Amenorrhea laboratory findings: Difference between revisions

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{{Amenorrhea}}
{{Amenorrhea}}
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==Overview==
==Overview==
The most first [[laboratory]] tests for evaluating amenorrhea are [[pregnancy test]], [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]], [[Follicle stimulating hormone|follicle stimulating hormone (FSH)]], and [[Prolactin|prolactin (PRL)]]. Second line [[laboratory]] tests include free and total [[testosterone]], [[Dehydroepiandrosterone-sulfate|dehydroepiandrosterone sulfate (DHEAS)]], and also [[progesterone]] challenge test.
==Laboratory Findings==
*The most first [[laboratory]] tests for evaluating amenorrhea are [[pregnancy test]], [[Thyroid stimulating hormone|thyroid stimulating hormone (TSH)]], [[Follicle stimulating hormone|follicle stimulating hormone (FSH)]], and [[Prolactin|prolactin (PRL)]].<ref name="pmid28832422">{{cite journal |vauthors=Pereira K, Brown AJ |title=Secondary amenorrhea: Diagnostic approach and treatment considerations |journal=Nurse Pract |volume=42 |issue=9 |pages=34–41 |year=2017 |pmid=28832422 |doi=10.1097/01.NPR.0000520832.14406.76 |url=}}</ref>
*Second line [[laboratory]] tests include free and total [[testosterone]], [[Dehydroepiandrosterone-sulfate|dehydroepiandrosterone sulfate (DHEAS)]], and also [[progesterone]] challenge test.
<span style="font-size:85%">'''Abbreviations:''' '''TSH:''' [[Hemoglobin]], '''T4:''' [[Thyroxin]], '''Anti-TPO Ab:''' Anti-[[thyroid peroxidase]] antibodies, '''Anti-TSH-R Ab:''' Anti-[[thyroid stimulating hormone]] antibodies, '''PRL:''' [[Prolactin]], '''LH:''' [[Luteinizing hormone]], '''FSH:''' [[Follicle stimulating hormone]], '''Prog.:''' [[Progesterone]], '''DHEAS:''' [[Dehydroepiandrosterone sulfate]], '''AD:''' [[Androstenedione|Delta 4-androstenedione]], '''17-OH-Prog.:''' [[17-hydroxyprogesterone]], '''FBS:''' [[Fasting blood sugar]], '''ACTH:''' [[Adrenocorticotropic hormone]], '''HPO axis:''' [[Hypothalamic-pituitary-gonadal axis|Hypothalamus-pituitary-ovary axis]].</span>
{| class="wikitable"
! rowspan="2" |Disease
! colspan="23" |Laboratory tests
|-
!Pregnancy test
!TSH
!T4
!Anti-TPO Ab
!Anti-TSH-R Ab
!PRL
!LH
!FSH
!Estradiol
!Prog.
!Testosterone
!DHEAS
!AD
!17-OH-prog.
!Insulin
!FBS
!Insulin resistance indexes
!ACTH
!Cortisol
!Markers of ovarian tumors
!Prog. challenge test
!Leptin
!Inhibin
|-
|'''[[Pregnancy]]'''
|Positive
|↑
|↓
| +/-
| -
|↑
| -
| -
| -
|↑
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|'''[[Hypothyroidism]]'''
| -
|↑↑
|↓
| +/-
| -
| -
| -
| -
|↓
|↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|'''[[Hyperthyroidism]]'''
| -
|↓↓
|↑
| -
| -
| -
| -
| -
|↓
|↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|'''[[Thyroiditis]]'''
| -
|↑↑
|↓↓
|Positive
| -
| -
| -
| -
|↓
|↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|[[Graves' disease|'''Graves' disease''']]
| -
|↓↓
|↑↑↑
| -
|Positive
| -
| -
| -
|↓
|↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|'''[[Hyperprolactinemia]]'''
| -
| -
| -
| -
| -
|↑↑
|↓
|↓
|↓
|↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|'''[[Prolactinoma]]'''
| -
|↓
|↓
| -
| -
|↑↑↑
|↓↓
|↓↓
|↓
|↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|'''[[Hypothalamic]] disease'''
| -
|↓↓
|↓↓
| -
| -
|↓↓
|↓↓
|↓↓
|↓↓
|↓↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|↓↓
| -
|-
|'''[[Premature ovarian failure]]'''
| -
| -
| -
| -
| -
| -
|↑↑
|↑↑
|↓↓
|↓↓
| -
| -
| -
|↓
| -
| -
| -
| -
| -
| -
| -
| -
|↓↓
|-
|'''[[Androgen insensitivity syndrome]]'''
| -
| -
| -
| -
| -
| -
|↑↑
|↑↑
|↓↓↓
|↓↓↓
|↑
|↑
|↑
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|'''[[Polycystic ovary syndrome|Polycystic ovary syndrome (PCOS)]]'''
| -
| -
| -
| -
| -
| -
|↑
|↑
|↓
|↓
|↑
|↑
|↑
| -
|↑
|↑
|↑
| -
| -
| -
|Positive
| -
| -
|-
|'''[[Congenital adrenal hyperplasia (CAH)]]'''
| -
| -
| -
| -
| -
| -
|↑
|↑
|↓
|↓
| -
| -
| -
|↑
| -
| -
| -
| -
|↓
| -
| -
| -
| -
|-
|'''[[Adreno-corticotrophic adenoma|ACTH-secreting adenoma]]'''
| -
| -
| -
| -
| -
|↓
|↓↓
|↓↓
|↓↓
|↓↓
| -
| -
| -
| -
| -
| -
| -
|↑
|↑
| -
| -
| -
| -
|-
|'''[[Ovarian cancer|Ovarian adenocarcinoma]]'''
| -
| -
| -
| -
| -
| -
|↑
|↑
|↓
|↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
|Positive
| -
| -
| -
|-
|'''[[Hypothalamic-pituitary-gonadal axis|HPO axis]] immaturity'''
| -
| -
| -
| -
| -
| -
|↓↓
|↓↓
|↓↓
|↓↓
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|Positive
| -
| -
|-
|'''[[Imperforate hymen]]'''
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|-
|[[Asherman's syndrome|'''Asherman's syndrome''']]
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
| -
|}
=== Urine or serum pregnancy test ===
* Some patients with amenorrhea may have positive urine or serum [[pregnancy test]], which is usually suggestive of [[pregnancy]]-induced amenorrhea.<ref name="pmid16669559">{{cite journal |vauthors=Master-Hunter T, Heiman DL |title=Amenorrhea: evaluation and treatment |journal=Am Fam Physician |volume=73 |issue=8 |pages=1374–82 |year=2006 |pmid=16669559 |doi= |url=}}</ref>
=== Thyroid function tests<ref name="pmid2110072">{{cite journal |vauthors=Rebar RW, Connolly HV |title=Clinical features of young women with hypergonadotropic amenorrhea |journal=Fertil. Steril. |volume=53 |issue=5 |pages=804–10 |year=1990 |pmid=2110072 |doi= |url=}}</ref> ===
* Some patients with amenorrhea may have elevated concentration of [[TSH]] and reduced concentration of free [[Thyroxine|thyroxine (T4)]], which are usually suggestive of amenorrhea due to [[hypothyroidism]].
* Some patients with amenorrhea may have reduced concentration of [[TSH]] and elevated concentration of [[Thyroxine|T4]], which are usually suggestive of amenorrhea due to [[hyperthyroidism]].
* Some patients with amenorrhea may have elevated concentration of [[Antithyroglobulin antibody|anti-thyroglobulin antibodies]] and anti-[[thyroid peroxidase]] [[antibodies]], which are usually suggestive of amenorrhea due to [[thyroiditis]].
* Some patients with amenorrhea may have elevated concentration of anti-[[thyrotropin receptor]] [[antibodies]], which are usually suggestive of amenorrhea due to [[Graves' disease]].
=== Prolactin (PRL) ===
* Some patients with amenorrhea may have elevated concentration of [[prolactin]], which is usually suggestive of amenorrhea due to [[hyperprolactinemia]].<ref name="PatelBamigboye2009">{{cite journal|last1=Patel|first1=S. S.|last2=Bamigboye|first2=V.|title=Hyperprolactinaemia|journal=Journal of Obstetrics and Gynaecology|volume=27|issue=5|year=2009|pages=455–459|issn=0144-3615|doi=10.1080/01443610701406125}}</ref>
* Some patients with amenorrhea may have elevated concentration of [[prolactin]], which is usually suggestive of amenorrhea due to [[pituitary]] causes ([[prolactinoma]]).<ref name="urlHyperprolactinemia and Associated Pituitary Prolactinomas. : Obstetrics & Gynecology">{{cite web |url=http://journals.lww.com/greenjournal/abstract/1985/05000/hyperprolactinemia_and_associated_pituitary.12.aspx |title=Hyperprolactinemia and Associated Pituitary Prolactinomas. : Obstetrics & Gynecology |format= |work= |accessdate=}}</ref>
=== Basal plasma gonadotropins ===
* Some patients with amenorrhea may have reduced concentration of [[Luteinizing hormone|luteinizing hormone (LH)]] and [[FSH]], which is usually suggestive of amenorrhea due to [[hypothalamic]] and [[pituitary]] diseases.<ref name="DeligeoroglouAthanasopoulos2010" />
* Some patients with amenorrhea may have reduced concentration of [[LH]] and [[FSH]], which is usually suggestive of amenorrhea due to [[premature ovarian failure]].<ref name="pmid12773939">{{cite journal |vauthors=Santoro N |title=Mechanisms of premature ovarian failure |journal=Ann. Endocrinol. (Paris) |volume=64 |issue=2 |pages=87–92 |year=2003 |pmid=12773939 |doi= |url=}}</ref>
* Some patients with amenorrhea may have reduced concentration of [[LH]], which is usually suggestive of amenorrhea due to complete [[androgen insensitivity syndrome]].<ref name="HughesDeeb2006">{{cite journal|last1=Hughes|first1=Ieuan A.|last2=Deeb|first2=Asma|title=Androgen resistance|journal=Best Practice & Research Clinical Endocrinology & Metabolism|volume=20|issue=4|year=2006|pages=577–598|issn=1521690X|doi=10.1016/j.beem.2006.11.003}}</ref>
=== Estradiol ===
* Some patients with amenorrhea may have reduced concentration of [[estradiol]], which is usually suggestive of amenorrhea due to [[ovarian failure]].<ref name="pmid12773939" />
* Some patients with amenorrhea may have elevated concentration of [[estradiol]], which is usually suggestive of amenorrhea due to complete [[androgen insensitivity syndrome]].
* Some patients with amenorrhea may have reduced concentration of [[estradiol]], which is usually suggestive of amenorrhea due to [[pituitary]] causes.<ref name="pmid16722528">{{cite journal |vauthors=Beck-Peccoz P, Persani L |title=Premature ovarian failure |journal=Orphanet J Rare Dis |volume=1 |issue= |pages=9 |year=2006 |pmid=16722528 |pmc=1502130 |doi=10.1186/1750-1172-1-9 |url=}}</ref>
=== Progesterone ===
* Some patients with amenorrhea may have reduced concentration of [[progesterone]], which is usually suggestive of [[ovarian failure]].<ref name="TimmreckReindollar2003">{{cite journal|last1=Timmreck|first1=Lorna S.|last2=Reindollar|first2=Richard H.|title=Contemporary issues in primary amenorrhea|journal=Obstetrics and Gynecology Clinics of North America|volume=30|issue=2|year=2003|pages=287–302|issn=08898545|doi=10.1016/S0889-8545(03)00027-5}}</ref>
=== Free and total testosterone ===
* Some patients with amenorrhea may have elevated concentration of [[testosterone]], which is usually suggestive of amenorrhea due to complete [[androgen insensitivity syndrome]].<ref name="HughesDeeb2006" />
=== Dehydroepiandrosterone sulfate (DHEAS) ===
* Some patients with amenorrhea may have elevated concentration of [[Dehydroepiandrosterone sulfate|dehydroepiandrosterone sulfate (DHEAS)]], which is usually suggestive of amenorrhea due to [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]].<ref name="pmid15181052">{{cite journal |vauthors=Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO |title=The prevalence and features of the polycystic ovary syndrome in an unselected population |journal=J. Clin. Endocrinol. Metab. |volume=89 |issue=6 |pages=2745–9 |year=2004 |pmid=15181052 |doi=10.1210/jc.2003-032046 |url=}}</ref>
=== Delta 4-androstenedione ===
* Some patients with amenorrhea may have elevated concentration of [[Androstenedione|delta 4-androstenedione]], which is usually suggestive of amenorrhea due to [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]].<ref name="pmid16891296">{{cite journal |vauthors=Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS |title=A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome |journal=Hum. Reprod. Update |volume=12 |issue=6 |pages=673–83 |year=2006 |pmid=16891296 |doi=10.1093/humupd/dml036 |url=}}</ref>
=== 17-hydroxyprogesterone ===
* Some patients with amenorrhea may have elevated concentration of [[17-hydroxyprogesterone]], which is usually suggestive of amenorrhea due to [[congenital adrenal hyperplasia (CAH)]].<ref name="DeligeoroglouAthanasopoulos2010" />
=== Fasting insulin ===
* Some patients with amenorrhea may have elevated concentration of fasting [[insulin]], which is usually suggestive of amenorrhea due to [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]].<ref name="pmid20591140">{{cite journal |vauthors=Teede H, Deeks A, Moran L |title=Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan |journal=BMC Med |volume=8 |issue= |pages=41 |year=2010 |pmid=20591140 |pmc=2909929 |doi=10.1186/1741-7015-8-41 |url=}}</ref>
=== Fasting glucose (FBS) ===
* Some patients with amenorrhea may have elevated concentration of [[Fasting plasma glucose|fasting glucose (FBS)]], which is usually suggestive of amenorrhea due to [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]].
=== Insulin resistance indexes ===
* Some patients with amenorrhea may have elevated [[insulin resistance]] indexes, which is usually suggestive of amenorrhea due to [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]].


=== Adrenocorticotropic hormone (ACTH) ===
* Some patients with amenorrhea may have elevated concentration of [[Adrenocorticotropic hormone|adrenocorticotropic hormone (ACTH)]], which is usually suggestive of amenorrhea due to [[pituitary]] causes ([[Adreno-corticotrophic adenoma|ACTH-secreting adenoma]]).


==Laboratory Findings==
=== Cortisol ===
Any woman of child bearing potential should have a [[pregnancy test]] ordered to rule out [[pregnancy]].
* Some patients with amenorrhea may have elevated concentration of [[cortisol]], which is usually suggestive of amenorrhea due to [[pituitary]] causes ([[Adreno-corticotrophic adenoma|ACTH-secreting adenoma]]).
 
=== Markers of ovarian tumors ===
* Some patients with amenorrhea may have elevated concentration of markers of [[Ovarian cancer|ovarian tumors]], which is usually suggestive of [[ovarian failure]] (due to [[adenocarcinoma]]).
 
=== Progesterone challenge test ===
* [[Progesterone]] challenge test is used in secondary amenorrhea with normal female [[androgen]] in order to measure circulating [[estrogen]]. It reveals the insufficient [[endometrial]] estrogenization.
* It is consisted of [[Provera]] 10 mg PO for 7 days and then following for [[Menstrual bleeding|bleeding]]. If patient bleed it means that [[estrogen]] is repleted, [[Hypothalamic-pituitary-gonadal axis|hypothalamic-pituitary-ovarian (HPO) axis]] immaturity or [[PCOS]].<ref name="DeligeoroglouAthanasopoulos2010">{{cite journal|last1=Deligeoroglou|first1=Efthimios|last2=Athanasopoulos|first2=Nikolaos|last3=Tsimaris|first3=Pandelis|last4=Dimopoulos|first4=Konstantinos D.|last5=Vrachnis|first5=Nikolaos|last6=Creatsas|first6=G.|title=Evaluation and management of adolescent amenorrhea|journal=Annals of the New York Academy of Sciences|volume=1205|issue=1|year=2010|pages=23–32|issn=00778923|doi=10.1111/j.1749-6632.2010.05669.x}}</ref>
 
=== Leptin ===
* Some patients with amenorrhea may have reduced concentration of [[leptin]], which is usually suggestive of amenorrhea due to [[hypothalamic]] disorders.<ref name="WeltChan2004">{{cite journal|last1=Welt|first1=Corrine K.|last2=Chan|first2=Jean L.|last3=Bullen|first3=John|last4=Murphy|first4=Robyn|last5=Smith|first5=Patricia|last6=DePaoli|first6=Alex M.|last7=Karalis|first7=Aspasia|last8=Mantzoros|first8=Christos S.|title=Recombinant Human Leptin in Women with Hypothalamic Amenorrhea|journal=New England Journal of Medicine|volume=351|issue=10|year=2004|pages=987–997|issn=0028-4793|doi=10.1056/NEJMoa040388}}</ref>


Otherwise, consideration should be given to the following laboratory studies based upon clinical suspicion:
=== Inhibin ===
* [[Estradiol]]
* Some patients with amenorrhea may have reduced concentration of [[inhibin]], which is usually suggestive of amenorrhea due to [[ovarian failure]].<ref name="pmid16722528" />
* [[Prolactin]]
* [[Thyroid stimulating hormone]] ([[TSH]])
* [[Follicle stimulating hormone]] ([[FSH]])
* [[Luteinizing hormone]] ([[LH]])
* [[Testosterone]]
* [[17-hydroxyprogesterone]]
* [[Dehydroepiandrosterone-sulfate]] ([[DHEA-S]])


==References==
==References==

Revision as of 18:46, 28 September 2017

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

Overview

The most first laboratory tests for evaluating amenorrhea are pregnancy test, thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), and prolactin (PRL). Second line laboratory tests include free and total testosterone, dehydroepiandrosterone sulfate (DHEAS), and also progesterone challenge test.

Laboratory Findings

Abbreviations: TSH: Hemoglobin, T4: Thyroxin, Anti-TPO Ab: Anti-thyroid peroxidase antibodies, Anti-TSH-R Ab: Anti-thyroid stimulating hormone antibodies, PRL: Prolactin, LH: Luteinizing hormone, FSH: Follicle stimulating hormone, Prog.: Progesterone, DHEAS: Dehydroepiandrosterone sulfate, AD: Delta 4-androstenedione, 17-OH-Prog.: 17-hydroxyprogesterone, FBS: Fasting blood sugar, ACTH: Adrenocorticotropic hormone, HPO axis: Hypothalamus-pituitary-ovary axis.

Disease Laboratory tests
Pregnancy test TSH T4 Anti-TPO Ab Anti-TSH-R Ab PRL LH FSH Estradiol Prog. Testosterone DHEAS AD 17-OH-prog. Insulin FBS Insulin resistance indexes ACTH Cortisol Markers of ovarian tumors Prog. challenge test Leptin Inhibin
Pregnancy Positive ↑ ↓ +/- - ↑ - - - ↑ - - - - - - - - - - - - -
Hypothyroidism - ↑↑ ↓ +/- - - - - ↓ ↓ - - - - - - - - - - - - -
Hyperthyroidism - ↓↓ ↑ - - - - - ↓ ↓ - - - - - - - - - - - - -
Thyroiditis - ↑↑ ↓↓ Positive - - - - ↓ ↓ - - - - - - - - - - - - -
Graves' disease - ↓↓ ↑↑↑ - Positive - - - ↓ ↓ - - - - - - - - - - - - -
Hyperprolactinemia - - - - - ↑↑ ↓ ↓ ↓ ↓ - - - - - - - - - - - - -
Prolactinoma - ↓ ↓ - - ↑↑↑ ↓↓ ↓↓ ↓ ↓ - - - - - - - - - - - - -
Hypothalamic disease - ↓↓ ↓↓ - - ↓↓ ↓↓ ↓↓ ↓↓ ↓↓ - - - - - - - - - - - ↓↓ -
Premature ovarian failure - - - - - - ↑↑ ↑↑ ↓↓ ↓↓ - - - ↓ - - - - - - - - ↓↓
Androgen insensitivity syndrome - - - - - - ↑↑ ↑↑ ↓↓↓ ↓↓↓ ↑ ↑ ↑ - - - - - - - - - -
Polycystic ovary syndrome (PCOS) - - - - - - ↑ ↑ ↓ ↓ ↑ ↑ ↑ - ↑ ↑ ↑ - - - Positive - -
Congenital adrenal hyperplasia (CAH) - - - - - - ↑ ↑ ↓ ↓ - - - ↑ - - - - ↓ - - - -
ACTH-secreting adenoma - - - - - ↓ ↓↓ ↓↓ ↓↓ ↓↓ - - - - - - - ↑ ↑ - - - -
Ovarian adenocarcinoma - - - - - - ↑ ↑ ↓ ↓ - - - - - - - - - Positive - - -
HPO axis immaturity - - - - - - ↓↓ ↓↓ ↓↓ ↓↓ - - - - - - - - - - Positive - -
Imperforate hymen - - - - - - - - - - - - - - - - - - - - - - -
Asherman's syndrome - - - - - - - - - - - - - - - - - - - - - - -

Urine or serum pregnancy test

  • Some patients with amenorrhea may have positive urine or serum pregnancy test, which is usually suggestive of pregnancy-induced amenorrhea.[2]

Thyroid function tests[3]

Prolactin (PRL)

Basal plasma gonadotropins

Estradiol

  • Some patients with amenorrhea may have reduced concentration of estradiol, which is usually suggestive of amenorrhea due to ovarian failure.[7]
  • Some patients with amenorrhea may have elevated concentration of estradiol, which is usually suggestive of amenorrhea due to complete androgen insensitivity syndrome.
  • Some patients with amenorrhea may have reduced concentration of estradiol, which is usually suggestive of amenorrhea due to pituitary causes.[9]

Progesterone

Free and total testosterone

Dehydroepiandrosterone sulfate (DHEAS)

Delta 4-androstenedione

17-hydroxyprogesterone

Fasting insulin

Fasting glucose (FBS)

Insulin resistance indexes

Adrenocorticotropic hormone (ACTH)

Cortisol

Markers of ovarian tumors

Progesterone challenge test

Leptin

  • Some patients with amenorrhea may have reduced concentration of leptin, which is usually suggestive of amenorrhea due to hypothalamic disorders.[14]

Inhibin

  • Some patients with amenorrhea may have reduced concentration of inhibin, which is usually suggestive of amenorrhea due to ovarian failure.[9]

References

  1. ↑ Pereira K, Brown AJ (2017). "Secondary amenorrhea: Diagnostic approach and treatment considerations". Nurse Pract. 42 (9): 34–41. doi:10.1097/01.NPR.0000520832.14406.76. PMID 28832422.
  2. ↑ Master-Hunter T, Heiman DL (2006). "Amenorrhea: evaluation and treatment". Am Fam Physician. 73 (8): 1374–82. PMID 16669559.
  3. ↑ Rebar RW, Connolly HV (1990). "Clinical features of young women with hypergonadotropic amenorrhea". Fertil. Steril. 53 (5): 804–10. PMID 2110072.
  4. ↑ Patel, S. S.; Bamigboye, V. (2009). "Hyperprolactinaemia". Journal of Obstetrics and Gynaecology. 27 (5): 455–459. doi:10.1080/01443610701406125. ISSN 0144-3615.
  5. ↑ "Hyperprolactinemia and Associated Pituitary Prolactinomas. : Obstetrics & Gynecology".
  6. ↑ 6.0 6.1 6.2 Deligeoroglou, Efthimios; Athanasopoulos, Nikolaos; Tsimaris, Pandelis; Dimopoulos, Konstantinos D.; Vrachnis, Nikolaos; Creatsas, G. (2010). "Evaluation and management of adolescent amenorrhea". Annals of the New York Academy of Sciences. 1205 (1): 23–32. doi:10.1111/j.1749-6632.2010.05669.x. ISSN 0077-8923.
  7. ↑ 7.0 7.1 Santoro N (2003). "Mechanisms of premature ovarian failure". Ann. Endocrinol. (Paris). 64 (2): 87–92. PMID 12773939.
  8. ↑ 8.0 8.1 Hughes, Ieuan A.; Deeb, Asma (2006). "Androgen resistance". Best Practice & Research Clinical Endocrinology & Metabolism. 20 (4): 577–598. doi:10.1016/j.beem.2006.11.003. ISSN 1521-690X.
  9. ↑ 9.0 9.1 Beck-Peccoz P, Persani L (2006). "Premature ovarian failure". Orphanet J Rare Dis. 1: 9. doi:10.1186/1750-1172-1-9. PMC 1502130. PMID 16722528.
  10. ↑ Timmreck, Lorna S.; Reindollar, Richard H. (2003). "Contemporary issues in primary amenorrhea". Obstetrics and Gynecology Clinics of North America. 30 (2): 287–302. doi:10.1016/S0889-8545(03)00027-5. ISSN 0889-8545.
  11. ↑ Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO (2004). "The prevalence and features of the polycystic ovary syndrome in an unselected population". J. Clin. Endocrinol. Metab. 89 (6): 2745–9. doi:10.1210/jc.2003-032046. PMID 15181052.
  12. ↑ Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS (2006). "A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome". Hum. Reprod. Update. 12 (6): 673–83. doi:10.1093/humupd/dml036. PMID 16891296.
  13. ↑ Teede H, Deeks A, Moran L (2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Med. 8: 41. doi:10.1186/1741-7015-8-41. PMC 2909929. PMID 20591140.
  14. ↑ Welt, Corrine K.; Chan, Jean L.; Bullen, John; Murphy, Robyn; Smith, Patricia; DePaoli, Alex M.; Karalis, Aspasia; Mantzoros, Christos S. (2004). "Recombinant Human Leptin in Women with Hypothalamic Amenorrhea". New England Journal of Medicine. 351 (10): 987–997. doi:10.1056/NEJMoa040388. ISSN 0028-4793.


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