CASE PRESENTATION (4)(6)(7)

Case 1: 17 yo female with primary amenorrhea Normal pubertal development Normal health No family history of delayed puberty Not involved in athletics Does well in school Not taking any meds

Case 1: Physical Exam Laboratory values Thin young woman (10% below IBW) Normal genitalia No galactorrhea Tanner stage 4 Laboratory values Urine and serum B-HCG negative Prolactin, FSH, TSH all normal

Case 1: Further history Patient’s parents concerned about her eating habits (very low fat intake and restricting calories)

Diagnose in case 1: Hypothalamic Amenorrhea Etiology is most likely inadequate caloric and fat intake. Patient should be referred for evaluation for an eating disorder. Chances of normal menstruation are very good if patient takes in adequate calories.

Diagnose in case 1: Hypothalamic Amenorrhea Etiology is most likely inadequate caloric and fat intake. Patient should be referred for evaluation for an eating disorder. Chances of normal menstruation are very good if patient takes in adequate calories.

Case 2: 32 years old woman with secondary amenorrhea Menarche at age 12 Periods have always been irregular Now amenorrhea for resent 10 months Overweight Wants to get pregnant

Case 2: Physical Exam Obese female Acne Normal genitalia Mild hirsutism

Case 2: Laboratory findings Urine B-HCG negative TSH, FSH and Prolactin normal Testosterone 180 ng/mL Pelvic U/S findings show polycystic ovaries

U/S findings in PCOS

Case 3: 29 yo woman with 18-month h/o amenorrhea Normal development No family history of amenorrhea Does not exercise excessively or restrict diet Denies galactorrhea Has h/o abortion with subsequent D & C

Case 3: Physical Exam Normal exam No galactorrhea

Case 3: Laboratory findings Urine B-HCG negative Prolactin normal TSH, FSH, LH all was normal

Case 3: Further work-up Fails Provera challenge Fails 1-month trial of estrogen + progesterone Pelvic U/S shows no uterine stripe Hysteroscope confirms diagnosis of…Asherman’s Syndrome