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{{Menopause}}
 
{{CMG}} {{RA}}
{{CMG}} {{RA}}


<br />


== Overview ==
 
[[Menopause]] should be differentiated from other [[diseases]] presenting with [[menstrual irregularities]] ([[oligomenorrhea]]/[[amenorrhea]]).<ref name="pmid9541295">{{cite journal |vauthors=Sato N, Sze G, Endo K |title=Hypophysitis: endocrinologic and dynamic MR findings |journal=AJNR Am J Neuroradiol |volume=19 |issue=3 |pages=439–44 |year=1998 |pmid=9541295 |doi= |url=}}</ref><ref name="pmid7758238">{{cite journal |vauthors=Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH |title=Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature |journal=Clin. Endocrinol. (Oxf) |volume=42 |issue=3 |pages=315–22 |year=1995 |pmid=7758238 |doi= |url=}}</ref><ref name="pmid26262437">{{cite journal |vauthors=Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S |title=Diagnosis of Primary Hypophysitis in Germany |journal=J. Clin. Endocrinol. Metab. |volume=100 |issue=10 |pages=3841–9 |year=2015 |pmid=26262437 |doi=10.1210/jc.2015-2152 |url=}}</ref><ref name="pmid7629223">{{cite journal |vauthors=Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S |title=Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings |journal=J. Clin. Endocrinol. Metab. |volume=80 |issue=8 |pages=2302–11 |year=1995 |pmid=7629223 |doi=10.1210/jcem.80.8.7629223 |url=}}</ref><ref name="pmid8345854">{{cite journal |vauthors=Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H |title=Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus |journal=N. Engl. J. Med. |volume=329 |issue=10 |pages=683–9 |year=1993 |pmid=8345854 |doi=10.1056/NEJM199309023291002 |url=}}</ref><ref name="pmid21668725">{{cite journal |vauthors=Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS |title=Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman |journal=Emerg Med Australas |volume=23 |issue=3 |pages=372–5 |year=2011 |pmid=21668725 |doi=10.1111/j.1742-6723.2011.01425.x |url=}}</ref><ref name="pmid9747750">{{cite journal |vauthors=Dejager S, Gerber S, Foubert L, Turpin G |title=Sheehan's syndrome: differential diagnosis in the acute phase |journal=J. Intern. Med. |volume=244 |issue=3 |pages=261–6 |year=1998 |pmid=9747750 |doi= |url=}}</ref>
==Overview==
[[Menopause]] should be differentiated from other [[diseases]] presenting with [[menstrual irregularities]] ([[oligomenorrhea]]/[[amenorrhea]]) that are include [[Sheehan's syndrome]], [[Lymphocytic hypophysitis]], [[Pituitary apoplexy]], [[Empty sella syndrome]], [[Pituitary]] [[cachexia]], [[Primary hypothyroidism|Hypothyroidism]], [[Hypogonadotropic hypogonadism]], [[Prolactin|Hypoprolactinemia]], [[Primary adrenal insufficiency]]/[[Addison's disease]].


==Differential diagnosis of menopause from other diseases==
==Differential diagnosis of menopause from other diseases==
<ref name="pmid9541295">{{cite journal |vauthors=Sato N, Sze G, Endo K |title=Hypophysitis: endocrinologic and dynamic MR findings |journal=AJNR Am J Neuroradiol |volume=19 |issue=3 |pages=439–44 |year=1998 |pmid=9541295 |doi= |url=}}</ref><ref name="pmid7758238">{{cite journal |vauthors=Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH |title=Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature |journal=Clin. Endocrinol. (Oxf) |volume=42 |issue=3 |pages=315–22 |year=1995 |pmid=7758238 |doi= |url=}}</ref><ref name="pmid26262437">{{cite journal |vauthors=Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S |title=Diagnosis of Primary Hypophysitis in Germany |journal=J. Clin. Endocrinol. Metab. |volume=100 |issue=10 |pages=3841–9 |year=2015 |pmid=26262437 |doi=10.1210/jc.2015-2152 |url=}}</ref><ref name="pmid7629223">{{cite journal |vauthors=Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S |title=Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings |journal=J. Clin. Endocrinol. Metab. |volume=80 |issue=8 |pages=2302–11 |year=1995 |pmid=7629223 |doi=10.1210/jcem.80.8.7629223 |url=}}</ref><ref name="pmid8345854">{{cite journal |vauthors=Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H |title=Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus |journal=N. Engl. J. Med. |volume=329 |issue=10 |pages=683–9 |year=1993 |pmid=8345854 |doi=10.1056/NEJM199309023291002 |url=}}</ref><ref name="pmid21668725">{{cite journal |vauthors=Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS |title=Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman |journal=Emerg Med Australas |volume=23 |issue=3 |pages=372–5 |year=2011 |pmid=21668725 |doi=10.1111/j.1742-6723.2011.01425.x |url=}}</ref><ref name="pmid9747750">{{cite journal |vauthors=Dejager S, Gerber S, Foubert L, Turpin G |title=Sheehan's syndrome: differential diagnosis in the acute phase |journal=J. Intern. Med. |volume=244 |issue=3 |pages=261–6 |year=1998 |pmid=9747750 |doi= |url=}}</ref>
<small>
<small>
{| class="wikitable"
{| class="wikitable"
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|Acute
|Acute
|<nowiki>++</nowiki>
|<nowiki>++</nowiki>
| ++
| ++
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
|Symptoms of:
|Symptoms of:
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*[[Breast tissue]] [[atrophy]]
*[[Breast tissue]] [[atrophy]]


* Decreased [[axillary]] and [[pubic]] hair growth
*Decreased [[axillary]] and [[pubic]] hair growth
|
|
*[[Pancytopenia]]
*[[Pancytopenia]]
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*[[Hyponatremia]]
*[[Hyponatremia]]


* Low [[fasting plasma glucose]]
*Low [[fasting plasma glucose]]


* Decreased levels of [[anterior pituitary]] [[hormones]] in blood
*Decreased levels of [[anterior pituitary]] [[hormones]] in blood


|
|
* Clinical diagnosis
*Clinical diagnosis


* Most senitive test: Low baseline [[prolactin]] levels w/o response to [[Thyrotropin-releasing hormone|TRH]]
*Most senitive test: Low baseline [[prolactin]] levels w/o response to [[Thyrotropin-releasing hormone|TRH]]
|CT/MRI:  
|CT/MRI:  


* Sequential changes of pituitary enlargement followed by:
*Sequential changes of pituitary enlargement followed by:
* Shrinkage and [[necrosis]] leading to decreased sellar volume or [[empty sella]]
*Shrinkage and [[necrosis]] leading to decreased sellar volume or [[empty sella]]
|
|
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
*Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
|-
|-
![[Lymphocytic hypophysitis]]
![[Lymphocytic hypophysitis]]
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|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
|
|
* Associated with [[autoimmune]] conditions
*Associated with [[autoimmune]] conditions


* Generalized [[headache]]
*Generalized [[headache]]


* Retro-orbital or Bitemporal [[pain]]
*Retro-orbital or Bitemporal [[pain]]


* Mass lesion effect such as [[Visual field defect|visual field defects]]
*Mass lesion effect such as [[Visual field defect|visual field defects]]
|
|
*[[Diabetes insipidus|DI]]
*[[Diabetes insipidus|DI]]
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*[[Autoimmune]] [[thyroiditis]]
*[[Autoimmune]] [[thyroiditis]]
|
|
* Decreased pituitary hormones([[Gonadotropins]] most common)
*Decreased pituitary hormones([[Gonadotropins]] most common)


*[[Hyperprolactinemia]](40%)
*[[Hyperprolactinemia]](40%)
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*[[CT]] & [[MRI]]: Features of a [[Pituitary gland|pituitary]] [[mass]]
*[[CT]] & [[MRI]]: Features of a [[Pituitary gland|pituitary]] [[mass]]


* Diffuse and homogeneous contrast enhancement
*Diffuse and homogeneous contrast enhancement
|[[Assay|Assays]] for:
|[[Assay|Assays]] for:


* Anti-TPO
*Anti-TPO
* Anti-Tg Ab
*Anti-Tg Ab
|-
|-
![[Pituitary apoplexy]]
![[Pituitary apoplexy]]
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|Severe [[headache]]
|Severe [[headache]]
*[[Nausea and vomiting]]
*[[Nausea and vomiting]]
* Paralysis of eye muscles ([[diplopia]])
*Paralysis of eye muscles ([[diplopia]])
* Changes in vision
*Changes in vision
|
|
*[[Visual acuity]] defects
*[[Visual acuity]] defects
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|
|
* Decreased levels of [[anterior]] pituitary hormones in blood.
*Decreased levels of [[anterior]] pituitary hormones in blood.
|
|
*[[Magnetic resonance imaging|MRI]]
*[[Magnetic resonance imaging|MRI]]
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*[[Headache]]
*[[Headache]]


* Low [[libido]]
*Low [[libido]]


|
|
* Signs of raised [[intracranial pressure]] may be present
*Signs of raised [[intracranial pressure]] may be present


*[[Nipple discharge|Nipple]] discharge
*[[Nipple discharge|Nipple]] discharge
|
|
* Decreased levels of pituitary hormones in the blood.
*Decreased levels of pituitary hormones in the blood.
|
|
*[[MRI]]
*[[MRI]]
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*[[Empty sella]] containing [[Cerebrospinal fluid|CSF]]
*[[Empty sella]] containing [[Cerebrospinal fluid|CSF]]
|
|
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
*Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
|-
|-
![[Simmond's Disease|Simmonds' disease]]/[[Pituitary]] [[cachexia]]
![[Simmond's Disease|Simmonds' disease]]/[[Pituitary]] [[cachexia]]
|Chronic
|Chronic
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
| +
| +
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
|
|
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*[[Premature aging|Premature]] aging
*[[Premature aging|Premature]] aging
|
|
* Progressive [[emaciation]]
*Progressive [[emaciation]]


* Loss of body hair
*Loss of body hair
|
|
* Decreased levels of anterior pituitary hormones in the blood.
*Decreased levels of anterior pituitary hormones in the blood.
|
|
*[[Magnetic resonance imaging|MRI]]
*[[Magnetic resonance imaging|MRI]]
|
|
* Done to rule out any pituitary cause
*Done to rule out any pituitary cause
|
|
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
*Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
|-
|-
![[Primary hypothyroidism|Hypothyroidism]]
![[Primary hypothyroidism|Hypothyroidism]]
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|[[Oligomenorrhea]]/[[menorrhagia]]
|[[Oligomenorrhea]]/[[menorrhagia]]
|
|
* Cold intolerance
*Cold intolerance
*[[Constipation]]
*[[Constipation]]
|
|
* Dry skin
*Dry skin


*[[Bradycardia]]
*[[Bradycardia]]


* Hair loss
*Hair loss


*[[Myxedema]]
*[[Myxedema]]


* Delayed relaxation phase of deep [[Tendon reflex|tendon reflexes]]
*Delayed relaxation phase of deep [[Tendon reflex|tendon reflexes]]
|
|
* Low [[T3]],[[T4]]
*Low [[T3]],[[T4]]


|
|
*[[TSH]] levels
*[[TSH]] levels
|
|
* Done to rule out any pituitary cause
*Done to rule out any pituitary cause
|
|
*Assays for anti-TPO and anti-Tg Ab
*Assays for anti-TPO and anti-Tg Ab
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*[[Hot flushes]]
*[[Hot flushes]]


* Energy and mood changes
*Energy and mood changes


* Decreased [[libido]]
*Decreased [[libido]]
|
|
*[[Breast tissue]] [[atrophy]]
*[[Breast tissue]] [[atrophy]]
* Decreased [[maturation]] of [[vaginal]] [[mucosa]]
*Decreased [[maturation]] of [[vaginal]] [[mucosa]]
|
|
* Low [[estrogen]], [[testosterone]]
*Low [[estrogen]], [[testosterone]]


* High [[FSH]]/[[Luteinizing hormone|LH]]
*High [[FSH]]/[[Luteinizing hormone|LH]]
|
|
*[[FSH]]
*[[FSH]]
*[[Luteinizing hormone|LH]]
*[[Luteinizing hormone|LH]]
|
|
* Done to rule out any pituitary cause
*Done to rule out any pituitary cause
|
|
* Genetic tests  ([[karyotype]])
*Genetic tests  ([[karyotype]])
* Measurement of total and free [[testosterone]] and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] concentrations
*Measurement of total and free [[testosterone]] and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] concentrations
|-
|-
!Hypoprolactinemia
!Hypoprolactinemia
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|
|
*[[Infertility]]
*[[Infertility]]
* Subfertility
*Subfertility
|
|
* Puerperal agalactogenesis
*Puerperal agalactogenesis
|
|
* No workup is necessary
*No workup is necessary
|
|
* Decreased prolactin levels
*Decreased prolactin levels
|
|
* Done to rule out any pituitary cause
*Done to rule out any pituitary cause
|
|
*[[Prolactin]] assay in [[3rd trimester]]
*[[Prolactin]] assay in [[3rd trimester]]
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*[[Polydipsia]]
*[[Polydipsia]]
* Features of [[hypothyroidism]] and [[hypoadrenalism]]
*Features of [[hypothyroidism]] and [[hypoadrenalism]]
|
|
*[[Growth failure]]
*[[Growth failure]]


* B/L [[hemianopsia]]
*B/L [[hemianopsia]]


*[[Papilledema]]
*[[Papilledema]]
|
|
* All pituitary hormones decreased
*All pituitary hormones decreased
|
|
*[[Magnetic resonance imaging|MRI]]
*[[Magnetic resonance imaging|MRI]]
|
|
* Done to rule out any pituitary cause
*Done to rule out any pituitary cause
|
|
* Left hand and wrist [[radiograph]] for [[bone age]]
*Left hand and wrist [[radiograph]] for [[bone age]]
|-
|-
![[Primary adrenal insufficiency]]/[[Addison's disease]]
![[Primary adrenal insufficiency]]/[[Addison's disease]]
|Chronic
|Chronic
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| -
| -
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
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*[[Hyperpigmentation]]
*[[Hyperpigmentation]]


* loss of [[pubic]] and [[axillary]] hair
*loss of [[pubic]] and [[axillary]] hair


|
|
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*[[Plasma renin activity]] to [[Aldosterone|aldosterone ratio]]
*[[Plasma renin activity]] to [[Aldosterone|aldosterone ratio]]
|
|
* Abdominal [[Computed tomography|CT]]
*Abdominal [[Computed tomography|CT]]
|
|
* Abdominal [[Computed tomography|CT]]
*Abdominal [[Computed tomography|CT]]
|
|
* Serum [[cortisol]] testing
*Serum [[cortisol]] testing


* Serum [[ACTH]] testing
*Serum [[ACTH]] testing


* Anti-adrenal [[Antibody|Ab]] testing
*Anti-adrenal [[Antibody|Ab]] testing
|-
|-
![[Menopause]]
![[Menopause]]
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*[[Insomnia]]
*[[Insomnia]]
*[[Weight gain]] and [[bloating]]
*[[Weight gain]] and [[bloating]]
* Mood changes
*Mood changes
|
|
*[[Vaginal atrophy]]
*[[Vaginal atrophy]]
* Loss of pelvic [[muscle tone]]
*Loss of pelvic [[muscle tone]]
|
|
* ↑ [[FSH]]
*↑ [[FSH]]
* ↓ [[Estradiol]] and [[inhibin]]
*↓ [[Estradiol]] and [[inhibin]]
|
|
*[[FSH]] > [[LH]]
*[[FSH]] > [[LH]]
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|}
|}
<small>
<small>


<br />
<br />
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{{WikiDoc Sources}}
{{WikiDoc Sources}}


[[Category:Disease]]
<br />[[Category:Disease]]
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]

Latest revision as of 05:19, 17 February 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Rahmah Al-Edresi, M.D.[2]


Overview

Menopause should be differentiated from other diseases presenting with menstrual irregularities (oligomenorrhea/amenorrhea) that are include Sheehan's syndrome, Lymphocytic hypophysitis, Pituitary apoplexy, Empty sella syndrome, Pituitary cachexia, Hypothyroidism, Hypogonadotropic hypogonadism, Hypoprolactinemia, Primary adrenal insufficiency/Addison's disease.

Differential diagnosis of menopause from other diseases

[1][2][3][4][5][6][7]

Diseases Onset Manifestations Diagnosis
History and Symptoms Physical examination Laboratory findings Gold standard Imaging Other investigation findings
Trumatic delivery Lactation failure Menstrual irregularities Other features
Sheehan's syndrome Acute ++ ++ Oligo/amenorrhea Symptoms of:
  • Clinical diagnosis
  • Most senitive test: Low baseline prolactin levels w/o response to TRH
 CT/MRI:
  • Sequential changes of pituitary enlargement followed by:
  • Shrinkage and necrosis leading to decreased sellar volume or empty sella
Lymphocytic hypophysitis Acute +/- + Oligo/amenorrhea
  • Retro-orbital or Bitemporal pain
  • Diffuse and homogeneous contrast enhancement
 Assays for:
  • Anti-TPO
  • Anti-Tg Ab
Pituitary apoplexy Acute +/- ++ Oligo/amenorrhea Severe headache
  • Decreased levels of anterior pituitary hormones in blood.
  • CT scan without contrast: Hemorrhage on CT presents as a hyperdense lesion

Blood tests may be done to check:

Empty sella syndrome Chronic - + Oligo/amenorrhea
  • Decreased levels of pituitary hormones in the blood.
Simmonds' disease/Pituitary cachexia Chronic +/- + Oligo/amenorrhea
  • Loss of body hair
  • Decreased levels of anterior pituitary hormones in the blood.
  • Done to rule out any pituitary cause
Hypothyroidism Chronic +/- - Oligomenorrhea/menorrhagia
  • Dry skin
  • Hair loss
  • Done to rule out any pituitary cause
  • Assays for anti-TPO and anti-Tg Ab
  • FNA biopsy
Hypogonadotropic hypogonadism Chronic - - Oligo/amenorrhea
  • Energy and mood changes
  • Done to rule out any pituitary cause
Hypoprolactinemia Chronic - + -
  • Puerperal agalactogenesis
  • No workup is necessary
  • Decreased prolactin levels
  • Done to rule out any pituitary cause
Panhypopituitarism Chronic - + Oligo/amenorrhea
  • All pituitary hormones decreased
  • Done to rule out any pituitary cause
Primary adrenal insufficiency/Addison's disease Chronic - - -
  • Abdominal CT
  • Abdominal CT
  • Anti-adrenal Ab testing
Menopause Chronic - +/- Oligo/amenorrhea Normal


References

  1. ↑ Sato N, Sze G, Endo K (1998). "Hypophysitis: endocrinologic and dynamic MR findings". AJNR Am J Neuroradiol. 19 (3): 439–44. PMID 9541295.
  2. ↑ Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH (1995). "Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature". Clin. Endocrinol. (Oxf). 42 (3): 315–22. PMID 7758238.
  3. ↑ Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S (2015). "Diagnosis of Primary Hypophysitis in Germany". J. Clin. Endocrinol. Metab. 100 (10): 3841–9. doi:10.1210/jc.2015-2152. PMID 26262437.
  4. ↑ Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S (1995). "Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings". J. Clin. Endocrinol. Metab. 80 (8): 2302–11. doi:10.1210/jcem.80.8.7629223. PMID 7629223.
  5. ↑ Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H (1993). "Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus". N. Engl. J. Med. 329 (10): 683–9. doi:10.1056/NEJM199309023291002. PMID 8345854.
  6. ↑ Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS (2011). "Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman". Emerg Med Australas. 23 (3): 372–5. doi:10.1111/j.1742-6723.2011.01425.x. PMID 21668725.
  7. ↑ Dejager S, Gerber S, Foubert L, Turpin G (1998). "Sheehan's syndrome: differential diagnosis in the acute phase". J. Intern. Med. 244 (3): 261–6. PMID 9747750.


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