❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Ch...
gynaecology.Primary amenorrhea.(dr.sundus)
1.
2.
3.
4.
5.
6. Amenorrhea is only a manifestation of the problem. Problem may be endocrinologic or embryologic: +/- secondary sexual characteristics +/- female internal genitalia
7.
8.
9.
10. Endocrinological Four Sub phenotypes (Breast & uterus ) 1. A bsent breast + presence of uterus 2. Presence breast + absence uterus 3. Absence breast + absence uterus 4 . Presence breast + presence uterus
11. FSH Serum level Low / normal High Hypogonadotropic hypogonadim (hypothalamic- pituitry) Hypergonadotropic Hypogonadism (gonadal dysgenesis)
33. History and physical examination completed for a patient with primary amenorrhea Secondary sexual characteristics present No Yes Measure FSH and LH levels Uterus absent or abnormal Uterus present or normal Karyotype analysis Outflow obstruction FSH and LH < 5 IU/ L Hypogonadotropic hypogonadism Hypergonadotropic hypogonadism Karyotype analysis 46, XY 46, XX No Yes Evaluate for secondary amenorrhea Imperforate hymen or transverse vaginal septum Perform ultrasonography of uterus Evaluation of Primary Amenorrhea FSH > 20 IU/ L and LH > 40 IU/ L Karyotype analysis CNS; HP Disorder Gonadal Failure Mullerian Agenesis Androgen Sensitivity Syndrome