Amenorrhea differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Amenorrhea]] | |||
{{CMG}}; {{AE}} {{EG}}, {{MJ}} | {{CMG}}; {{AE}} {{EG}}, {{MJ}} | ||
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== Differentiating Diseases with Amenorrhea from each other== | == Differentiating Diseases with Amenorrhea from each other== | ||
As amenorrhea manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. Primary amenorrhea must be differentiated from other diseases that cause lack of [[menstrual cycle]], such as [[Mullerian agenesis]], [[Congenital adrenal hyperplasia due to 3 beta-hydroxysteroid dehydrogenase deficiency|3-beta-hydroxysteroid dehydrogenase type 2 deficiency]], [[androgen insensitivity syndrome]], [[Kallmann syndrome]], [[Turner syndrome]], and [[17-alpha-hydroxylase deficiency]]. In contrast, secondary amenorrhea must be differentiated from other diseases that cause [[menstrual cycle]] arrest, such as [[Primary ovarian failure|primary ovarian insufficiency]], [[hypothyroidism]], [[hyperprolactinemia]], [[polycystic ovary syndrome]], and [[Asherman's syndrome]]. | As amenorrhea manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. Primary amenorrhea must be differentiated from other diseases that cause lack of [[menstrual cycle]], such as [[Mullerian agenesis]], [[Congenital adrenal hyperplasia due to 3 beta-hydroxysteroid dehydrogenase deficiency|3-beta-hydroxysteroid dehydrogenase type 2 deficiency]], [[androgen insensitivity syndrome]], [[Kallmann syndrome]], [[Turner syndrome]], and [[17-alpha-hydroxylase deficiency]]. In contrast, secondary amenorrhea must be differentiated from other diseases that cause [[menstrual cycle]] arrest, such as [[Primary ovarian failure|primary ovarian insufficiency]], [[hypothyroidism]], [[hyperprolactinemia]], [[polycystic ovary syndrome]], and [[Asherman's syndrome]]. | ||
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| rowspan="6" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |'''Primary amenorrhea''' | | rowspan="6" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |'''Primary amenorrhea''' | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Mullerian agenesis]]<ref name="pmid11023205">{{cite journal |vauthors=Folch M, Pigem I, Konje JC |title=Müllerian agenesis: etiology, diagnosis, and management |journal=Obstet Gynecol Surv |volume=55 |issue=10 |pages=644–9 |year=2000 |pmid=11023205 |doi= |url=}}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Mullerian agenesis]]<ref name="pmid11023205">{{cite journal |vauthors=Folch M, Pigem I, Konje JC |title=Müllerian agenesis: etiology, diagnosis, and management |journal=Obstet Gynecol Surv |volume=55 |issue=10 |pages=644–9 |year=2000 |pmid=11023205 |doi= |url=}}</ref>''' | ||
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| style="background: #F5F5F5; padding: 5px;" |46 [[XX]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XX]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Urinary tract malformation|Urinary tract defects]] | * [[Urinary tract malformation|Urinary tract defects]] | ||
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital adrenal hyperplasia due to 3 beta-hydroxysteroid dehydrogenase deficiency|3-beta-hydroxysteroid dehydrogenase type 2 deficiency]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital adrenal hyperplasia due to 3 beta-hydroxysteroid dehydrogenase deficiency|3-beta-hydroxysteroid dehydrogenase type 2 deficiency]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
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| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
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| style="background: #F5F5F5; padding: 5px;" |46 [[XX]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XX]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Clitoromegaly]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Clitoromegaly]] | ||
| style="background: #F5F5F5; padding: 5px;" | -/+ | | style="background: #F5F5F5; padding: 5px; text-align: center;" | -/+ | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Hyponatremia]] | * [[Hyponatremia]] | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Androgen insensitivity syndrome]]<ref name="pmid15237040">{{cite journal |vauthors= |title=Current evaluation of amenorrhea |journal=Fertil. Steril. |volume=82 |issue=1 |pages=266–72 |year=2004 |pmid=15237040 |doi=10.1016/j.fertnstert.2004.02.098 |url=}}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Androgen insensitivity syndrome]]<ref name="pmid15237040">{{cite journal |vauthors= |title=Current evaluation of amenorrhea |journal=Fertil. Steril. |volume=82 |issue=1 |pages=266–72 |year=2004 |pmid=15237040 |doi=10.1016/j.fertnstert.2004.02.098 |url=}}</ref>''' | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |46 [[XY]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XY]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Undescended testes|Undescended testis]] | * [[Undescended testes|Undescended testis]] | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Kallmann syndrome]]<ref name="pmid7641400">{{cite journal |vauthors=Albanese A, Stanhope R |title=Investigation of delayed puberty |journal=Clin. Endocrinol. (Oxf) |volume=43 |issue=1 |pages=105–10 |year=1995 |pmid=7641400 |doi= |url=}}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Kallmann syndrome]]<ref name="pmid7641400">{{cite journal |vauthors=Albanese A, Stanhope R |title=Investigation of delayed puberty |journal=Clin. Endocrinol. (Oxf) |volume=43 |issue=1 |pages=105–10 |year=1995 |pmid=7641400 |doi= |url=}}</ref>''' | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |46 [[XX]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XX]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Anosmia]]/[[Hyposmia]] | * [[Anosmia]]/[[Hyposmia]] | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Turner syndrome]]<ref name="pmid15371580">{{cite journal |vauthors=Sybert VP, McCauley E |title=Turner's syndrome |journal=N. Engl. J. Med. |volume=351 |issue=12 |pages=1227–38 |year=2004 |pmid=15371580 |doi=10.1056/NEJMra030360 |url=}}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Turner syndrome]]<ref name="pmid15371580">{{cite journal |vauthors=Sybert VP, McCauley E |title=Turner's syndrome |journal=N. Engl. J. Med. |volume=351 |issue=12 |pages=1227–38 |year=2004 |pmid=15371580 |doi=10.1056/NEJMra030360 |url=}}</ref>''' | ||
| style="background: #F5F5F5; padding: 5px;" |↓↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |[[Turner syndrome|45 XO]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Turner syndrome|45 XO]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px; text-align: center;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Webbed neck]] | * [[Webbed neck]] | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[17-alpha-hydroxylase deficiency]]''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[17-alpha-hydroxylase deficiency]]''' | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |46 [[XY]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XY]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Infantilism]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Infantilism]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Hypertension]] | * [[Hypertension]] | ||
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| rowspan="5" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |'''Secondary amenorrhea''' | | rowspan="5" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |'''Secondary amenorrhea''' | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Primary ovarian failure|Primary ovarian insufficiency]]<ref name="pmid19196677">{{cite journal |vauthors=Nelson LM |title=Clinical practice. Primary ovarian insufficiency |journal=N. Engl. J. Med. |volume=360 |issue=6 |pages=606–14 |year=2009 |pmid=19196677 |pmc=2762081 |doi=10.1056/NEJMcp0808697 |url=}}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Primary ovarian failure|Primary ovarian insufficiency]]<ref name="pmid19196677">{{cite journal |vauthors=Nelson LM |title=Clinical practice. Primary ovarian insufficiency |journal=N. Engl. J. Med. |volume=360 |issue=6 |pages=606–14 |year=2009 |pmid=19196677 |pmc=2762081 |doi=10.1056/NEJMcp0808697 |url=}}</ref>''' | ||
| style="background: #F5F5F5; padding: 5px;" |↓↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |46 [[XX]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XX]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Osteoporosis]] | * [[Osteoporosis]] | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hypothyroidism]]<ref name="pmid14575026">{{cite journal |vauthors=Kalro BN |title=Impaired fertility caused by endocrine dysfunction in women |journal=Endocrinol. Metab. Clin. North Am. |volume=32 |issue=3 |pages=573–92 |year=2003 |pmid=14575026 |doi= |url=}}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hypothyroidism]]<ref name="pmid14575026">{{cite journal |vauthors=Kalro BN |title=Impaired fertility caused by endocrine dysfunction in women |journal=Endocrinol. Metab. Clin. North Am. |volume=32 |issue=3 |pages=573–92 |year=2003 |pmid=14575026 |doi= |url=}}</ref>''' | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |↓↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓↓ | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |46 [[XX]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XX]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Fatigue]] | * [[Fatigue]] | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hyperprolactinemia]]<ref name="pmid15024895">{{cite journal |vauthors=Pickett CA |title=Diagnosis and management of pituitary tumors: recent advances |journal=Prim. Care |volume=30 |issue=4 |pages=765–89 |year=2003 |pmid=15024895 |doi= |url=}}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hyperprolactinemia]]<ref name="pmid15024895">{{cite journal |vauthors=Pickett CA |title=Diagnosis and management of pituitary tumors: recent advances |journal=Prim. Care |volume=30 |issue=4 |pages=765–89 |year=2003 |pmid=15024895 |doi= |url=}}</ref>''' | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓ | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |46 [[XX]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XX]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Galactorrhea]] | * [[Galactorrhea]] | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Polycystic ovary syndrome]]<ref name="pmid12434783">{{cite journal |vauthors= |title=ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists. Number 40, November 2002 |journal=Obstet Gynecol |volume=100 |issue=5 Pt 1 |pages=1045–50 |year=2002 |pmid=12434783 |doi= |url=}}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Polycystic ovary syndrome]]<ref name="pmid12434783">{{cite journal |vauthors= |title=ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists. Number 40, November 2002 |journal=Obstet Gynecol |volume=100 |issue=5 Pt 1 |pages=1045–50 |year=2002 |pmid=12434783 |doi= |url=}}</ref>''' | ||
| style="background: #F5F5F5; padding: 5px;" |↓↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓↓ | ||
| style="background: #F5F5F5; padding: 5px;" |↓↓ | | style="background: #F5F5F5; padding: 5px; text-align: center;" |↓↓ | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" |'''↑''' | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |46 [[XX]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XX]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Hirsutism]] | * [[Hirsutism]] | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Asherman's syndrome]]<ref>{{cite book | last = Fritz | first = Marc | title = Clinical gynecologic endocrinology and infertility | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2011 | isbn = 978-0781779685 }}</ref>''' | | style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Asherman's syndrome]]<ref>{{cite book | last = Fritz | first = Marc | title = Clinical gynecologic endocrinology and infertility | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2011 | isbn = 978-0781779685 }}</ref>''' | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" |46 [[XX]] | | style="background: #F5F5F5; padding: 5px; text-align: center;" |46 [[XX]] | ||
| style="background: #F5F5F5; padding: 5px;" |Nl | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Nl | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* History of [[uterus]] [[surgery]] | * History of [[uterus]] [[surgery]] | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category: | [[Category:Medicine]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
[[Category:Obstetrics]] | |||
Latest revision as of 20:22, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2], Mehrian Jafarizade, M.D [3]
Overview
As amenorrhea manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. Primary amenorrhea must be differentiated from other diseases that cause lack of menstrual cycle, such as Mullerian agenesis, 3-beta-hydroxysteroid dehydrogenase type 2 deficiency, androgen insensitivity syndrome, Kallmann syndrome, Turner syndrome, and 17-alpha-hydroxylase deficiency. In contrast, secondary amenorrhea must be differentiated from other diseases that cause menstrual cycle arrest, such as primary ovarian insufficiency, hypothyroidism, hyperprolactinemia, polycystic ovary syndrome, and Asherman's syndrome.
Differentiating Diseases with Amenorrhea from each other
As amenorrhea manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. Primary amenorrhea must be differentiated from other diseases that cause lack of menstrual cycle, such as Mullerian agenesis, 3-beta-hydroxysteroid dehydrogenase type 2 deficiency, androgen insensitivity syndrome, Kallmann syndrome, Turner syndrome, and 17-alpha-hydroxylase deficiency. In contrast, secondary amenorrhea must be differentiated from other diseases that cause menstrual cycle arrest, such as primary ovarian insufficiency, hypothyroidism, hyperprolactinemia, polycystic ovary syndrome, and Asherman's syndrome.
| Group | Diseases | Laboratory Findings | Physical Examination | Other Findings | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Estrogen | Progesterone | GnRH | LH | FSH | Androgen | TSH | T4 | PRL | Karyotype | Externl genitalia | Breast development | Pubic hair | Uterus | |||
| Primary amenorrhea | Mullerian agenesis[1] | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | 46 XX | Nl | + | + | - | |
| 3-beta-hydroxysteroid dehydrogenase type 2 deficiency | Nl | Nl | Nl | Nl | Nl | ↓ | Nl | Nl | Nl | 46 XX | Clitoromegaly | -/+ | + | + | ||
| Androgen insensitivity syndrome[2] | Nl | Nl | ↓ | ↑ | Nl | ↑↑ | Nl | Nl | Nl | 46 XY | Nl | + | + | - | ||
| Kallmann syndrome[3] | ↓ | ↓ | ↓↓ | ↓ | ↓ | ↓ | Nl | Nl | Nl | 46 XX | Nl | - | - | + | ||
| Turner syndrome[4] | ↓↓ | ↓ | ↑ | ↑ | ↑ | Nl | Nl | Nl | Nl | 45 XO | Nl | +/- | + | + |
| |
| 17-alpha-hydroxylase deficiency | ↓ | Nl | ↑ | ↑ | ↑ | ↓ | Nl | Nl | Nl | 46 XY | Infantilism | - | - | - | ||
| Secondary amenorrhea | Primary ovarian insufficiency[5] | ↓↓ | ↓ | ↑ | ↑ | ↑ | Nl | Nl | Nl | Nl | 46 XX | Nl | + | + | + | |
| Hypothyroidism[6] | Nl | Nl | Nl | Nl | Nl | ↑ | ↑↑ | ↓↓ | Nl | 46 XX | Nl | + | + | + |
| |
| Hyperprolactinemia[7] | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | Nl | Nl | ↑ | 46 XX | Nl | + | + | + | ||
| Polycystic ovary syndrome[8] | ↓↓ | ↓↓ | ↑ | ↑ | ↑ | ↑ | Nl | Nl | Nl | 46 XX | Nl | + | + | + | ||
| Asherman's syndrome[9] | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | 46 XX | Nl | + | + | + | ||
References
- ↑ Folch M, Pigem I, Konje JC (2000). "Müllerian agenesis: etiology, diagnosis, and management". Obstet Gynecol Surv. 55 (10): 644–9. PMID 11023205.
- ↑ "Current evaluation of amenorrhea". Fertil. Steril. 82 (1): 266–72. 2004. doi:10.1016/j.fertnstert.2004.02.098. PMID 15237040.
- ↑ Albanese A, Stanhope R (1995). "Investigation of delayed puberty". Clin. Endocrinol. (Oxf). 43 (1): 105–10. PMID 7641400.
- ↑ Sybert VP, McCauley E (2004). "Turner's syndrome". N. Engl. J. Med. 351 (12): 1227–38. doi:10.1056/NEJMra030360. PMID 15371580.
- ↑ Nelson LM (2009). "Clinical practice. Primary ovarian insufficiency". N. Engl. J. Med. 360 (6): 606–14. doi:10.1056/NEJMcp0808697. PMC 2762081. PMID 19196677.
- ↑ Kalro BN (2003). "Impaired fertility caused by endocrine dysfunction in women". Endocrinol. Metab. Clin. North Am. 32 (3): 573–92. PMID 14575026.
- ↑ Pickett CA (2003). "Diagnosis and management of pituitary tumors: recent advances". Prim. Care. 30 (4): 765–89. PMID 15024895.
- ↑ "ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists. Number 40, November 2002". Obstet Gynecol. 100 (5 Pt 1): 1045–50. 2002. PMID 12434783.
- ↑ Fritz, Marc (2011). Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0781779685.