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) Normal genitalia No galactorrhea Tanner stage 4

Laboratory values Urine and serum B-HCG negative Prolactin, FSH, TSH all normal

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

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 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

• Menarche at age 12

• Periods have always been irregular

• Now amenorrhea for resent 10 months

• Overweight

• Wants to get pregnant

Case 2: Physical Exam

• Obese female• Acne• Normal genitalia• Mild hirsutism

Case 2: Laboratory findings

• Urine B-HCG negative• TSH, FSH and Prolactin normal• Testosterone 180 ng/mL• Pelvic U/S findings show polycystic ovaries

U/S findings in PCOS

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

• Normal exam

• No galactorrhea

Case 3: Laboratory findings

• Urine B-HCG negative

• Prolactin normal

• TSH, FSH, LH all was normal

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