutations
Initial workup of amenorrhea
1. History and physical examination (clinical
evaluation of estrogen status)
2. R/O pregnancy
4. Progestin administration