Amenorrhoea Amenorhhea

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Amenorrhoea Amenorhhea

  1. 1. AMENORRHOEA II
  2. 2. PRIMARY AMENORRHOEA Amenorrhoea without sec sex characters • E from ovaries → Breast development • No breast dev – No E → Amenorrhoea ↓ Hypogonadism Hypergonadotrophic Hypogonadotrophic
  3. 3. Hypergonadotrophic Amenorrhoea • 30% have genetic abnormalities • Most common – Turner’s Syndrome – 45 XO (accelerated atresia of follicles) – Short stature – Webbed neck – Shield chest – Cubitus valgus – Associated conditions • Coarctation of aorta • Horse-shoe kidney • Autoimmune thyroiditis
  4. 4. Hypergonadotrophic Amenorrhoea • Pure Gonadal Dysgenesis – Swyer syndrome – XY female • Mixed Gonadal Dysgenesis – Streak gonad & testis • Enzyme Deficiency (Defect in steroid synthesis) – Congenital adrenal hyperplasia • Premature ovarian failure – Galactosemia, chemotherapy, radiation
  5. 5. Hypogonadotrophic Amenorrhoea • Physiological / Constitutional Delay • Kallman’s Syndrome – Amenorrhoea, sexual infantilism, anosmia • Inflammation, Trauma, Tumour, Vascular lesions • CNS tumour Diagnosis – History, Clinical, Investigation Treatment – Replacement therapy, Surgery
  6. 6. PRIMARY AMENORRHOEA Amenorrhoea with sec sex characters • Anatomic abnormalities – Obstruction – Absence of uterus(M-R-K-H syndrome) • Assoc with pelvic or horse shoe kidney, double urinary collecting system, skeletal abnormalities
  7. 7. PRIMARY AMENORRHOEA • Androgen Insensitivity (Testicular feminisation syn) : problem of androgen receptors – Male pseudohermaphrodite – AMH present : no uterus, only blind vagina – Well dev breast with pale areola & immature nipple – Scant or absent pubic / axillary hair
  8. 8. MANAGEMENT • • • • Removal of obstruction Cervix absent or hypoplastic – TAH Short vagina – Dilatation or reconstruction Gonad containing Y chromosome – Gonadectomy – In androgen insensitivity done after pubertal development
  9. 9. ASHERMAN’S SYNDROME Endometrial destruction →Sec amenorrhoea Cause : Overzealous curettage, metroplasty, myomectomy, uterine art embolisation Diagnosis : HSG, Hysteroscopy Treatment : D & C, Hysteroscopic adhesiolysis → Foley’s catheter + Oestrogen
  10. 10. PITUITARY DISORDERS • Tumour – Prolactinoma – Acromegaly, Cushing’s Disease – Craniopharyngioma, meningioma, glioma • Infarction (Sheehan’s Syndrome) • Inflammation • Radiological / Surgical ablation
  11. 11. PITUITARY TUMOURS • Mechanism of action – Decrease secretion of GnRH – Mass effect • Compression of pituitary stalk and prevent delivery of GnRH • Empty sella syndrome • Diagnosis : S/S specific to hormone Headache, visual symptoms Imaging • Treatment : Dopamine agonist, Surgery
  12. 12. HYPOTHALAMIC DISORDER • Commonest cause of hypogonadotrophic amenorrhoea • Diagnosed by exclusion of pituitary lesions • Low or normal gonadotrophins • Stress, wt loss, psy disorder, exercise • Ultimate cause – GnRH suppression • LPD → anovulation → amenorrhoea
  13. 13. GnRH REGULATION • ↓ GnRH – Endogenous opiods, dopamine – CRH – GABA – ↑ Neuropeptide Y – ↓ Leptin • ↑ GnRH – Catecholamines – Acetylcholine
  14. 14. EFFECT OF BODY FAT • Critical level of body – 17 % for initiation of menses – 22 % for sustaining menses • “ Fat talks to the brain via leptin” • “ When available energy is excessively diverted as in exercise or when insufficient as with eating disorders, reproduction is suspended in order to support essential metabolism for survival”.
  15. 15. ANOREXIA NERVOSA • Wt loss of 25% or wt below 15% of normal • Intense fear of becoming fat • Altered perception of one’s body image • Amenorrhoea • Food restriction, induced vomitting, laxative use, intense exercise • Cold & heat intolerance, lanugo hair, hypotension, bradycardia, yellow skin,diabetes insipidus, binge eating • Can be life threatening → Psychotherapy

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