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CASE PRESENTATION (4)(6)(7). Case 1: 17 yo female with primary amenorrhea. Normal pubertal development Normal health No family history of delayed puberty Not involved in athletics Does well in school Not taking any meds. Case 1: Physical Exam. Thin young woman (10% below IBW)

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case 1 17 yo female with primary amenorrhea
Case 1: 17 yo female with primary amenorrhea
  • Normal pubertal development
  • Normal health
  • No family history of delayed puberty
  • Not involved in athletics
  • Does well in school
  • Not taking any meds
case 1 physical exam
Case 1: Physical Exam
  • Thin young woman (10% below IBW)
  • Normal genitalia
  • No galactorrhea
  • Tanner stage 4

Laboratory values

  • Urine and serum B-HCG negative
  • Prolactin, FSH, TSH all normal
case 1 further history
Case 1: Further history

Patient’s parents concerned about her eating habits (very low fat intake and restricting calories)

diagnose in case 1 hypothalamic amenorrhea
Diagnose in case 1: Hypothalamic Amenorrhea
  • Etiology is most likely inadequate caloric and fat intake.
  • Patient should be referred for evaluation for an eating disorder.
  • Chances of normal menstruation are very good if patient takes in adequate calories.
diagnose in case 1 hypothalamic amenorrhea1
Diagnose in case 1: Hypothalamic Amenorrhea
  • Etiology is most likely inadequate caloric and fat intake.
  • Patient should be referred for evaluation for an eating disorder.
  • Chances of normal menstruation are very good if patient takes in adequate calories.
case 2 32 years old woman with secondary amenorrhea
Case 2:32 years old woman with secondary amenorrhea
  • Menarche at age 12
  • Periods have always been irregular
  • Now amenorrhea for resent 10 months
  • Overweight
  • Wants to get pregnant
case 2 physical exam
Case 2: Physical Exam
  • Obese female
  • Acne
  • Normal genitalia
  • Mild hirsutism
case 2 laboratory findings
Case 2: Laboratory findings
  • Urine B-HCG negative
  • TSH, FSH and Prolactinnormal
  • Testosterone 180 ng/mL
  • Pelvic U/S findings show polycystic ovaries
case 3 29 yo woman with 18 month h o amenorrhea
Case 3: 29 yo woman with 18-month h/o amenorrhea
  • Normal development
  • No family history of amenorrhea
  • Does not exercise excessively or restrict diet
  • Denies galactorrhea
  • Has h/o abortion with subsequent D & C
case 3 physical exam
Case 3:Physical Exam
  • Normal exam
  • No galactorrhea
case 3 laboratory findings
Case 3: Laboratory findings
  • Urine B-HCG negative
  • Prolactinnormal
  • TSH, FSH, LH all was normal
case 3 further work up
Case 3: Further work-up
  • Fails Provera challenge
  • Fails 1-month trial of estrogen + progesterone
  • Pelvic U/S shows no uterine stripe
  • Hysteroscope confirms diagnosis of…Asherman’s Syndrome