Amenorrhea differential diagnosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 8: Line 8:
== 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]].
 
<div style="width: 80%;">
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
Line 32: Line 32:
!Uterus
!Uterus
|-
|-
| rowspan="6" |'''Primary amenorrhea'''
| rowspan="6" style="background: #7d7d7d; 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>'''
| style="background: #F5F5F5; padding: 5px;" |Nl
| style="background: #F5F5F5; padding: 5px;" |Nl
Line 144: Line 144:
* [[Hypertension]]
* [[Hypertension]]
|-
|-
| rowspan="5" |'''Secondary amenorrhea'''
| rowspan="5" style="background: #7d7d7d; 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;" |↓↓
Line 241: Line 241:
* [[Uterus]] scarring
* [[Uterus]] scarring
|}
|}
 
</div>


==References==
==References==

Revision as of 15:19, 2 November 2017

Amenorrhea Microchapters

Home

Patient Information

Primary amenorrhea
Secondary amenorrhea

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Amenorrhea from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Amenorrhea differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Amenorrhea differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Amenorrhea differential diagnosis

CDC on Amenorrhea differential diagnosis

Amenorrhea differential diagnosis in the news

Blogs on Amenorrhea differential diagnosis

Directions to Hospitals Treating Amenorrhea

Risk calculators and risk factors for Amenorrhea differential diagnosis

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

  1. Folch M, Pigem I, Konje JC (2000). "Müllerian agenesis: etiology, diagnosis, and management". Obstet Gynecol Surv. 55 (10): 644–9. PMID 11023205.
  2. "Current evaluation of amenorrhea". Fertil. Steril. 82 (1): 266–72. 2004. doi:10.1016/j.fertnstert.2004.02.098. PMID 15237040.
  3. Albanese A, Stanhope R (1995). "Investigation of delayed puberty". Clin. Endocrinol. (Oxf). 43 (1): 105–10. PMID 7641400.
  4. Sybert VP, McCauley E (2004). "Turner's syndrome". N. Engl. J. Med. 351 (12): 1227–38. doi:10.1056/NEJMra030360. PMID 15371580.
  5. Nelson LM (2009). "Clinical practice. Primary ovarian insufficiency". N. Engl. J. Med. 360 (6): 606–14. doi:10.1056/NEJMcp0808697. PMC 2762081. PMID 19196677.
  6. Kalro BN (2003). "Impaired fertility caused by endocrine dysfunction in women". Endocrinol. Metab. Clin. North Am. 32 (3): 573–92. PMID 14575026.
  7. Pickett CA (2003). "Diagnosis and management of pituitary tumors: recent advances". Prim. Care. 30 (4): 765–89. PMID 15024895.
  8. "ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists. Number 40, November 2002". Obstet Gynecol. 100 (5 Pt 1): 1045–50. 2002. PMID 12434783.
  9. Fritz, Marc (2011). Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0781779685.


Template:WH Template:WS