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Approach to primary amenorrhea

Huda A.K Hamouda 09090116 MBBS 4th year

primary amenorrhea

functional menses
Compartment IV CNS ( Hypothalamic ) Compartment III Anterior Pituitary Compartment II ovary ( Estrogen & Progesterone) Compartment I outflow tract ( uterine target organ)

Primary amenorrhea Hx & PE

2nd sex char -

2nd sex char +

FSH & LH

FSH & LH

Uterus -

Uterus +

Hypergonadotropic hypogonadism

Hypo/ Normogonadotropic hypogonadism MRI abnormal :

46XY

46XX

Outflow -

Outflow +

46XX

45XO

Premature ovarian failure Pure gonadal dysgenesis

Turners syndrome

AN BN Chronic diseases Wt loss , malnutrition

CNS tumor

AIS

Mullerian agenesis

Imperforate hymen transverse vaginal septum

Evaluate 2nd amenorrhea

constitutional delay kalmanns syndrome

Thank you