Diagnosis of primary amenorrhea Normal breast, normal uterus: Similar to that of secondary amenorrhea Normal breast, poor uterus: Testosterone and Karyotyping 46, XX female level ofT: mullerian dysgenesis 46, XY& male level of T: Androgen insensitivity Poor breast, poor uterus Karyotyping 46, XX: Congenital absence of uterus 46.XY: Pure gonadal dysgenesis Poor breast, normal uterus: Karotyping fsh FSH T: Gonadal dysgenesis(e.g. Turner's syndrome) FSH↓/→→: Hypothalamus or pituitary gland
Diagnosis of primary amenorrhea Normal breast, normal uterus: Similar to that of secondary amenorrhea Normal breast, poor uterus: Testosterone and Karyotyping 46, XX & female level of T: Mullerian dysgenesis 46, XY & male level of T: Androgen insensitivity Poor breast, poor uterus: Karyotyping 46, XX: Congenital absence of uterus 46, XY: Pure gonadal dysgenesis Poor breast, normal uterus: Karotyping & FSH FSH ↑: Gonadal dysgenesis (e.g. Turner’s syndrome) FSH ↓ /→ : Hypothalamus or pituitary gland
原发性闭经 乳房检查 的发育 不发育 子宫检查 子宫检查 子官发育 1一子宫不发育 子宫发育宫不发育 告,R测定,的全毛发分布检查 FSH浏定 核型分析 正常 升高 正常女性T值正常男性值升高正常或酶缺乏先天性 孕激素试验cTMN楼型4X正核型4XY无 下降XY单纯子宫缺 性性腺乏 有撒药性出血无撤药性出血垂体性 发育不近 ,市H测定国S测定主MR综合征丸女性化综合性发 症(雄激素不敏育不良下丘脑、资( 感综合征)(如染垂体性中:等 正常升高正常或下降升高 日欲迎体寝海班染自流发法同 丘脑性POS下丘脑垂 巢 合型)谋读 图356原发性闭经的诊断步骤甲的时目一
Secondary amenorrhea
Secondary Amenorrhea
Etiology and classification Central nervous system Gnrh Hypothalamus 55% Pituitary 20% FSH. LH Ovary 20% Estrogen, progesterone Uterus 5% Outflow tract eases
Central nervous system Hypothalamus 55% Pituitary 20% Ovary 20% Uterus 5% Outflow tract Menses GnRH FSH, LH Estrogen, progesterone Etiology and Classification
Etiology and classification 1. Central nervous system and hypothalamic Most common, mostly dysfunction 1)Psychogenic(stress) CRH>pulsatile GnRH secretion 2)Weight loss/Nutritional deprivation Anorexia nervosa(神经性厌食症) Weight loss> GnRH concentration V 3)Strenuous exercise Reduction in proportion of adipose tissue gnrh secretion
1. Central nervous system and hypothalamic Most common, mostly dysfunction 1) Psychogenic (stress) CRH →pulsatile GnRH secretion 2) Weight loss/Nutritional deprivation Anorexia nervosa （神经性厌食症） Weight loss → GnRH concentration 3) Strenuous exercise Reduction in proportion of adipose tissue GnRH secretion Etiology and Classification