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PRIMARY AMENORRHOEA [PRIMARY HYPOGONADISM IN FEMALES] |
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hypogonadotrophic [low LH and FSH]: |
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hypothalamic: |
Kallman's syndrome [+ anosmia]hypothyroidism [causes low LHRH] |
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functional: |
diet-induced / weight-related amenorrhoea stress anorexia nervosa regular exercise [juvenile athletes] |
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pituitary: |
tumours, eg. craniopharyngioma, prolactinoma |
NB: on giving LHRH, no LH / FSH response occurs with pituitary tumours, but there is a rise if the cause is hypothalamic
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hypergonadotrophic [increased LH and FSH]: |
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polycystic ovary syndrome [raised LH / FSH ratio to >2:1; raised testosterone]Turner's syndrome [45XO karyotype; typical features]testicular feminisation [= androgen insensitivity; 46XY karyotype]ovarian dysgenesis [any karyotype]congenital adrenal hyperplasia [various defects]primary ovarian failure [? autoimmune]previous chemotherapy or radiotherapy with damage to ovaries androgen-secreting ovarian / adrenal tumours [occurring before puberty] |
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congenital uterovaginal abnormalities: |
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imperforate hymen / vagina / cervix absent vagina / Mullerian agenesis |
NB: main causes of amenorrhoea with virilisation are:
congenital adrenal hyperplasia (primary amenorrhoea)
androgen-secreting tumours (primary or secondary amenorrhoea)
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