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1、12006-11-15 七年制AmenorrheaAmenorrhea Amenorrhea is the absence of menstruation. Primary SecondaryAbsence of menses by age 16 with normal secondary sexual characteristicsAbsence of menses by age 14 without secondary sexual developmentAbsence of menses for 6 months in a previously menstruating female22
2、006-11-15 七年制AmenorrheaEvents of PubertyvThelarche (breast development)Requires estrogenvPubarche/adrenarche (pubic hair development)Requires androgensvMenarcheRequires:GnRH from the hypothalamusFSH and LH from the pituitaryEstrogen and progesterone from the ovariesNormal outflow tract32006-11-15 七年
3、制AmenorrheaP1P1P5P5P4P4P3P3P2P2TannersTanners42006-11-15 七年制AmenorrheaClassification of amenorrheav hypothalamic amenorrheav pituitary amenorrheav ovarian amenorrheav uterine amenorrhea52006-11-15 七年制AmenorrheaEtiology v hypothalamic amenorrheaPsychological stress5a-Reductase deficiencyAnorexia nerv
4、osa, weight loss Increased exercise levelsKallmann syndrome drug-induced amenorrhea Space-occupying lesion of CNS62006-11-15 七年制AmenorrheaEtiology vpituitary amenorrhea tumor Empty sella syndrome Sheehan syndrome72006-11-15 七年制AmenorrheaEtiologyv ovarian amenorrheaGonadal dysgenesisTurner syndrome:
5、low hair line, web neck, shield chest, and widely spaced nipples) Swyer syndrome resistant ovary syndromePremature ovarian failure82006-11-15 七年制AmenorrheaTunner staging92006-11-15 七年制AmenorrheaAcanthosis nigrans 102006-11-15 七年制AmenorrheaStriae 112006-11-15 七年制AmenorrheaTypical features of Turner S
6、yndrome122006-11-15 七年制AmenorrheaEtiology v uterine amenorrhea Absence of uterus Asherman syndromev anatomic abnormalities of the reproductive tract Imperforate Hymen132006-11-15 七年制AmenorrheaImperforate Hymen142006-11-15 七年制AmenorrheaMayer-Rokitansky-Kuster-Hauser Syndrome (utero-vaginal agenesis)v
7、15% of primary amenorrhea vNormal secondary development & external female genitaliavNormal female range testosterone levelvAbsent uterus and upper vagina & normal ovariesvKaryotype 46-XXv15-30% renal, skeletal and middle ear anomalies152006-11-15 七年制AmenorrheaAndrogen InsensitivityvNormal breasts bu
8、t no sexual hairvNormal looking female external genitaliavAbsent uterus and upper vaginavKaryotype 46, XYvMale range testosterone levelvTreatment : gonadectomy after puberty + HRT162006-11-15 七年制AmenorrheaDiagnosis vHistory vPhysical examinationPhysical examination begins with vital signs, including
9、 height and weight, and with sexual maturity ratings vLaboratory evaluation 172006-11-15 七年制Amenorrhea VE- preg testTSH ,PROLACTIN, Prog.challenge testwithdrawal bleedingwithout withdrawal bleedinghypoestrogenic compromised outflow tract.+ve.est,progest.challenge test-ve.est,progest.challenge testFS
10、H30-40Normal FSHHSG OR hysteroscopyasherman2wkFSH norm.repeatRepeat+serum ,est.levelPROFhypothalamic-pituitary failureanovulation 182006-11-15 七年制AmenorrheaTreatment vtreatment varies depending upon the causes of the amenorrhea. Treatment options include:Dietary changes, including an increase in fat
11、 and calories in order to stimulate estrogen production. Counseling for eating disorders. Using stress reduction techniques to help regulate the period. Hormonal supplements, like the birth control pill or patch, or hormone replacement therapy. Surgery to remove cysts, fibroids or tumors DI WEN M.D., Ph.D. Professor & Chairman Department of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine Thanks for Your Attention
