119 amenorrheic Patients were diagnosed in the department of Obstetrics ana Gynecology of Chungnam National University Hospital and Hanyang University Hospital during the period of 57 months from November, 1979,to July, 1984.
The retrospective study was undertaken to determine whether or not the division of patients with amenorrhea into specific categories based on physical findings and srecific laboratory tests would be valid and useful for the differential diagnosis of amenorrhea.
The results obtained were as follows :
1. Of 119 amenorrheic patients 38 patients (31.9%) were primary type and 81 patients (68.1%)were secondary type.
2. Of 38 primary amenorrheic patients the most common cause of the amenorrhea was hypos-onadotrophic hypogonadism (9 cases). The cause of the remainder was Turner syndrome (5 cases),testicular feminization (5 cases), gonadal dysgenesis (3 cases), hypothalamic dysfunction (3 cases),hypothalamo-pituitary failure (3 cases:, Rokitansky syndrome (2 cases), pituitary adenoma (2cases), Stein-Leventhal syndrome (2 cases), of arian failure (2 cases), CO poisoning (1 case) andanorexia nervosa (1 case).
3. Of 81 secondary amenorrheic patients the most common cause of amenorrhea was hypotha-lamic dysfunction (42 cases). The cause of the remainder was functional hyperprolactinemia (11cases), premature menopause (9 :.cases), Stein-Let´enthal s)·ndrome (6 cases), hypothalamo-pituitary failure (5 cases), pituitary adenoma (4 cases), hypothrroidism (1 case), empty sella syndrome (1 case), Sheehan´s syndrome tl case) and adrenal masculinizing tumor (1 case).
4. 119 amenorrheic patients were classified into 3 group : 1) breast development absent and uterus present (17 cases), 2) breast development present and uterus absent (7 cases), and 3) both treast development and uterus present (95 cases) .
5. Patients in category 1 were diagnosed as having hypogonadotrophic hypogonadism or gonadal dysgenesis. Patients in category 2 were diagncsed as having Rokifansky syndrome or testicular feminization. Patients in category 3 were diagnosed as having ovarian failure, Stein-Leventhal syndrome, hyperprolactinemia, hypothalamc dysfunction, or hypothalamo-pituitary failure.
6. Patients in category 1 could to differentiated by measurement of serum FSH level. Patients in category 2 could he differentiated Or chromosome study. Patients in category 3 could be differentiated by following method. By measurement of serum FSH levl ovarian failure was differentiated. Of the remaining patients, patients with Stein-Leventhal syndrome were identified by measurement of serum LH. The next step of measurement of serum prolactin couldidentifr hrperprolactinemia. The remaining patients were divided into hypothalamic dysfunction or hypothalamo-pituitary failure by progesterone withdrawal test.
This study demonstrated that it is possible to classily patients with primary or second arfamenorrhea into 3 useful diagnostic categories based on physical examination and minimal laboratory test.
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