Slide No. 9: (2 Marks)

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Slide No. 9 (2 Marks)
A 15 years female complaining of delayed
menarche Findings(A) Inspection of abdomen
(B) Inspection of vulva

• Most Probable Diagnosis Imperforate Hymen
• Treatment Hymenectomy or Hymontomy

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Slide No. 5 (2 Marks)
A 16-years girl with delayed menarche

• What is your diagnosis? Imperforate Hymen
• The most serious complication of this operation
  Infection

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Slide No. 7
Ovarian findings
Ultrasonography
Laparoscopy
Gross appearance

• Name three possible complains?
• 1. Hirsutism.
• 2. Oligmenorrhea / amenorrhea.
• 3. Infertility.

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SLIDE 1
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SLIDE 2
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SLIDE 9
UTERUS
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Ultrasonography
Abdominal Examination
During surgery
Local Examination
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Imperforate hymen
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Utero-vaginal Agenisis Mayer-Rokitansky-Kuster-Ha
user syndrome

• 15 of 1ry amenorrhea
• Normal breasts and Sexual Hair development
  Normal looking external female genitalia
• Normal female range testosterone level
• Absent uterus and upper vagina Normal ovaries
• Karyotype 46-XX
• 30 renal,10 skeletal and middle ear anomalies
• Treatment STERILE ? Vaginal creation(Dilatation
  VSVagino-plasty)

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Androgen insensitivityTesticular feminization
syndrome

• X-linked recessive gene.
• Absent cytosol receptors
• Normal breasts but no sexual hair
• Normal looking female external genitalia
• Absent uterus and upper vagina
• Karyotype 46, XY
• Male range testosterone level
• Treatment gonadectomy after puberty HRT
• ? Vaginal creation (dilatation VS Vaginoplasty )

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Slide No. 10 (2 Marks)
A 18-years girl with primary amenorrhea
146 cm.
Ovary
Uterus

• What is the most probable diagnosis Turners
  syndrome
• Sure diagnosis is by Karotyping (45 0X)

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Turners syndrome
Mosaic (46-XX / 45-XO)
(Classic 45-XO)
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Ovarian dysgenesis
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AMENORRHEAAbsent or poor secondary sex
Characteristics
FSH Serum level
Low / normal
High
Hypogonadotropic hypogonadim
Gonadal dysgenesis
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Hypogonadotrophic Hypogonadism

• Normal hight
• Normal external and internal genital organs
  (infantile)
• Low FSH and LH
• MRI to R/O intra-cranial pathology.
• 30-40 anosmia (kallmanns syndrome)
• Sometimes ? constitutional delay
• Treat according to the cause (HRT), potentially
  fertile.

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Cushings syndrome

• Clinical suspicion Hirsutism, truncal obesity,
  purple striae,? BP
• If Suspicion is high
• dexamethasone suppression test (1 mg PO 11 pm
  ) and obtaine serum cortisol level at 8 am
• lt 5 µg/ dl excludes cushings
• 24 hours total urine free cortisol level to
  confirm diagnosis
• 2 forms adrenal tumour or ACTH hypersecretion
  (pituitary or ectopic site)

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Weight-related amenorrhoeaAnorexia Nervosa

• 1o or 2o Amenorrhea is often first sign
• A body mass index (BMI) lt17 kg/m²? menstrual
  irregularity and amenorrhea
• Hypothalamic suppression
• Abnormal body image, intense fear of weight gain,
  often strenuous exercise
• Mean age onset 13-14 yrs (range 10-21 yrs)
• Low estradiol ? risk of osteoporosis
• Bulemics less commonly have amenorrhea due to
  fluctuations in body wt, but any disordered
  eating pattern (crash diets) can cause menstrual
  irregularity.
• Treatment ? body wt. (Psychiatrist referral)

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Exercise-associated amenorrhoea

• Common in women who participate in sports (e.g.
  competitive athletes, ballet dancers)
• Eating disorders have a higher prevalence in
  female athletes than non-athletes
• Hypothalamic disorder caused by abnormal
  gonadotrophin-releasing hormone pulsatility,
  resulting in impaired gonadotrophin levels,
  particularly LH, and subsequently low oestrogen
  levels

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Ashermans syndrome