Absence of Menses in a 17 Year Old
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This document discusses the evaluation and diagnosis of a 17-year-old girl presenting with absence of menses (amenorrhea). It provides a list of potential causes to consider and evaluate through history, physical exam, and testing, including pregnancy, medical conditions, and endocrine or anatomical abnormalities. If diagnosis is secondary amenorrhea, potential causes include pituitary disorders, stress, prolactinoma, Sheehan's syndrome, or ovarian failure; if primary amenorrhea, causes may include vaginal atresia, imperforate hymen, Turner syndrome, or other intersex conditions. Laboratory tests and imaging can help identify the specific diagnosis.
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Absence of Menses in a 17 Year Old
- 1. A 17 year old girl with a complaint of Absence Of Menses Amenorrhea is not pathologic until age 16 years.
- 3. Make sure to explore this issues before making a diagnosis • Age • Adolecent (Development Delay/Abnormality) • Old (Menopause) • Sexually Active • Exclude Pregnancy • Gauge the anthropometry • Too Thin (Anorexia?) • Too Fat (PCOS ?) • Any congenital syndrome (Turner ? Swyer syndrome ?) • Post-Partum Hemorrage ? • Any breast discharge ? / Headache / Visual Disturbances ? • Cytotoxic Chemo ? Be careful w the presentation
- 5. Look for signs like : • Obesity • Hirsutism / Virilism • Other puberty signs (Gonadarche, , Pubarche) • Thyroid assessment • Vaginal inspection Thelarche
- 6. Laying down the diagnosis Secondary Amenorrhea • Pituitary Disorders • Stress • Prolactinoma • Sheehan’s Syndrome • Asherman Syndrome Other notable endocrine disorder • Ovarian failure / Menopause • PCOS • Ovarian Tumors Primary Amenorrhea Female & Sexually Developed • Vaginal Atresia • Imperforate Hymen • Swyer syndrome (XY Female) • Leptin deficiency • Constitutional delay of menarche Female w Sexual Infantilism • Turners syndrome • Gonadal Dysgenesis • Pan-Hypopituitarism Female w Virilism • CAH (Adult onset) • XY Female
- 7. Planning an investigation Blood tests may include: • Estradiol • FSH • LH • Prolactin • Testosterone • TSH • T3 and T4 • 17 hydroxyprogesterone • Chromosome analysis • Serum progresterone • Serum testosterone levels Ultrasonography -Pelvic ultrasonography congenital abnormalities of the uterus, cervix, and vagina, or absence of these organs. -However, a report of absence of the uterus on ultrasonography does not always mean that the patient does not have a uterus. In primary amenorrhea in association with estrogen deficient states, the uterine fundus may be underdeveloped and may not be readily visible at the time of ultrasonography. With proper estrogen replacement, it may reach the normal size. Magnetic resonance imaging MRI of the pituitary and hypothalamus is often indicated in the evaluation of amenorrhea.
- 8. Treatment
- 9. Laying down the diagnosis Secondary Amenorrhea • Pituitary Disorders • Stress • Prolactinoma • Sheehan’s Syndrome Other notable endocrine disorder • Ovarian failure • PCOS • Ovarian Tumors • Asherman Syndrome Primary Amenorrhea Female & Sexually Developed • Vaginal Atresia • Imperforate Hymen • Swyer syndrome (XY Female) • Leptin deficiency • Constitutional delay of menarche Female w Sexual Infantilism • Turners syndrome • Gonadal Dysgenesis • Pan-Hypopituitarism Female w Virilism • CAH (Adult onset) • XY Female