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  1. 1. amenorrhea <ul><li>Done By : Sumayyah Juaid R2 </li></ul><ul><li>Supervesised By : Nabeel Brasha </li></ul>
  2. 2. wikipedia an abnormal absence of menstruation. ORIGIN from Greek
  3. 3. clinically Primary Secondary
  4. 4. Classification of amenorrhea <ul><li>Hypothalamic Amenorrhea </li></ul><ul><li>Pituitary Amenorrhea </li></ul><ul><li>Ovarian Amenorrhea </li></ul><ul><li>Uterine Amenorrhea </li></ul>
  5. 5. Events of Puberty <ul><li>Thelarche : </li></ul><ul><li>the breast development </li></ul><ul><li>Requires estrogen </li></ul>
  6. 6. <ul><li>Pubarche/adrenarche : </li></ul><ul><li>pubic hair development </li></ul><ul><li>Requires androgens </li></ul>Events of Puberty
  7. 7. <ul><li>Menarche : </li></ul><ul><li>Requires: </li></ul><ul><li>GnRH from the hypothalamus </li></ul><ul><li>FSH and LH from the pituitary </li></ul><ul><li>Estrogen and progesterone from the ovaries </li></ul><ul><li>Normal outflow tract </li></ul>Events of Puberty
  8. 8. functional menses Compartment I outflow tract ( uterine target organ) Compartment II ovary ( Estrogen & Progesterone) Compartment III Anterior Pituitary Compartment IV CNS ( Hypothalamic )
  9. 10. primary amenorrhea
  10. 11. primary amenorrhea <ul><li>pregnancy </li></ul><ul><li>anatomical defects </li></ul><ul><li>...... 2nd ry amenorrhea </li></ul><ul><li>mullerian a-genesis </li></ul><ul><li>testicular feminaization </li></ul><ul><li>gonadal disorders </li></ul><ul><li>CNS : hypothalamic-pituitary </li></ul><ul><ul><ul><li>RARE </li></ul></ul></ul>
  11. 12. <ul><li>pregnancy </li></ul><ul><li>anatomical defects : </li></ul><ul><li>mullerian anaomalies : imperforated hymen, vaginal septum, </li></ul><ul><li>causes 2nd ry amenorrhea : </li></ul><ul><li>hypothalamic, pituitary ,ovarian ,uterine etiology </li></ul>
  12. 13. (Mayer-Rokitansky-Kuster-Hauser syndrome)
  13. 15. 46 XX
  14. 16. Typical features of Turner Syndrome
  15. 17. hypogonadotropic hypogonadism j بديل مواقع الكلامن والثاني
  16. 18. hypogonadotropic hypogonadism <ul><li>2nd most common </li></ul><ul><li>insufficient pulsatile secretion of GnRH -> leads to deficiencies in FSH and LH </li></ul><ul><li>normal height for their age </li></ul><ul><li>most common </li></ul><ul><li>the lack of physical development caused by delayed reactivation of the GnRH pulse generator </li></ul><ul><li>short for their chronologic agenormal for their bone age </li></ul>
  17. 19. <ul><li>A craniopharyngioma is a benign tumor that develops near the pituitary gland . </li></ul><ul><li>most commonly in childhood and adolescence and in later adult life. </li></ul><ul><li>compresses the pitui tary stalk or g land, the tumor can cause partial or complete pituitary hormone de ficiency. </li></ul>
  18. 20. <ul><li>17,20 -desmolase deficincy </li></ul><ul><li>agonadieisim </li></ul><ul><li>17 alf-hydroxylase deficincy (46, XY ) </li></ul>
  19. 22. secondary amenorrhea Compartment I outflow tract ( uterine target organ) <ul><li>pregnancy </li></ul><ul><li>Asherman's Syndrome (synchiea) </li></ul>
  20. 23. secondary amenorrhea <ul><li>Premature Ovarian Failure </li></ul><ul><li>Resistance Ovarian Syndrome </li></ul><ul><li>(ovarian hypofolliculogenesis) </li></ul><ul><li>Radiation & Chemotherapy . </li></ul><ul><li>Radiation & Chemotherapy . </li></ul>Compartment II Ovary (Hypergonadotropic Hypogonadism)
  21. 24. secondary amenorrhea <ul><li>Hyper - prolactinemia </li></ul><ul><li>Tumors </li></ul><ul><li>Shehan Syndrome </li></ul>Compartment III Anterior Pituitary
  22. 25. secondary amenorrhea <ul><li>Hypothyrodesim </li></ul><ul><li>Stress anxiety </li></ul><ul><li>Anorexia </li></ul><ul><li>Excessive Exercise </li></ul><ul><li>Drugs </li></ul>Compartment IV CNS ( Hypothalamic )
  23. 26. Clinical assessment 1- BHCG 2- TFT 3- Prolactin TOP Bottom
  24. 27. <ul><li>Provera 10 mg PO once daily 7-10 days or </li></ul><ul><li>Norethindrone 5 mg PO once daily for 7-10 days or </li></ul><ul><li>Progesterone 200 mg IM for one dose . </li></ul>Progesterone Challenge Test :
  25. 29. <ul><li>Premarin 1.25 mg orally daily for 21 days </li></ul><ul><li>Oral Contraceptiv e for 2 Cycles </li></ul><ul><li>Estradiol 2 mg orally daily for 21 days and Follow with 7-10 days of Progesterone </li></ul>estrogen progesterone challenge test
  26. 30. step 2
  27. 31. step 3
  28. 32. thanks