1. CASE PRESENTATION (4)(6)(7)

2. 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

3. 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

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

5. 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.

6. 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.

7. 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

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

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

10. U/S findings in PCOS

11. 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

12. Case 3: Physical Exam
Normal exam
No galactorrhea

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

14. 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