Amenorrhea is a simple symptom though expected to be caused by so various= and diverse etiologies that it usually induces a complicated controversy and represents a confusing and difficult diagnostic dilemma to the most clinicians. Therefore, an organized systemic approach is essential to achieve an efficent and. correct diagnosis even many articles about a simplified approach to the diagnosis of amenorrhea have been proposed.
In this study a new flow diagram for the approach to. the diagnosis of amenorrhea was tried and this was thought to be useful for the advanced evaluation. in clinical point of view.
The materials were 28 primary and secondary amenorrheic patients seen in theDepartment of Obstetrics and Gynecology of Hanyang University Hospital during the period of 13 months from July, 1979 to July, 1980 and 5 clinical groups were classified as following;
1. Four patients (14.3%) were classified as hyperprolactinemia group. Three patients of these had galactorrhea. One of four patients had a pituitary adenoma. The prolactin level was over 27. Ing/ml and FSH level or LH level were in normal range except one.
2. Ten patients (35.7%) were classified as hypothalamo-pituitary dysfunction group. None of these was subclassified as Stein-Leventhal syndrome. These patients had a normal estradiol level (mean 47.08pg/ml). LH level was also, in normal (mean 16.87mIU/ml), but FSH level was in low normal (mean 6.58mIU/ml).
3. Six patients (21. 5 % )) were classified as hypothalamo-pituitary failure groupOne of these was subclassified as Sheehan´s syndrome. These patients had low FSH level (mean 2. 31mIU/ml), low normal LH level (mean 8.34mlU/ml) and very low estradiol level (less than 25pg/ml), which were markedly lower level than the hypothalamo-pituitary dysfunction group.
4. Six patients (21.5 %) were classified as ovarian failure group. Of these one: patient was subclassified as true hermaphroditism, one as premature meno pause, one as mixed gonadal dysgenesis, one as Turner´s syndrome and two as streak gonad syndrome. These patients had very high FSH level (mean_ 128. 06mIU/ml). LH level was also more or less increased(mean 48.5mIU/ml) but estradiol level was markedly decreased (less than 25pg/ml). For the subclassification of this group, karyotypic analysis of chromosome and diagnostic laparoscopy were useful procedures.
5. Two patients (7. 0 %) were classified as end organ defect group. One of these was subclassified as Asheiinan´s syndrome by means of serum progesterone and hysterosalpingogram and the other was subclassified as testicular feminization by means of karyotypic analysis of chromosome and laparoscopy.
|