Amenorhea妇产科仁济临床医院.ppt

Amenorrhea,DIWENM.D.,Ph.D.,Professor&ChairmanDepartmentOfObstetrics&GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicine,2,2006-11-15七年制,Amenorrhea,Amenorrhea,Amenorrheaistheabsenceofmenstruation.PrimarySecondary,Absenceofmensesbyage16withnormalsecondarysexualcharacteristicsAbsenceofmensesbyage14withoutsecondarysexualdevelopment,Absenceofmensesfor6monthsinapreviouslymenstruatingfemale,3,2006-11-15七年制,Amenorrhea,EventsofPuberty,Thelarche(breastdevelopment)RequiresestrogenPubarche/adrenarche(pubichairdevelopment)RequiresandrogensMenarcheRequires:GnRHfromthehypothalamusFSHandLHfromthepituitaryEstrogenandprogesteronefromtheovariesNormaloutflowtract,4,2006-11-15七年制,Amenorrhea,5,2006-11-15七年制,Amenorrhea,Classificationofamenorrhea,hypothalamicamenorrheapituitaryamenorrheaovarianamenorrheauterineamenorrhea,6,2006-11-15七年制,Amenorrhea,Etiology,hypothalamicamenorrheaPsychologicalstress5a-ReductasedeficiencyAnorexianervosa,weightlossIncreasedexerciselevelsKallmannsyndromedrug-inducedamenorrheaSpace-occupyinglesionofCNS,7,2006-11-15七年制,Amenorrhea,Etiology,pituitaryamenorrheatumorEmptysellasyndromeSheehansyndrome,8,2006-11-15七年制,Amenorrhea,Etiology,ovarianamenorrheaGonadaldysgenesisTurnersyndrome:lowhairline,webneck,shieldchest,andwidelyspacednipples)SwyersyndromeresistantovarysyndromePrematureovarianfailure,9,2006-11-15七年制,Amenorrhea,Tunnerstaging,10,2006-11-15七年制,Amenorrhea,Acanthosisnigrans,11,2006-11-15七年制,Amenorrhea,Striae,12,2006-11-15七年制,Amenorrhea,TypicalfeaturesofTurnerSyndrome,13,2006-11-15七年制,Amenorrhea,Etiology,uterineamenorrheaAbsenceofuterusAshermansyndromeanatomicabnormalitiesofthereproductivetractImperforateHymen,14,2006-11-15七年制,Amenorrhea,ImperforateHymen,15,2006-11-15七年制,Amenorrhea,Mayer-Rokitansky-Kuster-HauserSyndrome(utero-vaginalagenesis),15%ofprimaryamenorrheaNormalsecondarydevelopment&externalfemalegenitaliaNormalfemalerangetestosteronelevelAbsentuterusanduppervagina&normalovariesKaryotype46-XX15-30%renal,skeletalandmiddleearanomalies,16,2006-11-15七年制,Amenorrhea,AndrogenInsensitivity,NormalbreastsbutnosexualhairNormallookingfemaleexternalgenitaliaAbsentuterusanduppervaginaKaryotype46,XYMalerangetestosteronelevelTreatment:gonadectomyafterpuberty+HRT,17,2006-11-15七年制,Amenorrhea,Diagnosis,HistoryPhysicalexaminationPhysicalexaminationbeginswithvitalsigns,includingheightandweight,andwithsexualmaturityratingsLaboratoryevaluation,18,2006-11-15七年制,Amenorrhea,VE-pregtest,TSH,PROLACTIN,Prog.challengetest,withdrawalbleeding,withoutwithdrawalbleeding,hypoestrogenic,compromisedoutflowtract.,+ve.est,progest.challengetest,-ve.est,progest.challengetest,FSH30-40,NormalFSH,HSGORhysteroscopyasherman,2wk,FSHnorm.,repeat,Repeat+serum,est.level,PROF,hypothalamic-pituitaryfailure,anovulation,19,2006-11-15七年制,Amenorrhea,Treatment,treatmentvariesdependinguponthecausesoftheamenorrhea.Treatmentoptionsinclude:Dietarychanges,includinganincreaseinfatandcaloriesinordertostimulateestrogenproduction.Counselingforeatingdisorders.Usingstressreductiontechniquestohelpregulatetheperiod.Hormonalsupplements,likethebirthcontrolpillorpatch,orhormonereplacementtherapy.Surgerytor