1. Reproductive and endocrine disease Shujun Gao

2. Individual Each in normal position Each keeps normal activity Each has normal reaction

3. System Normal——interaction in balance Dysfunction——lost of balance

4. Inferior colliculus GnRH Pituitary gland Gonadotropi n FSHLH progestogen estrogen Center stratum cutaneum ？ Reproductive endocrine axis

5. amenorrhea xxx ， 16-year-old with secondary sexual characters ， but absence of menstruation Question ： What is the diagnosis and how to treat?

6. Correlated knowledge The initiate and maintain of the normal menstruation Normal growth sequence of puberty Conditions of ovarian growth Physiologic function of ovarian Methods of examination of ovarian function

7. Causation and pathophysiology Hypothalamic amenorrhea Pituitary amenorrhea Ovarian amenorrhea Uterine amenorrhea Congenital dysplasia of low genital tract Dysfunction of other endocrine glands

8. Definition It is a common symptom,not a disease Primary amenorrhea ： secondary sexual characters not appears after 14-years or no menarche after 16- years although secondary sexual characters appeared. Secondary amenorrhea ： cessation of the periods for 6months after menstruation has been established

9. Classification (one) Primary amenorrhea——most due to congenital diseases or functional disorder and deformed genital tract,about 5% 。 Secondary amenorrhea——most due to secondary dysfunction or tumor,about 95% 。

10. Classification (two) Physiologic amenorrhea Pathological amenorrhea

11. Classification （ three ） According to the anatomic site Congenital dysplasia of low genital tract Uterine amenorrhea Ovarian amenorrhea Pituitary amenorrhea Central nerve-hypothalamic amenorrhea

12. Classification （ four ） According to the level of sex hormone Hypergonadotropic hypogonadism ： FSH≥30IU/L ， lesion presence in ovarian hypogonadotropic hypogonadism ： FSH and LH both<5IU/L ， lesion presence in center

13. Dysfunctional uterine bleeding Patient ——Troubled by dysfunctional uterine bleeding sees a doctor to resolve bleeding and to get normal menstruation Doctor —— you ， should know how to satisfy the patient To solve the problem, diagnosis, differential diagnosis and treatment should be mastered

14. Patient ： 17-year-old ， 46kg Chief complaint ： menstrual disorder for 2 months,vaginal bleeding for 18 days Menstruation: 11year 5-7/20-30days 。 Pmp 2007.07.03,Lmp 2007 08.24 。 History of present illness: She had a heavy vaginal bleeding from September 5th, 2007,accompany with dizziness, vertigo and fatigue,and was hospitalized emergency Medical examination: T36.7 、 P88cpm 、 R21cpm 、 BP90/50mmg. depressed with an anemia face Gynecology examination ： corpus ： middle position with normal size adnexa ： no masses ultrasound: UT46× 45×40mm, EN10mm ROV31×28×23mm, LOV33×17×16mm. Cul-de-sac hydrops ： 18mm.

15. discussion diagnosis ： puberty dysfunctional uterine bleeding secondary anemia Procedure of diagnosis: history of illness medical examination gynecological examination auxiliary examination ： urine HCG 、 ultrasound 、 sex hormone 、 blood routine. Therapeutics ： sex hormone diagnostic curettage antibiotics treatment of anemia