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Sample records for amenorrhea

  1. Amenorrhea associated with carotenemia.

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    Kemmann, E; Pasquale, S A; Skaf, R

    1983-02-18

    Data are presented for ten women with anovulation, nine of them with amenorrhea, who have associated carotenemia. Classic explanations for carotenemia in amenorrheic patients have been weight loss or anorexia nervosa, yet carotenemia in our patients appeared to be diet induced. All patients consumed a pure or predominantly vegetarian diet; there was no intake of red meats. Clinical and laboratory data of the patients are presented. The amenorrhea of the patient is consistent with hypothalamic hypogonadotropic anovulation (HHA). It appeared that diet modification not only led to reduction in carotene levels, but also improved the menstrual status. The association of carotenemia and menstrual disorders is reviewed. The possibility that carotenemia is related to the development of HHA is discussed. PMID:6823046

  2. [Cytogenetic studies in primary amenorrhea].

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    Baron, J; Warenik-Szymankiewicz, A

    1975-01-01

    Cytogenetic analysis in 125 women with primary amenorrhea consisting of determinations of sex chromatin and karyotype, and in some cases of autoradiography were performed. On the basis of clinical, endocrinologic and cytogenetic criteria, the women were divided into ten clinical groups. In Turner's syndrome 45,X monosomie was observed only in 9 patients and in the remaining 12 cases varies types of mosaicism or of structural aberrations of the X chromosome. In pure gonadal dysgenesis, the patients exhibited 46,XY karyotype have the tendency to malign tumors of the gonads. In all cases with male pseudohermaphroditism the karyotypes 46,XY were observed. The remaining patients with primary amenorrhea exhibited 46,XX karyotype and belonged to the cases with Mayer-Rokitansky-Kustner syndrome, with adrenogenital syndrome, with hypoplasia of the ovaries, with primary amenorrhea of uterine or pituitary origin or at last with pubertas tarda. PMID:1189755

  3. Cytogenetic analysis of patients with amenorrhea

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    Zhang Ying; Zhang Xiu-ling; Li Yan

    2006-01-01

    Objective: To analyse the cytogenetic examination results and investigate the effect of chromosome abnormalities on amenorrhea.Methods: The routine cytogenetic analysis was performed, including the chromosome G band analysis and karyotype analysis of the cultured peripheral blood lymphocytes from the patients with primary amenorrhea or secondary amenorrhea.Results: One hundred and thirty-seven cases were found with chromosome abnormalities in 234 patients with primary amenorrhea. The incidence of chromosome abnormality was 58.6%. In 309 with secondary amenorrhea, the incidence of chromosome abnormality was 13.6%.The reported abnormalities included the numerical and structural abnormalities of X chromosome, 46,XY, 45,X0/46,XY,and the structural abnormality of autosome.Conclusions: Chromosome abnormality is one of the main causes of amenorrhea. Karyotype analysis of chromosome is absolutely necessary for the diagnosis and treatment of patient with amenorrhea.

  4. Amenorrhea

    Science.gov (United States)

    ... the pituitary • Increased prolactin by a small benign tumor • Pituitary damage • Radiation to the head Abnormal balance of other hormones • Polycystic ovary syndrome • Adrenal or thyroid gland disorders Scarring of the uterus • Some uterine procedures ...

  5. Ovarian biopsy in the evaluation of amenorrhea.

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    Karam, K; Mroueh, A

    1978-01-01

    Endoscopic ovarian biopsies were performed on 78 amenorrheic patients in an attempt to determine the etiology of their amenorrhea and predict its prognosis, correlating the histologic examination with physical findings, endocrine patterns and cytogenetic studies. Ovarian follicles were present while gonadotropins were high in 14 cases (6 primary, 8 secondary) and there were no follicles in 4 cases (3 primary, 1 secondary) whose gonadotropins were low. Secondary sex characteristics were well developed without prior estrogen stimulation in 5 cases of primary amenorrhea who had no follicles and whose gonadotropins were either low, 3, or high, 2. The mere presence of ovarian follicles was not enough to make them responsive to gonadotropin stimulation whether endogenous or exogenous; a phenomenon that had to do with the quality and quantity of germinal follicles available. The histologic examination of ovarian tissue for the evaluation of amenorrhea has been made feasible and relatively safe through recent advances in endoscopic techniques. PMID:151477

  6. Primary Amenorrhea with Bilateral Endometriotic Cysts

    International Nuclear Information System (INIS)

    Primary amenorrhea is a common problem. Diagnosis is usually by going through systematic approach of history, examination and investigations. This case had bilateral large endometriotic cysts in the adnexal region. Uterus was normal sized with well-formed endometrium. She underwent laparotomy followed by drainage of endometriotic cysts, stripping and reconstruction of ovaries was performed. Patient was given a trial of combined oral contraceptive pills for two consecutive cycles to observe withdrawal bleeding, but it failed. Till now we are unable to find out such case in literature. Exact case of primary amenorrhea could not be found. (author)

  7. Cytogenetic investigation of patients with primary amenorrhea

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    K Vijaya Laxmi

    2012-01-01

    Full Text Available Primary amenorrhea refers to absence of spontaneous menarche even after the age of 16. Cytogenetic analysis in two cases with primary amenorrhea, short stature, poorly developed secondary sexual characteristics, and growth retardation were studied. Routine GTG-band analysis of metaphases from peripheral blood leucocytes revealed female karyotype with a 15(ps+ and an isochromosome of X, i(Xq, in one patient and 46,X, i(Xq, in another patient. Ascertainment of the karyotype aided in confirmation of the provisional diagnosis, a better phenotype-genotype correlation to understand clinical heterogeneity in genetic counseling.

  8. Delayed Menarche and Amenorrhea in Ballet Dancers

    OpenAIRE

    Frisch, Rose Epstein; Wyshak, Grace; Vincent, Larry

    1980-01-01

    YOUNG female ballet dancers attending professional schools or dancing in companies in which thinness is much admired restrict their food intake and are highly active. The unusual eating habits and levels of activity of some of these dancers have been related to lack of menstrual cycles.1 Amenorrhea and late menarche among girls and women with average activity levels are associated with undernutrition and weight loss in the range of 10 to 15 per cent of the normal weight for height; such weigh...

  9. Cytogenetic investigation of 468 patients with primary amenorrhea

    Institute of Scientific and Technical Information of China (English)

    Yu Hong; Bian Xu-min; Liu Jun-tao; Hao Na; Zhou Jing; Liu Shan-ying

    2010-01-01

    Objective: To analyze the relationship between karyotypes and clinic features of patients with primary amenorrhea. Method: G-banding was employed in karyotype analysis of patients with primary amenorrhea. Results: Karyotype analysis of 468 patients with primary amenorrhea revealed that 255 patients (54.49%) had normal female karyotypes and 213 patients (45.41%) had abnormal karyotypes, including 143 patients with abnormal X chromosome, 4 patients with mosaic X-Y chromosome, 57 patients with 46,XY karyotype, 8 patients with abnormal autosome and one patient with X-autosome translocation. All primary amenorrhea patients with deletion or break-up in Xp11.1-11.4 were short in stature. Conclusion: One of the main reasons of primary amenorrhea was chromosome abnormalities, especially sex chromosome abnormalities. Karyotype analysis should be routinely applied to detect primary amenorrhea patients. Xp11-12 may be critical to development of stature.

  10. True hermaphrodite presenting as primary amenorrhea

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    Lal Bahadur Palo

    2012-01-01

    Full Text Available True hermaphrodite is one of the rare variety of disorders of sex development. Most of them are genotypically females (46 XX and present as under virilized males. Features of hyperandrogenism are present in those reared as females. The commonest histological variety of gonad found in them is ovotestis, which is at risk for malignancy. We report a girl with 46 XY true hermaphrodite without ovotestis presenting as primary amenorrhea and isolated clitoromegaly in the absence of any other features of virilization.

  11. A Rare Case of Primary Amenorrhea with Two Etiologies, Hypothalamic Amenorrhea, Transverse Vaginal Septum, and No Hematocolpos

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    Firouzeh Ghaffari

    2015-01-01

    Full Text Available We reported a rare case of hypothalamic amenorrhea and transverse vaginal septum. A 28-year-old woman presented with primary amenorrhea and no complaint of abdominal pain. Laparoscopy revealed a small rudimentary uterus with streak ovaries and a vaginal pouch. The patient with diagnosis of Mayer-Rokitansky-Kuster-Hauser (MRKH syndrome was subjected to a vaginoplasty in another fertility center. In our institute, after two courses of estrogen and progesterone, sonography revealed hematocolpos, while, under anesthesia, transverse vaginal septum was resected. Hysteroscopy revealed normal uterine cavity. She became pregnant 5 months postoperatively with controlled ovarian stimulation (COS in conjunction with intrauterine insemination, and she has two healthy babies now. This case highlights the importance of careful evaluation of all primary amenorrheas. Clinicians should be aware of presence of more than one etiology which causes atypical presentations and accomplishes a systematic strategy for the evaluation of amenorrhea potential to avoid long-term side effects of a misdiagnosis.

  12. Frequency of primary amenorrhea due to chromosomal aberration

    International Nuclear Information System (INIS)

    Objective: To find out the frequency of primary amenorrhea due to chromosomal aberration and the different options available for management. Subjects and Methods: All patients with primary amenorrhea due to chromosomal aberrations were included in study. Patient's detailed history, general physical examination, presence or absence of secondary sexual characteristics, abdominal and pelvic examination finding were noted. Targeted investigations, including ultrasound, hormonal assay, buccal smear and karyotyping results were recorded. The management options were individually tailored with focus n psychological management. Results: Eighteen patients out of 30,000 patients were diagnosed as having primary amenorrhea. Six had primary amenorrhea due to chromosomal aberrations with the frequency of 0.02%. The age at presentation was 20 years and above in 50%. The most common cause was Turner's syndrome seen in 4 out of 6. The presenting symptoms were delay in onset of menstruation in 05 patients and primary infertility in 01 patient. Conclusion: Primary amenorrhea due to chromosomal aberration is an uncommon condition requiring an early and accurate diagnosis. Turner's syndrome is a relatively common cause of this condition. Management should be multi-disciplinary and individualized according to the patient's age and symptom at presentation. Psychological management is very important and counselling throughout treatment is recommended. (author)

  13. Postpartum Sexuality and the Lactational Amenorrhea Method for Contraception.

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    Labbok, Miriam H

    2015-12-01

    This chapter reviews the literature on postpartum coital behavior, anovulatory and ovulatory bleeding episodes, and the methodology and efficacy of Lactational Amenorrhea Method and progesterone-only oral contraceptives. Of interest is the finding that breastfeeding women may resume coital behavior earlier postpartum, but report increased discomfort over time. The high efficacy of the Lactational Amenorrhea Method is confirmed and data illustrating possible relaxation of some criteria are presented. The conflicting guidance of CDC and WHO concerning immediate postpartum use of progestin-only methods is presented. The dearth of recent studies calls for new research on these topics. PMID:26457855

  14. Bromocryptine therapy in cases of amenorrhea-galactorrhea.

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    Mroueh, A M; Siler-Khodr, T M

    1977-02-01

    Of 28 patients presenting with amenorrhea-galactorrhea, pituitary tumors were confirmed in eight. Six patients had occult hypothyroidism and the rest had an endocrine profile suggestive of pituitary tumor or of an idiopathic etiology. Treatment with bromocryptine resulted in suppression of the inappropriate lactation and restoration of regular menstrual function. In five cases, however, the galactorrhea was only diminished and in four of these cases, normal ovarian function did not return. Of the 19 patients that were seeking fertility and continued the medication for at least 20 days, nine pregnancies resulted. A similar response to bromocryptine was observed regardless of the underlying cause of the amenorrhea-galactorrhea. PMID:576372

  15. Chromosomal abnormalities and hormonal disorders of primary amenorrhea patients in Egypt

    OpenAIRE

    Faeza El-Dahtory

    2012-01-01

    Background: Primary amenorrhea is defined as the absence of menstruation and secondary sexual characteristics in phenotypic women aged 14 years or older. Hormonal disorders are main causes of primary amenorrhea. Common hormonal cause of primary amenorrhea includes pituitary dysfunction and absent ovarian function. The aim of this study was to estimate the incidence and types of chromosomal abnormalities in patients with primary amenorrhea in Egypt. Materials and Methods: Chromosomal analys...

  16. What is the Health Risk Associated with Amenorrhea?

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    Vrkljan, Milan; Brkić, Marijo; Zečević, Ana-Marija; Topić, Patricija

    2001-01-01

    Amenorrhea is one of the most common symptoms in the woman’s health pathology. It can be caused by anatomical defects of the outflow tract (uterus, cervix, vagina), thus being in the gynecologist’s domain, or can be observed in gonadal dysgenesis (Turner’s syndrome), hypopituitarism (Sheehan’s syndrome), prolactin-secreting pituitary tumors, Cushing’s syndrome, hyperthyroidism, stress, anorexia nervosa, polycystic ovaries, and in women upon discontinuation of oral contraceptives, especially i...

  17. The -female athlete triad-: Eating disorders - amenorrhea- osteoporosis

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    Maria Polikandrioti

    2007-01-01

    Full Text Available The female athlete triad is a syndrome which consists of eating disorders, amenorrhea and osteoporosis. The syndrome is increasing in prevalence over the last thirty years, as more women are participating in sports at a competitive level. The aim of the present study was to review the research data regarding the female athlete triad in order to underline the significance of the problem. The method οf this study included search of international medical and nursing literature data-bases, for the reason that the female athlete triad has been extensively studied after 1990. The results from the review of relevant studies showed that female athletes who follow hard preparative athletic programmes in which body weight is critical for success, often manifest eating disorder patterns. These lead to dysregulation of the hypothalamic-pituitarian-ovarian axis (HPO and as a result to amenorrhea. Hypothalamic amenorrhea can lead to osteoporosis and increased fracture risk. Adolescents may particularly be at risk because it is during this crucial time that females attain their peak bone mass. Conclusively, a course of action that aims at preventing the occurrence of the syndrome is necessary. Prevention of the female athlete triad through education and identification of the athletes at risk may decrease the incidence of long-term catastrophic effects to health. Monitoring from a group of specialists should serve as a cornerstone when planning a program of training and preparation for high athletic performance

  18. Leptin: A Link Between Energy Imbalance and Exercise-Induced Amenorrhea in Female Athletes

    OpenAIRE

    Miles, Marie

    2001-01-01

    Up to a quarter of female athletes may experience exercise-induced amenorrhea, depending on the type of sport and the level of competition. This amenorrhea is a component of the Female Athlete Triad, a term used to describe three interrelated conditions commonly seen together in the elite female athlete: chronic dieting and/or disordered eating, amenorrhea, and decreased bone mass. Leptin, a hormone secreted by adipose tissue and believed to play a central role in eating behaviors and energy ...

  19. The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes

    OpenAIRE

    Dadgostar Haleh; Razi Mohammad; Aleyasin Ashraf; Alenabi Talia; Dahaghin Saeideh

    2009-01-01

    Abstract Background In 1992, the concept of female athlete triad was introduced to describe the interrelated problems of amenorrhea, eating disorders and osteoporosis seen in female athletes. To gain a clearer picture of amenorrhea/oligomenorrhea in Iran, one of the main components of the female athlete triad, we therefore established this study on the prevalence of amenorrhea/oligomenorrhea in elite Iranian female athletes, also evaluating the risk factors of these disorders in the same popu...

  20. A Natural Method for Family Planning: Lactational Amenorrhea Method

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    Ayten Senturk Erenel

    2010-08-01

    Full Text Available Use of an family planning method during the postpartum period is important both to space births, and to prevent unwanted pregnancies. Under-utilization of family planning services during this period not only leads to adverse conditions caused by excessive fertility, but also has negative effects on both maternal and infant health. Women are in close contact with health care providers before, during, and after childbirth, when they are most likely to be impressed by the services they receive. Effective provision of health care services in these periods is therefore of great importance. Literature indicates high rates of success and compliance with family planning services provided during these periods. Many women neglect to use a modern contraceptive method in the postpartum period believing that breastfeeding alone ensures sufficient protection against pregnancy. Indeed, breastfeeding can be 98% effective as a contraceptive method; however, this is only true if certain criteria are observed. There are three basic criteria for the lactational amenorrhea method to be effective: the baby must be less than six months old, must be exclusively or almost exclusively breast-fed, and the mother must not be menstruating. In a conference held in Bellago in August 1988 by the World Health Organization and other international agencies, a consensus was developed for effective use of lactational amenorrhea method, and it was agreed to adopt breastfeeding as a potential family planning method in maternal and child health programs. [TAF Prev Med Bull 2010; 9(4.000: 383-390

  1. Switching to quetiapine for risperidone-induced amenorrhea: Report of two cases

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    P K Pardal

    2010-01-01

    Full Text Available Almost all the antipsychotics can cause hyperprolactinemia-related side-effects like amenorrhea. Quetiapine has been reported to have minimal propensity to cause hyperprolactinemia. We report here two cases of risperidone-induced amenorrhea, who resumed their normal cycle on switching over the medication to quetiapine.

  2. Switching to quetiapine for risperidone-induced amenorrhea: Report of two cases

    OpenAIRE

    Pardal, P. K.; Raaj Konwar; Jyoti Prakash

    2010-01-01

    Almost all the antipsychotics can cause hyperprolactinemia-related side-effects like amenorrhea. Quetiapine has been reported to have minimal propensity to cause hyperprolactinemia. We report here two cases of risperidone-induced amenorrhea, who resumed their normal cycle on switching over the medication to quetiapine.

  3. Computed tomographic scan of amenorrhea-galactorrhea syndrome

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    Nemoto, Yutaka; Inoue, Yuichi; Takemoto, Kazumasa; Oda, Atsuo; Yahata, Satoshi (Osaka City Univ. (Japan). Faculty of Medicine)

    1984-05-01

    Thin (2 mm) section CT scans of a pituitary gland of 30 amenorrhea-galactorrhea patients were reviewed. Eleven out of 30 patients were diagnosed as having a pituitary adenoma (tumor group); nine prolactionomas were verified by surgery. Tumor density compared with normal pituitary gland was low in five, low-mixed in three and isodense in four. The upper margin of a prolactinoma was convexed upward in seven, flat in two and concaved downward in two. Pituitary stalk was deviated in two and not visualized in four. Serum prolactine level (PRL) was more than 130 ng/ml in tumor group. There was a positive correlation between the size of a prolactinoma and PRL. Four prolactinomas invaded the cavernous sinus; three of them showed higher PRL than 1,000 ng/ml.

  4. Mosaic triple X syndrome in a female with primary amenorrhea

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    A Venkateshwari

    2012-01-01

    Full Text Available Background: Turner′s syndrome is the most common chromosomal abnormality in females, affecting 1 in 2,500 live female births. It is a result of absence of an X chromosome or the presence of a structurally abnormal X chromosome. Its most consistent clinical features are short stature and ovarian failure. Aim: The aim of the study was to report a rare case of mosaic triple X syndrome in a female with primary amenorrhea. Materials and Methods: The chromosomal analysis using GTG banding was carried out, which revealed a mosaicism with 45,XO/47,XXX chromosomal constitution. Fluorescent in situ hybridization was also carried out to further confirm the observation made in the study. Conclusion: The physical features presented by the female could be due to the 45,XO/47,XXX mosaicism and the karyotype analysis was consistent with the diagnosis and clinical symptoms. Triple X mosaicism was confirmed with conventional and molecular cytogenetic analysis.

  5. Use of cognitive behavior therapy for functional hypothalamic amenorrhea.

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    Berga, Sarah L; Loucks, Tammy L

    2006-12-01

    Behaviors that chronically activate the hypothalamic-pituitary-adrenal (HPA) axis and/or suppress the hypothalamic-pituitary-thyroidal (HPT) axis disrupt the hypothalamic-pituitary-gonadal axis in women and men. Individuals with functional hypothalamic hypogonadism typically engage in a combination of behaviors that concomitantly heighten psychogenic stress and increase energy demand. Although it is not widely recognized clinically, functional forms of hypothalamic hypogonadism are more than an isolated disruption of gonadotropin-releasing hormone (GnRH) drive and reproductive compromise. Indeed, women with functional hypothalamic amenorrhea display a constellation of neuroendocrine aberrations that reflect allostatic adjustments to chronic stress. Given these considerations, we have suggested that complete neuroendocrine recovery would involve more than reproductive recovery. Hormone replacement strategies have limited benefit because they do not ameliorate allostatic endocrine adjustments, particularly the activation of the adrenal and the suppression of the thyroidal axes. Indeed, the rationale for the use of sex steroid replacement is based on the erroneous assumption that functional forms of hypothalamic hypogonadism represent only or primarily an alteration in the hypothalamic-pituitary-gonadal axis. Potential health consequences of functional hypothalamic amenorrhea, often termed stress-induced anovulation, may include an increased risk of cardiovascular disease, osteoporosis, depression, other psychiatric conditions, and dementia. Although fertility can be restored with exogenous administration of gonadotropins or pulsatile GnRH, fertility management alone will not permit recovery of the adrenal and thyroidal axes. Initiating pregnancy with exogenous means without reversing the hormonal milieu induced by chronic stress may increase the likelihood of poor obstetrical, fetal, or neonatal outcomes. In contrast, behavioral and psychological interventions that

  6. An overview of amenorrhea and respective remedies in Traditional Persian Medicine

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    Abdolmajid Elahi

    2016-03-01

    Full Text Available Amenorrhea is described as complete absence or cessation of menstruation. Besides conventional treatment approaches, traditional and complementary medical systems have suggested numerous natural medications for management of amenorrhea. Current study aimed to compile the pharmacological reports on amenorrhea from the standpoints of early Persian scholars. Medical and pharmaceutical manuscripts of Persian medicine from 9th to 18th centuries A.D. have been reviewed to extract the critical points and natural remedies. Based on Traditional Persian Medicine (TPM, impairment in uterus, brain and circulation are main causes of amenorrhea. Any obstruction, either anatomical or functional, in uterus and allied organs or tissues may lead the body to this disorder. Concerning herbal therapy of amenorrhea in TPM, 71 medicinal plants related to 35 families were found. The most prevalent families were Apiaceae, Asteraceae, Lamiaceae and Fabaceae, respectively. Usual routes of administration were oral, vaginal and topical. However, there was one report on a medicament, spoken to be effective nasally. Traditionally, emmenagogue medicines should possess diuretic activity to be effective for amenorrhea. All reported remedies were known as diuretic agents. However, this description is not corresponded with what is now accepted as diuretic. On the other hand, only Foeniculum vulgare showed therapeutic effects on amenorrhea in a randomized placebo-controlled trial. Despite lack of novel information on emmenagogue activity of these remedies, design and conducting evidence-based animal or human studies may be beneficial for new drug discovery from traditional knowledge.

  7. Clinical significance of determination serum sex hormones levels in patients with secondary amenorrhea

    International Nuclear Information System (INIS)

    Objective: To explore the clinical significance of changes of serum sex hormones levels in patients with secondary amenorrhea. Methods: Serum levels of E2, FSH, LH, PRL and P were detected with RIA in 33 patients with secondary amenorrhea and 30 controls. Results: In the patients, the serum E2 levels were significantly lower and FSH, LH, PRL and P levels were significantly higher than those in controls (P2, FSH, LH, PRL and P levels is of help for assessment of severity of secondary amenorrhea as well as outcome prediction. (authors)

  8. [Prevalence and etiology of secondary amenorrhea in a selected Mexican population].

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    Hernández, I; Cervera-Aguilar, R; Vergara, M D; Ayala, A R

    1999-08-01

    Studies performed upon american and european population indicate that secondary amenorrhea is associated to 3 months without menses, despite biases observed in age variation and intervals of apparition; nonetheless a 3 month lapse is the standard of reference to quality patients within mexican females. Hence, we investigated the prevalence of secondary amenorrhea among all females (n = 1099) that consulted in our clinic, grouped by age (15-50 yrs), time (months) of amenorrea and identifying the etiology when possible. The prevalence observed was 4.9% with major incidence of 4-12 months of amenorrhea duration (x 5.7 months) between 26-35 years of age. The three most common causes in order of frequency were: Hypothyroidism (14.8%); hiperandrogenism (12.9%) and pituitary adenoma (11.1%). It is concluded that the prevalence of secondary amenorrhea in our study resembled that found in the literature, although in this instance primary hyperthyroidism was the leading cause. PMID:10504790

  9. Clinical significance of combined measurement of serum sex hormones in secondary amenorrhea

    International Nuclear Information System (INIS)

    Objective: To study the clinical significance of changes of levels of serum sex hormones in the diagnosis of the types of secondary amenorrhea. Methods: Serum sex hormones levels were measured with chemiluminescence in 100 patients with secondary amenorrhea and 42 controls. The serum hormones determined were: estradiol (E2)-, progesterone (PROG), follicle stimulating hormone (FSH)-, luteinizing hormone (LH), prolactin (PRL), testosterone (TSTO). Results: Patients with secondary amenorrhea had significantly higher levels of serum FSH, LH and PRL ( P2 (P<0.05) than those in the controls. Serum levels of PROG and TSTO were about the same in the patients and controls. Conclusion: Determination of serum hormones levels with chemiluminescence is clinically useful for diagnosis of the types of secondary amenorrhea. (authors)

  10. Deoxyribonucleic acid damage study in primary amenorrhea by comet assay and karyotyping

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    Sarah Ramamurthy; Parkash Chand; Latha Chaturvedula; K Ramachandra Rao

    2013-01-01

    Aim: This study aims at evaluating the chromosomal abnormalities and deoxyribonucleic acid (DNA) damage in cases with primary amenorrhea by karyotyping and comet assay. Study Design: A total of 30 cases of primary amenorrhea were recruited. Secondary sexual characters were assessed by Tanner staging. Chromosomal analysis was performed by conventional phytohemagglutinin stimulated lymphocyte cell culture technique. Alkaline version of comet assay was used to evaluate DNA damage. Result...

  11. Contemporary issues in primary amenorrhea: An experience from a Tertiary Care Center

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    Ashok Krishna Bhuyan

    2012-01-01

    Full Text Available Introduction: Amenorrhea is classified as primary if menstrual bleeding has never occurred in the absence of hormonal treatment. The clinical significance of a lack of regular menstrual cycles extends beyond reproductive concerns. Episodes of amenorrhea as short as 90 day may have implications for bone and cardiovascular health. Aims and Objective: To evaluate all patients presenting with primary amenorrhea in the Endocrinology OPD of Gauhati Medical College and Hospital. Materials and Methods: A total of 14 patients presenting to the Endocrinology OPD from March 2010 to May 2012 with a history of primary amenorrhea were included in the study. All patients were subjected to a detailed history, a thorough clinical examination, and relevant biochemical, hormonal, and radiological investigations. Result: In our study, the average age of presentation was 17.23 ± 4.2 years. Out of the 14 patients presenting with primary amenorrhea, 5 patients (35.71% were found to have Turner′s syndrome, 2 (14.28% had XX (pure gonadal dysgenesis, 2 (14.28% patients had XY gonadal dysgenesis (Swyer syndrome, 2 (14.28% patients had Müllerian agenesis, 2 (14.28% patients had hypothalamic amenorrhea, and 1 (7.14% patient was found to have multiple pituitary hormone deficiency. Conclusion: In concordance with other studies, Turner′s syndrome, Müllerian agenesis, and gonadal dysgenesis are the commonest causes of primary amenorrhea in our study. However, in contrast to certain Western reports, primary amenorrhea rather than short stature remains the commonest cause for seeking medical evaluation in patients with Turner′s syndrome.

  12. The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes

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    Dadgostar Haleh

    2009-07-01

    Full Text Available Abstract Background In 1992, the concept of female athlete triad was introduced to describe the interrelated problems of amenorrhea, eating disorders and osteoporosis seen in female athletes. To gain a clearer picture of amenorrhea/oligomenorrhea in Iran, one of the main components of the female athlete triad, we therefore established this study on the prevalence of amenorrhea/oligomenorrhea in elite Iranian female athletes, also evaluating the risk factors of these disorders in the same population. Methods This study performed as a cross-sectional study. All elite Iranian female athletes of 34 sports federation, including female athletes in national teams and medalists of Tehran were invited to participate. A total of 788 (95% response rate returned the questionnaires and were examined. Younger athletes under the age of menarche were excluded. Each athlete completed a self-administered questionnaire, which covered the following questions about participant's demographic information, athletic history, history of injuries and menstrual pattern. In order to diagnose the causes of amenorrhea/Oligomenorrhea including polycystic ovary syndrome(PCOS, participants with amenorrhea/Oligomenorrhea underwent further investigation. They were evaluated by following Para clinic investigation, and an ultrasonographic study of ovary. Results The age ranged from 13–37 (mean = 21.1, SD = 4.5. Seventy one (9.0% individuals had amenorrhea/oligomenorrhea, among those, 11 (15.5% had PCOS. There was also a positive association between amenorrhea/oligomenorrhea and the following: age under 20 OR; 2.67, 95%CI(1.47 – 4.85, weight class sports OR; 2.09, 95%CI(1.15 – 3.82, endurance sports OR; 2.89, 95%CI(1.22 – 6.84, late onset of menarche OR; 3.32 95%CI(1.04–10.51, and use of oral contraceptive pills OR; 6.17, 95%CI(3.00 – 12.69. Intensity of training sport or BMI were not risk factors. Conclusion These findings support the previous findings in the literature

  13. Low leptin levels predict amenorrhea in underweight and eating disordered females.

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    Köpp, W; Blum, W F; von Prittwitz, S; Ziegler, A; Lübbert, H; Emons, G; Herzog, W; Herpertz, S; Deter, H C; Remschmidt, H; Hebebrand, J

    1997-07-01

    Evidence that leptin plays an important role in reproductive function is accumulating rapidly. We hypothesized that low leptin synthesis is associated with amenorrhea. We therefore determined serum leptin levels in 43 underweight female students, who were screened for lifetime occurrence of amenorrhea. We assessed the predictive value of leptin, body mass index (BMI), fat mass and percent body fat, respectively, for lifetime occurrence of amenorrea. Factors predicting amenorrhea were tested for their capability to predict current amenorrhea in a second cohort of 63 inpatients with anorexia nervosa (AN) or bulimia nervosa (BN). Furthermore, the relationships between serum leptin levels and of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone, respectively, were evaluated. Only leptin predicted lifetime occurrence of amenorrhea in the student cohort. The critical leptin level was in the range of 1.85 micrograms L-1. This level served to largely separate anorectic from bulimic patients. In patients with AN mean serum log10 leptin levels over the first 4 weeks of inpatient treatment were correlated with mean FSH, LH and estradiol levels, respectively. Evidently, a critical leptin level is needed to maintain menstruation. In affluent populations eating disorders are likely to be a major cause of a low leptin synthesis. PMID:9246675

  14. Incidence of chemotherapy-induced amenorrhea in non-menopausal women with breast cancer

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    Shahrbanoo Keihanian

    2009-01-01

    Full Text Available , , 2, , (Received 14 January, 2009; Accepted 17 June, 2009AbstractBackground and purpose: Although adjunct chemotherapy may increase life in non-menopausal breast cancer patients, however, it may cause short-term complications such as nausea, vomiting, alopecia, as well as long-term complications in ovarian failure and premature menopausal. The objective of this study was to investigate chemotherapy-induced secondary amenorrhea in non-menopausal women with breast cancer.Materials and methods: A descriptive design (case series was preformed on fifty breast cancer patients, non-menopausal (normal mense and chemotherapy in Ramsar Emam Sajad Hospital Oncology unit from 2007 to 2008. Sampling was consecutive. Data gathering method was questionnaire & blood sampling (FSH & Progesterone for prior and 12 months after the end of chemotherapy. Data was analyzed by paired-t, independent-t and one-way ANOVA tests.Results: Results showed that 62% of patients were amenorrhea 12 months after the end of chemotherapy. Results showed that there was no meaningful relationship between age, hormone therapy, disease stage, node-positive and ER & PR status to amenorrhea; however, there was a meaningful relationship between duration of treatment, type and dose of chemotherapy to amenorrhea.Conclusion: In pre-menopausal patients with breast cancer, receiving cytotoxic chemotherapy against tumor cells, amenorrhea may occur do to ovarian failure.J Mazand Univ Med Sci 2009; 19(70: 9-17 (Persian

  15. Amenorrhea in the Female Athlete: What to Do and When to Worry.

    Science.gov (United States)

    Berz, Kate; McCambridge, Teri

    2016-03-01

    Functional hypothalamic amenorrhea is a diagnosis of exclusion that is common in female athletes, particularly those participating in aesthetic sports (ballet, other dance genres, figure skating, and gymnastics) and endurance sports (cross-country running). Although common, it should be considered abnormal even in the high-level elite athlete. Amenorrhea in combination with low energy availability and low bone density is labeled "the Female Athlete Triad." Studies have demonstrated numerous long-term consequences of athletes suffering from all or a portion of this triad, including increased rate of musculoskeletal injuries, stress fractures, abnormal lipid profiles, endothelial dysfunction, potential irreversible bone loss, depression, anxiety, low self- esteem, and increased mortality. This article provides the clinician with the tools to evaluate an athlete with secondary amenorrhea, reviews the recommended treatment options for affected athletes, and discusses when to return to the activity in an effort to facilitate "healthy" participation. PMID:27031318

  16. A case of primary amenorrhea with 46+XY genotype from Kashmir Valley

    Directory of Open Access Journals (Sweden)

    Shahid Mudassir Baba

    2013-01-01

    Full Text Available Primary amenorrhea is one of the common reproductive disorder affecting females. It leads to the absence of menarche in the reproductive age group in females and/or complete absence of reproductive organs. There are many causes which lead to PA, including genetic aberrations which are the leading factors.

  17. Exercise-Associated Amenorrhea: Are Altered Leptin Levels an Early Warning Sign?

    Science.gov (United States)

    Warren, Michelle P.; Ramos, Russalind H.; Bronson, Emily M.

    2002-01-01

    Although the exact cause of the female athlete triad (amenorrhea, disordered eating, and osteoporosis) is unknown, recent research implicates leptin, a hormone secreted by adipocytes. Leptin may be an important indicator of nutritional status and may play a role in reproductive function. Physicians who develop a plan for early recognition and…

  18. Hypercortisolemia Is Associated with Severity of Bone Loss and Depression in Hypothalamic Amenorrhea and Anorexia Nervosa

    OpenAIRE

    Lawson, Elizabeth A; Donoho, Daniel; Miller, Karen K.; Misra, Madhusmita; Meenaghan, Erinne; Lydecker, Janet; Wexler, Tamara; Herzog, David B.; Klibanski, Anne

    2009-01-01

    Context: Anorexia nervosa (AN) and functional hypothalamic amenorrhea (HA) are associated with low bone density, anxiety, and depression. Women with AN and HA have elevated cortisol levels. Significant hypercortisolemia, as in Cushing’s disease, causes bone loss. It is unknown whether anxiety and depression and/or cortisol dysregulation contribute to low bone density in AN or HA.

  19. Female genital tuberculosis and ndash; still a common cause of primary amenorrhea in developing countries

    Directory of Open Access Journals (Sweden)

    Ramesh Bettaiah

    2016-08-01

    Full Text Available Primary amenorrhea is defined as, no menses by age 14yrs in absence of growth or development of secondary sexual characteristics and no menses by age 16yrs regardless of the presence of normal growth or development of secondary sexual characteristics. Although pulmonary tuberculosis remains the commonest and the most infectious type of tuberculosis, extra pulmonary tuberculosis is becoming more prevalent especially in young women throughout the world. We report a case of young woman presenting as primary amenorrhea apparently having no signs and symptoms of tuberculosis. 20 yrs old unmarried girl was referred for primary amenorrhea with normal secondary sexual characters and presence of uterus, tubes and ovaries on abdominal scan. Hormonal assay and karyotyping was normal. She had negative progesterone challenge test and estrogen progesterone challenge test. Diagnosis of genital tuberculosis was confirmed by diagnostic hysterolaparoscopy and positive tubercular polymerase chain reaction and culture. Hysterolaparoscopy is a key tool for confirmation of diagnosis in cases of primary amenorrhea when the dilemma exists. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2891-2894

  20. Clinical research of impulse GnRH infusion treatment to a patient with central secondary amenorrhea

    Institute of Scientific and Technical Information of China (English)

    孙首悦

    2014-01-01

    Objective To apply continuous subcutaneous pulse infusion of gonadotropin-releasing hormone(GnRH)to treat patients with central secondary amenorrhea,and to observe the induction of spontaneous ovulation and natural fertilization.Methods Using micro-pulse infusion pumps with each 90-minute infusion of LHRH 10μg daily,the serum LH,FSH,estrogen,and progesterone lev-

  1. Continuous hormone replacement therapy for menopause combining nomegestrol acetate and gel, patch, or oral estrogen: a comparison of amenorrhea rates.

    Science.gov (United States)

    Blanc, B; Cravello, L; Micheletti, M C; d'Ercole, C; Zartarian, M

    1998-01-01

    This open-label, prospective, randomized, multicenter trial compared the incidence of amenorrhea in 54 postmenopausal women (mean age, 54.9 +/- 0.6 years) who underwent six 4-week cycles of continuous hormone replacement therapy combining a progestin-nomegestrol acetate 2.5 mg/d--plus one of three estrogens: percutaneous 17beta-estradiol gel (1.5 mg/d, group A), transdermal 17beta-estradiol patch (50 microg/d, group B), or oral estradiol valerate (2 mg/d, group C). Based on an intent-to-treat analysis, the rate of amenorrhea varied significantly according to which estrogen preparation was used. Calculated cycle by cycle, rates of amenorrhea were 67% to 83% for group A, 25% to 56% for group B, and 53% to 61% for group C. Overall rates of persistent amenorrhea were not statistically different between groups for cycles 1 through 3, but for cycles 4 through 6, significantly more women in groups A and C (67% and 46%, respectively) experienced amenorrhea than did those in group B (12%). Amenorrhea rates for the entire six-cycle period were 78% for group A, 48% for group B, and 60% for group C. These differences were not statistically significant. The differences in rates could not be attributed to endometrial atrophy, since when measured by transvaginal sonography, endometrial thickness did not differ significantly between groups. Of the original population, 7% withdrew prematurely because of bleeding. The data for all three groups confirmed that in two out of three women, the occurrence of amenorrhea during the first three cycles predicted continuation of amenorrhea during subsequent cycles and that for 51% of women, estradiol gel, although findings were similar with estradiol valerate. The percutaneous 17beta-estradiol gel was also associated with a higher percentage of amenorrheal cycles than was estradiol valerate or transdermal estrogen, although differences were significant only in comparison with the transdermal formulation. This difference may have positive

  2. Hyperandrogenism in female athletes with functional hypothalamic amenorrhea: a distinct phenotype

    OpenAIRE

    Javed A; Kashyap R; Lteif AN

    2015-01-01

    Asma Javed,1 Rahul Kashyap,2 Aida N Lteif1 1Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology Mayo Clinic, Rochester, MN, USA; 2Department of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA Objective: To compare the reproductive, metabolic, and skeletal profiles of young athletic women with functional hypothalamic amenorrhea (FHA) as well as clinical or biochemical hyperandrogenism (FHA-EX+HA) with body mass index matched women with FHA due to exe...

  3. FEMALE GENITAL TUBERCULOSIS AS A CAUSE OF PRIMARY AMENORRHEA IN A YOUNG UNMARRIED WOMAN.

    OpenAIRE

    Zende Prashant; Aher; Dandavate

    2013-01-01

    ABSTRACT: Primary Amenorrhea is defined as 1)No periods by ag e 14 in the absence of growth or development of secondary sexual character.2)No peri ods by age 16 regardless of the presence of normal growth & development with the appearance of secondary sexual characters. Incidence of Extrapulmonary TB(EPTB)is increasing i n young women throughout the world. We report a case of young woman apparently having n o sings & symptoms of Tuberculosis. CASE REPORT :-...

  4. Disordered eating, amenorrhea, and substance use and misuse among professional ballet dancers: Preliminary analysis

    OpenAIRE

    Mia Peric; Natasa Zenic; Damir Sekulic; Miran Kondric; Petra Zaletel

    2016-01-01

    Background: Substance use and misuse (SUM), eating disorders (ED) and consequent amenorrhea (AM) occur frequently in professional ballet dancing. The objective of this study has been to explore the prevalence and association between ED, AM and SUM in ballet. Material and Methods: The sample comprised 21 ballet dancers, 23.1±4.5 years old, members of the professional National Ballet Ensemble from Croatia. Variables were collected by questionnaires examining SUM, occurrence of amenorrh...

  5. Serum Levels of Tryptophan, 5-Hydroxytryptophan and Serotonin in Patients Affected with Different Forms of Amenorrhea

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    S. Comai

    2010-06-01

    Full Text Available Tryptophan (Trp is present in the serum, partly bound to albumine and in the free form. The unbound portion of circulating tryptophan has the property of crossing the hematoencephalic barrier and being converted within the brain into serotonin (5-HT through the enzymatic processes of hydroxylation and decarboxylation. The serotoninergic system plays an important role in neuroendocrine control of reproductive hormone secretion, and in particular, it may influence GnRH pulsatility, a function essential for reproductive processes. In this study, we analysed serum levels of tryptophan, serotonin and 5-hydroxytryptophan (5-HTP in women with three different forms of amenorrhea: 16 patients were diagnosed with anorexia nervosa, 60 patients with functional hypothalamic amenorrhea, and 14 patients with hyperprolactinemia. Data were compared with those of a group of 25 healthy women. Serum Trp levels were significantly (P ≤ 0.05 lower in the anorexic (11.64 ± 0.53 µg/ml, mean ± S.E. than in the control (12.98 ± 0.37 µg/ml groups. In addition, in the anorexic group a statistical dispersion of Trp values was shown indicating a bimodal data distribution suggesting the existence of two different subgroups of patients. Regarding 5-HTP, an increase of its serum level was observed in all the groups with amenorrhea with the highest value in hyperprolactinemic patients. On the contrary, no statistical differences in serum 5-HT levels among the four analyzed groups were observed. This study shows that women affected by various forms of amenorrhea present an altered metabolism of tryptophan via serotonin and, in particular, markedly high differences are observed between the two subgroups of anorexic patients.

  6. Primary Amenorrhea in Anorexia Nervosa: Impact on Characteristic Masculine and Feminine Traits

    OpenAIRE

    Baker, Jessica H; Sisk, Cheryl L.; Thornton, Laura M.; Brandt, Harry; Crawford, Steven; Fichter, Manfred M.; Halmi, Katherine A.; Johnson, Craig; Jones, Ian; Kaplan, Allan S; Mitchell, James E.; Strober, Michael; Treasure, Janet; Woodside, D. Blake; Berrettini, Wade H.

    2013-01-01

    Animal studies indicate gonadal hormones at puberty have an effect on the development of masculine and feminine traits. However, it is unknown whether similar processes occur in humans. We examined whether women with anorexia nervosa (AN), who often experience primary amenorrhea, exhibit attenuated feminization in their psychological characteristics in adulthood due to the decrease/absence of gonadal hormones at puberty. Women with AN were compared on a number of psychological characteristics...

  7. Study on the differences between the serum sex hormones levels in menopausal women and patients with secondary amenorrhea

    International Nuclear Information System (INIS)

    Objective: To assess the differences between the ovarian function in menopausal women and patients with secondary amenorrhea with measurement of serum sex hormones levels. Methods: Serum FSH, LH, E2 prolactin, progesterone and testosterone levels were measured with RIA in: (1) 40 women with normal menstration (2) 40 menopausal women and (3) 40 patients with secondary amenorrhea. Results: Among the three groups, the serum FSH and LH levels wre highest in the menopausal women with secondary amenorrhea patients the next. On the contrary, the serum E2 levels were lowest in the menopausal women with secondary amenorrhea patients the next. The sreum prolactin levels in women with normal menstruation and menopausal women were about the same and both were significantly lower than those in patients with secondary amenorrhea. The serum progestrone levels were extremely low in menopausal women (0.63 ± 0.39 ng/ml), while the levels in patients with secondary menopause were only moderately decreased (4.91 ± 2. 83 ng/ml vs 11.25 ± 4.51 ng/ml in women with normal menstruation), indicating possible presence of ovulation. Testosterone levels were also lowest in menopausal women. Conclusion: Ovarian atrophy with functional failure was present in menopausal women. Secondury amenorrhea was usually due to dysfunction of hypothalamus-pituitary-ovary-uterus axis (HPOV axis) with rentention of ovarian function. (authors)

  8. FEMALE GENITAL TUBERCULOSIS AS A CAUSE OF PRIMARY AMENORRHEA IN A YOUNG UNMARRIED WOMAN.

    Directory of Open Access Journals (Sweden)

    Zende Prashant

    2013-05-01

    Full Text Available ABSTRACT: Primary Amenorrhea is defined as 1No periods by ag e 14 in the absence of growth or development of secondary sexual character.2No peri ods by age 16 regardless of the presence of normal growth & development with the appearance of secondary sexual characters. Incidence of Extrapulmonary TB(EPTBis increasing i n young women throughout the world. We report a case of young woman apparently having n o sings & symptoms of Tuberculosis. CASE REPORT :-18 years young female patient was referred to us as a case of Primary Amenorrhea.She had Normal secondary sexual characte rs & normal Breast Development(Tanner staging of Breast-IV.She had negative Progesterone Challenge Test (PCT.Estrogen & Progesterone Challenge Test was negative. Diagnosis of End Organ Problem was done. Diagnosis of Genital Tuberculosis was confirmed by Hysterolaparoscopy. S he was given AKT for six months. Now she has positive Progestogen Challenge Test. DISCUSSION : Hysterolaparoscopy is important investigation in a case of Primary Amenorrhea with negative Estrogen & Progesterone Challenge Test. Counseling is necessary in unmarried young wo man for Minimally Invasive procedure like Hysterolaparoscopy. Short Chemotherapy has found to useful for FGTB.

  9. Disordered eating, amenorrhea, and substance use and misuse among professional ballet dancers: Preliminary analysis

    Directory of Open Access Journals (Sweden)

    Mia Peric

    2016-04-01

    Full Text Available Background: Substance use and misuse (SUM, eating disorders (ED and consequent amenorrhea (AM occur frequently in professional ballet dancing. The objective of this study has been to explore the prevalence and association between ED, AM and SUM in ballet. Material and Methods: The sample comprised 21 ballet dancers, 23.1±4.5 years old, members of the professional National Ballet Ensemble from Croatia. Variables were collected by questionnaires examining SUM, occurrence of amenorrhea, and corresponding ballet-specific and socio-demographic factors (Questionnaire on Substance Use – QSU and the level of ED (Brief Eating Disorder in Athletes Questionnaire – BEDA-Q. Results: Smoking is prevalent in 40% of dancers (25% smoke on a daily basis, 36% often use analgesics, and 25% engage in binge drinking at least once a month. Smoking and binge drinking are less frequent in ballerinas with a higher academic level (r = 0.60 and r = 0.54 for binge drinking and smoking, respectively; p < 0.05. Alcohol drinking is higher among dancers who consume analgesics more often and those with a higher BEDA-Q score (r = 0.53 and r = 0.54 for analgesics and BEDA-Q, respectively; p < 0.05. Amenorrhea is more prevalent among those dancers with a higher BEDA-Q score. Women who consume nutritional supplements are less likely to use analgesics (Mann Whitney U test = 2.11; p < 0.05. Conclusions: Efforts seeking to prevent ED in ballet should target dancers who consume alcohol to a greater extent. Future studies should specifically explore the less frequent consumption of analgesics among dancers who consume nutritional supplements. Med Pr 2016;67(1:21–27

  10. Ovarian granulosa cell tumor: An uncommon presentation with primary amenorrhea and virilization in a pubertal girl

    OpenAIRE

    Sunil Kumar Kota; Kotni Gayatri; Jaya Prakash Pani; Lalit Kumar Meher; Siva Krishna Kota; Kirtikumar D Modi

    2012-01-01

    A 16-year-old girl presented with primary amenorrhea and excess hair growth on her body and face for the last three years, along with pain and a mass in her lower abdomen for last one year. Examination revealed hirsutism and other virilizing features, with an irregular mass in the lower abdomen corresponding to 16 weeks′gestation. Serum testosterone was 320 ng / dl and ultrasonogram of the pelvis revealed a solid mass of 5 × 4 cm in the left adnexa. Suspecting it to be a virilizing tumor of t...

  11. Frequency and pattern of cytogenetic alterations in primary amenorrhea cases of Kashmir, North India

    Directory of Open Access Journals (Sweden)

    Tahir M. Malla

    2016-01-01

    Conclusion: The results of the present study indicate that chromosomal analysis of females with PA, after the exclusion of non-genetic causes, should be essentially considered for the precise diagnosis and the development of more successful treatment. The study being the first of its kind in this part of the world forms the basis for further studies of the PA cases of this region. The precise molecular characterization of the unique breakpoint regions reported in our study can possibly help in the identification of new genes involved in primary amenorrhea.

  12. Secondary amenorrhea

    Science.gov (United States)

    ... level) Prolactin level Serum hormone levels such as testosterone levels Thyroid stimulating hormone (TSH) Other tests that ... lack of menstrual period due to obesity , vigorous exercise, or weight loss may respond to a change ...

  13. Amenorrhea - primary

    Science.gov (United States)

    ... Androgen insensitivity syndrome Anorexia Bulimia Congenital adrenal hyperplasia Congenital heart disease Craniopharyngioma Crohn disease Cystic fibrosis Hyperthyroidism Hypogonadotropic hypogonadism Hypothyroidism Intersex Low blood sugar Polycystic ovary syndrome Prader- ...

  14. Secondary amenorrhea

    Science.gov (United States)

    ... gastric bypass surgery ) Other causes include: Brain (pituitary) tumors Chemotherapy drugs for cancer Drugs to treat schizophrenia or psychosis Overactive thyroid gland Polycystic ovarian syndrome Reduced function of the ovaries ...

  15. Diagnostic evaluation of serum FSH and LH in primary amenorrhea by radioimmunoassay

    International Nuclear Information System (INIS)

    The usefulness of single, random measurements of serum FSH and LH in the diagnosis of primary amenorrhea by radioimmunoassay was investigated. The 16 patients were divided into 3 groups by the level of serum FSH and LH. The first group with increased level of serum FSH and LH is five patients, all of these are related to the acquired or congenital abnormality of the ovary. Further studies indicated include buccal smear, chromosome analysis, gynecography and laparoscopy. The second group with normal serum FSH and LH is nine patients, four patients of these are related to the developmental anomaly of the Mullerian duct and five patients are undetermined origin. Further studies indicated include laparoscopy and gynecography. The third group with decreased serum FSH and normal or decreased serum LH is two patients, one of these is related to the pituitary function, isolated FSH deficiency, the other is undetermined origin. Further studies indicated include the pituitary function test, LH-RH stimulation test, skull radiography. Determination of serum FSH and LH levels does not permit a specific etiologic diagnosis of promary amenorrhea. However the serum levels of FSH and LH can be used to differentiate the principal area of the investigation and can be of assistance in choosing more specific testing procedures. (Author)

  16. Ultrasonographic Findings in a Group of Iranian Patients with Primary Amenorrhea

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    M. Pourafkari

    2008-06-01

    Full Text Available Background/Objective: This study was performed to report the ultrasonographic finding and final diagnosis of a group of primary amenorrhea patients."nPatients and Methods: Pelvic ultrasonography (US was employed as the first diagnostic modality to evaluate primary amenorrhea in 53 patients who were admitted to gynecology or endocrinology clinics at Taleghani hospital from 2002 to 2006. US was based upon the presence or absence of the uterus and ovaries and any other abnormal sonographic findings. Karyotype analysis was also performed for all the patients."nResults: The uterus was not visualized in 16 (30% patients: due to müllerian agenesis in 14 and testicular feminization and true hermaphroditism in two other patients. Müllerian anomalies with hematometrocolpos or hematometra were seen in 5 (9% patients. Thirty-two (60% patients had a normal or hypoplastic uterus. Pelvic US showed that ovaries were in normal limits in 39 (73% patients; they were not visible in 9 patients. The report of pelvic US was not conclusive in 3 patients; 2 had an ovarian tumor or cyst. Irrespective of the presence or absence of the uterus, all patients with visible ovaries (except one had a normal karyotype."nConclusion: US of the pelvis can be the initial diagnostic modality. Based on US findings, we can make decision for further work ups; there is no need to perform all paraclinical investigations for each patient.

  17. Deoxyribonucleic acid damage study in primary amenorrhea by comet assay and karyotyping

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    Sarah Ramamurthy

    2013-01-01

    Full Text Available Aim: This study aims at evaluating the chromosomal abnormalities and deoxyribonucleic acid (DNA damage in cases with primary amenorrhea by karyotyping and comet assay. Study Design: A total of 30 cases of primary amenorrhea were recruited. Secondary sexual characters were assessed by Tanner staging. Chromosomal analysis was performed by conventional phytohemagglutinin stimulated lymphocyte cell culture technique. Alkaline version of comet assay was used to evaluate DNA damage. Results: The chromosomal pattern of 20 subjects (66.7% was found to be normal (46,XX. Two subjects had 46,XY pattern and eight subjects had Turner syndrome (45,X or 45,X/46,XX. The comet parameters were found to be increased among subjects with 45,X monosomy, when compared to the rest of the study group and also in subjects with Tanner stage 1 when compared to stage 2. Conclusion: Comet assay revealed increased DNA damage in cases with 45,X monosomy, compared with subjects with 46,XX and 46,XY karyotype, which correlated with clinical features.

  18. Amenorréia e osteoporose em adolescentes atletas Amenorrhea and osteosporosis in adolescents athletes

    Directory of Open Access Journals (Sweden)

    Graziela MANTOANELLI

    2002-09-01

    Full Text Available A participação feminina no esporte foi crescendo ao longo dos anos. Trabalhos científicos têm mostrado os benefícios trazidos por esta prática para a saúde da mulher, mas quando se trata de esporte competitivo podem surgir problemas. A complicação mais comum descrita pela literatura é a "tríade da atleta", a qual envolve três processos: o distúrbio alimentar, a amenorréia e a osteoporose. A amenorréia atinge, nos Estados Unidos, até 66% das atletas de competição, e algumas de suas possíveis causas são: perda de peso, excesso de treino, quantidade insuficiente de gordura corporal, perda de estoques específicos de gordura corporal e dieta inadequada. Como conseqüência da amenorréia, a esportista pode desenvolver osteoporose precoce. Não se sabe ao certo a porcentagem de atletas com osteopenia, mas há indícios de que a falta de estrógeno, a dieta inadequada e o consumo insuficiente de cálcio serem fatores que as predispõem a desenvolver a doença.The female participation in sports has been increasing over the years. Scientific studies have shown the benefits this practice brings to women's health, but, when it comes to competitive sports, problems may arise. The most common complication described by the literature is the "Female Athlete Triad", which involves three processes: the eating disorder, the amenorrhea, and the osteoporosis. In the United States, the amenorrhea afflicts up to 66% of the competition athletes, and some of its possible causes of are: weight loss, excessive training, insufficient quantity of body fat, loss of specific stores of body fat, and inadequate diet. As a consequence of the amenorrhea, the sportswoman may develop precocious osteoporosis. It is not known for sure the percentage of athletes with osteopenia, but there are indications that the lack of estrogen, the inadequate diet, and the insufficient consumption of calcium are factors predisposing them to develop the disease.

  19. Ovarian granulosa cell tumor: An uncommon presentation with primary amenorrhea and virilization in a pubertal girl

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Kota

    2012-01-01

    Full Text Available A 16-year-old girl presented with primary amenorrhea and excess hair growth on her body and face for the last three years, along with pain and a mass in her lower abdomen for last one year. Examination revealed hirsutism and other virilizing features, with an irregular mass in the lower abdomen corresponding to 16 weeks′gestation. Serum testosterone was 320 ng / dl and ultrasonogram of the pelvis revealed a solid mass of 5 × 4 cm in the left adnexa. Suspecting it to be a virilizing tumor of the left ovary, the patient was subjected to staging laparotomy, which revealed stage 1a ovarian involvement amenable to surgical resection alone. Histopathological examination confirmed the diagnosis of granulosa cell tumor of the ovary. Postoperatively the serum testosterone returned to 40 ng / dl and her menstrual cycle started after two months of surgery.

  20. Steroidogenic factor-1 (SF-1 gene mutation as a frequent cause of primary amenorrhea in 46,XY female adolescents with low testosterone concentration

    Directory of Open Access Journals (Sweden)

    Servant Nadège

    2010-03-01

    Full Text Available Abstract Background Primary amenorrhea due to 46,XY disorders of sex differentiation (DSD is a frequent reason for consultation in endocrine and gynecology clinics. Among the genetic causes of low-testosterone primary amenorrhea due to 46,XY DSD, SRY gene is reported to be frequently involved, but other genes, such as SF1 and WT1, have never been studied for their prevalence. Methods We directly sequenced SRY, SF1 and WT1 genes in 15 adolescent girls with primary amenorrhea, low testosterone concentration, and XY karyotype, to determine the prevalence of mutations. We also analyzed the LH receptor gene in patients with high LH and normal FSH concentrations. Results Among the 15 adolescents with primary amenorrhea and low testosterone concentration, we identified two new SRY mutations, five new SF1 mutations and one new LH receptor gene mutation. Our study confirms the 10-15% prevalence of SRY mutations and shows the high prevalence (33% of SF1 abnormalities in primary amenorrhea due to 46,XY DSD with low plasma testosterone concentration. Conclusions The genetic analysis of low-testosterone primary amenorrhea is complex as several factors may be involved. This work underlines the need to systematically analyze the SF1 sequence in girls with primary amenorrhea due to 46,XY DSD and low testosterone, as well as in newborns with 46,XY DSD.

  1. Amenorréia e anormalidades do cromossomo X Amenorrhea and X chromosome abnormalities

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    Rafael Fabiano Machado Rosa

    2008-10-01

    Full Text Available OBJETIVO: correlacionar as manifestações clínicas de pacientes com amenorréia e anormalidades do cromossomo X. MÉTODOS: realizou-se uma análise retrospectiva dos achados clínicos e laboratoriais das pacientes com amenorréia e anormalidades do cromossomo X, atendidas entre janeiro de 1975 e novembro de 2007. Suas medidas antropométricas foram avaliadas através de tabelas de crescimento padrão, sendo que, quando presentes, dismorfias menores e maiores foram anotadas. O estudo dos cromossomos foi realizado através do cariótipo com bandamento GTG. RESULTADOS: do total de 141 pacientes com amenorréia, 16% apresentavam anormalidades numéricas e 13% estruturais do cromossomo X. Destas pacientes com anormalidade do X (n=41, 35 possuíam descrição clínica completa. Todas elas apresentavam hipogonadismo hipergonadotrófico. Amenorréia primária foi observada em 24 pacientes, das quais 91,7% com fenótipo de síndrome de Turner. Com exceção de um caso com deleção Xq22-q28, todas as demais pacientes com este fenótipo apresentavam alterações envolvendo Xp (uma com uma linhagem 46,XY associada. Os dois casos restantes com apenas amenorréia primária possuíam deleções proximais de Xq. Entre as 11 pacientes com amenorréia secundária, 54,5% apresentavam fenótipo de Turner (todas com monossomia do X isolada ou em mosaico. Entre aquelas com fenótipo de falência ovariana isolada observaram-se somente deleções Xq e trissomia do X. CONCLUSÕES: a análise cromossômica deve sempre ser realizada em mulheres com falência ovariana de causa não conhecida, mesmo na ausência de achados dismórficos. Esta também é de extrema importância em pacientes sindrômicas, pois, além de confirmar o diagnóstico, é capaz de identificar pacientes em risco, como nos casos com uma linhagem 46,XY.PURPOSE: to correlate the clinical manifestations of patients with amenorrhea and X chromosome abnormalities. METHODS: a retrospective analysis of the

  2. Hyperandrogenism in female athletes with functional hypothalamic amenorrhea: a distinct phenotype

    Directory of Open Access Journals (Sweden)

    Javed A

    2015-01-01

    Full Text Available Asma Javed,1 Rahul Kashyap,2 Aida N Lteif1 1Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology Mayo Clinic, Rochester, MN, USA; 2Department of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA Objective: To compare the reproductive, metabolic, and skeletal profiles of young athletic women with functional hypothalamic amenorrhea (FHA as well as clinical or biochemical hyperandrogenism (FHA-EX+HA with body mass index matched women with FHA due to exercise (FHA-EX or anorexia nervosa (FHA-AN alone.Design: Retrospective cohort study.Setting: Tertiary care teaching hospital.Population: Adolescents and young women, 15–30 years of age, diagnosed with FHA along with concurrent signs of hyperandrogenism (n=22 and body mass index matched control groups consisting of 22 women in each group of FHA-EX and FHA-AN. Main outcomes: 1 Reproductive hormone profile: luteinizing hormone (LH, follicle stimulating hormone (FSH, total testosterone, pelvic ultrasound features. 2 Metabolic function and skeletal health markers: fasting glucose, cholesterol, number of stress fractures and bone mineral density as assessed by spine dual-energy X-ray absorptiometry z scores. Results: FHA-EX+HA group was older at diagnosis compared to the other groups with a median (interquartile range [IQR] age of 22 (18.75–25.25 years versus (vs 17.5 (15.75–19 for FHA-EX; (P<0.01 and 18 (16–22.25 years for FHA-AN (P=0.01. There were no differences among the groups based on number of hours of exercise per week, type of physical activity or duration of amenorrhea. Median (IQR LH/FSH ratio was higher in FHA-EX+HA than both other groups, 1.44 (1.03–1.77 vs 0.50 (0.20–0.94 for FHA-EX and 0.67 (0.51–0.87 for FHA-AN (P<0.01 for both. Total testosterone concentrations were not different among the groups. Median (IQR fasting serum glucose concentration was higher in FHA-EX+HA vs FHA-EX, 88.5 mg/dL (82.8–90 mg/dL vs 83.5 mg/dL (78.8–86.3 mg

  3. Multiple endocrine adenomatosis with Cushing's disease and the amenorrhea-galactorrhea syndrome responsive to proton beam irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Veseley, D.L.; Fass, F.H.

    1981-09-01

    Multiple endocrine adenomatosis (MEA) or neoplasia is a hereditary disorder consisting of tumors of hyperplasia of several endocrine glands. In MEA-1 the pituitary, parathyroids, and pancreatic islets are most frequently involved, while in MEA-2 the thyroid (medullary carcinoma of the thyroid), parathyroids,and adrenals (pheochromocytomas) are the endocrine glands most likely to be involved. Cushings's syndrome may occur in MEA-1 and has also been found in patients with MEA-2, where the cause of Cushing's syndrome is usually ectopic ACTH production from medullary carcinoma of the thyroid. Recently, there have been reports of amenorrhea-galactorrhea syndrome in patients with MEA-1, and confirmation that hyperprolactinemia is associated with this syndrom has been found in patients with MEA-1. The present report details a patient who has been followed up for 20 years since she first presented with amenorrhea and galactorrhea. Ten years after first being seen she was noted to have Cushing's syndrom and hyperparathyroidism due to parathyroid hyperplasia. Both the amenorrhea-galactorrhea syndrome and Cushing's sydrome disappeared with proton beam irradiation to the pituitary.

  4. Multiple endocrine adenomatosis with Cushing's disease and the amenorrhea-galactorrhea syndrome responsive to proton beam irradiation

    International Nuclear Information System (INIS)

    Multiple endocrine adenomatosis (MEA) or neoplasia is a hereditary disorder consisting of tumors of hyperplasia of several endocrine glands. In MEA-1 the pituitary, parathyroids, and pancreatic islets are most frequently involved, while in MEA-2 the thyroid (medullary carcinoma of the thyroid), parathyroids,and adrenals (pheochromocytomas) are the endocrine glands most likely to be involved. Cushings's syndrome may occur in MEA-1 and has also been found in patients with MEA-2, where the cause of Cushing's syndrome is usually ectopic ACTH production from medullary carcinoma of the thyroid. Recently, there have been reports of amenorrhea-galactorrhea syndrome in patients with MEA-1, and confirmation that hyperprolactinemia is associated with this syndrom has been found in patients with MEA-1. The present report details a patient who has been followed up for 20 years since she first presented with amenorrhea and galactorrhea. Ten years after first being seen she was noted to have Cushing's syndrom and hyperparathyroidism due to parathyroid hyperplasia. Both the amenorrhea-galactorrhea syndrome and Cushing's sydrome disappeared with proton beam irradiation to the pituitary

  5. The influence of estrogen therapies on bone mineral density in premenopausal women with anorexia nervosa and amenorrhea.

    Science.gov (United States)

    Lebow, Jocelyn; Sim, Leslie

    2013-01-01

    Low bone mineral density is one of the primary risks of chronic amenorrhea, and the effects of potentially long-term menstrual disruption on bone mass are serious concerns for individuals with a past or current anorexia nervosa (AN) diagnosis. As such, estrogen therapies are frequently used to address amenorrhea associated with AN. A systematic review of the literature was conducted to examine the effectiveness of estrogen therapies on bone mineral density in women with amenorrhea. Data regarding the effectiveness of oral contraceptives were of low quality and mixed, with the majority of studies finding no benefit of these treatments on bone mineral density. Hormone replacement therapy findings were also mixed, though promising results were found in a study comparing transdermal administration of physiologic estrogen, delivered in developmentally sensitive incremental doses to placebo controls. Though this study suggests a possible role for estrogen therapies in addressing bone density loss in women with AN, in general, more studies are needed. Clinical drawbacks of using these therapies in the treatment of AN, including the loss of menses resumption as a clinical marker for weight and nutritional rehabilitation, must be considered in the decision to use estrogen therapies, particularly given the uncertain effectiveness of most of these treatments. PMID:23601427

  6. 17-Alpha Hydroxylase Deficiency: A Rare Case of Primary Amenorrhea and Hypertension

    Directory of Open Access Journals (Sweden)

    Yasin Şimşek

    2014-12-01

    Full Text Available 17-alpha hydroxylase deficiency (17OHD is an uncommon cause of congenital adrenal hyperplasia (CAH resulting from mutation in the CYP17 gene. It is an autosomal recessive disease leading to the deficiency of enzyme activity which results in impaired synthesis of cortisol, androgen and sex steroids. A 35-year-old woman was admitted to the hospital with hypokalemia, weakness, and fatigue. Medical history revealed two attempts of in vitro fertilization (IVF without achieving pregnancy. Laboratory evaluation showed hypokalemia, hypocortisolemia, hypergonadotropic hypogonadism and increased levels of 11-deoxycorticosterone. Her karyotype was 46XX. The patient had no history of menarche. She had Tanner stage 2 breast development. Genotyping showed homozygous mutation located in exon 7 which abolishes both 17-alpha hydroxylase and 17,20 lyase activities of the CYP17A1 protein. After starting dexamethasone 0.5 mg/day, her potassium level was normalized, and blood pressure improved. In conclusion, a comprehensive evaluation should be performed before using assisted reproductive techniques, such as in vitro fertilization in hypertensive women with sexual infantilism, primary amenorrhea, and hypokalemia.

  7. Magnetic resonance imaging of sella turcica: evaluation of patients with galactorrhea, amenorrhea and hyperprolactinemia

    International Nuclear Information System (INIS)

    We have selected 135 cases of patients who have done magnetic resonance imaging of sella region, carried out from September, 1991 to August, 1996, who had galactorrhea (G), amenorrhea(A), and hyperprolactinemia (H), isolated or in association. The patients were divided in seven groups, according to the presence of these symptoms and signs. All examinations were made in a private clinic in the city of Rio de Janeiro, Brazil. Correlating these patients with the results of the magnetic resonance images, we found 57 micro adenomas, 31 normal examinations, 22 macro adenomas, 11 pituitary hyperplasias, 7 empty sella and 7 cases included in other aspects. The micro adenoma predominated in groups 1 (GAH), 2 (GH), 3 (HA) and 5 (H), that is, in all groups whose patients had hyperprolactinemia. In macro adenomas, a bright signal on T 1-weighted images indicates pituitary apoplexy with intratumoral hemorrhage. All in all, the magnetic resonance imaging is excellent method to be used in the evaluation of patients with changes in the hypothalamic-pituitary axis. (author)

  8. Hypercortisolemia Is Associated with Severity of Bone Loss and Depression in Hypothalamic Amenorrhea and Anorexia Nervosa

    Science.gov (United States)

    Lawson, Elizabeth A.; Donoho, Daniel; Miller, Karen K.; Misra, Madhusmita; Meenaghan, Erinne; Lydecker, Janet; Wexler, Tamara; Herzog, David B.; Klibanski, Anne

    2009-01-01

    Context: Anorexia nervosa (AN) and functional hypothalamic amenorrhea (HA) are associated with low bone density, anxiety, and depression. Women with AN and HA have elevated cortisol levels. Significant hypercortisolemia, as in Cushing’s disease, causes bone loss. It is unknown whether anxiety and depression and/or cortisol dysregulation contribute to low bone density in AN or HA. Objective: Our objective was to investigate whether hypercortisolemia is associated with bone loss and mood disturbance in women with HA and AN. Design and Setting: We conducted a cross-sectional study in a clinical research center. Participants: We studied 52 women [21 healthy controls (HC), 13 normal-weight women with functional HA, and 18 amenorrheic women with AN]. Outcome Measures: Serum samples were measured every 20 min for 12 h overnight and pooled for average cortisol levels. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry (DXA) at anteroposterior and lateral spine and hip. Hamilton Rating Scales for Anxiety (HAM-A) and Depression (HAM-D) were administered. Results: BMD was lower in AN and HA than HC at all sites and lower in AN than HA at the spine. On the HAM-D and HAM-A, AN scored higher than HA, and HA scored higher than HC. Cortisol levels were highest in AN, intermediate in HA, and lowest in HC. HAM-A and HAM-D scores were associated with decreased BMD. Cortisol levels were positively associated with HAM-A and HAM-D scores and negatively associated with BMD. Conclusions: Hypercortisolemia is a potential mediator of bone loss and mood disturbance in these disorders. PMID:19837921

  9. MUSCULAR OXIDATIVE CAPACITY IN OVARIECTOMIZED RATS DISCUSSION ON THE ENDURANCE PERFORMANCE OF FEMALE ATHLETES WITH SPORTS-RELATED-AMENORRHEA

    Directory of Open Access Journals (Sweden)

    Natsuo Yasui

    2004-11-01

    Full Text Available The purpose of this study was to evaluate the effects of ovariectomy on intramuscular energy metabolism in adult rats. Based on the results, we discussed the skeletal muscle metabolism in female athlete with sports related amenorrhea. Twenty-five adult (20-week-old Sprague-Dawley female rats were used. Fifteen rats underwent ovariectomy (OVX group, and the other ten rats were sham-operated (Sham group. One and four weeks after surgery, muscular oxidative capacity was measured using 31P-MR spectra of the gastrocnemius-plantaris-soleus (GPS muscles group at rest and during electric stimulation. Wet weight and maximum tension of the whole GPS muscles group were also measured. From the MRS measurements, the muscle oxidative capacity in the OVX group was significantly lower than that in the Sham group (p < 0.05 at both one and four weeks after surgery. The muscle's wet weight one week after surgery in the OVX group was the same as the Sham group, while four weeks after surgery it was significantly greater than that in the Sham group (p < 0.05. There were no significant differences in maximum tension among the groups. In conclusion, in adult rats the oxidative capacity decreased due to ovariectomy despite the increase in muscle weight. It is suggested that the muscular endurance capacity in female adult athletes with sports related amenorrhea may deteriorate.

  10. A rare case of ovarian granulosa cell tumour in an adolescent girl with secondary amenorrhea and virilisation

    Directory of Open Access Journals (Sweden)

    Arun Nayak

    2015-10-01

    Full Text Available Sex cord stromal ovarian tumors account for about 5-8% of all ovarian malignancies. Granulosa cell tumor is an estrogen secreting low grade malignant tumor and is seen in women of all ages with 2% bilaterality. Based upon histology, these neoplasms can be classified as adult and juvenile Granulosa cell tumors. Pre-pubertal lesions present clinically with sexual pseudo precocity whereas post-pubertal lesions present with menstrual irregularities or secondary amenorrhea or postmenopausal bleeding. This case report presents a rare case of Granulosa cell tumor with clinical presentation mimicking virilizing ovarian neoplasm in a 19 year old girl with history of abdominal swelling, secondary amenorrhea and virilization since one year duration. Clinical examination revealed a 20-22 weeks size abdominal mass, cystic in consistency, arising from pelvis and CT scan suggested presence of mucinous cystadenoma with solid areas with suspected malignancy. Exploratory laparotomy with right salpingo-oophorectomy was performed with staging as tumor was found confined to ovary with no involvement of other ovary or any other pelvic organ or peritoneum. Therefore, disease was staged as stage 1A. Histopathological examination confirmed the presence of Granulosa cell tumor with fibrothecomatous areas. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1653-1656

  11. 浅谈针灸治疗运动性闭经%Discuss the Treatment of Athletic Secondary Amenorrhea by Acupuncture

    Institute of Scientific and Technical Information of China (English)

    彭举华

    2013-01-01

      目的:对目前女性,尤其是年轻的女运动员出现的越来越多的运动性闭经现象进行调查与分析,根据其临床特点及诊治过程进行研究分析,为运动性闭经的治疗提供经验和方法。方法:我们可以使用中医针灸的治疗方法来治疗运动性闭经。结果:临床试验的经验表明,针灸疗法在治疗运动性闭经方面具有可观的效果。结论:我们了解到运动性闭经的症状主要会在女运动员中出现较多,她们参加较多的体育训练或者是各种比赛,在高强度大运动量的训练或比赛后,运动员容易出现精神过度紧张、内分泌失调等症状,这些都与运动性闭经的产生原因有关。因此,通过研究,我们可以运用针灸疗法来对运动性闭经进行有效的治疗。%Objective:To investigate and analyze the phenomenon of more and more athletic sec-ondary amenorrhea had happened in groups of young female athletes, and try to offer some experi-ence and methods of treatment of athletic secondary amenorrhea, according to the research on clini-cal features and diagnosis and treatment process. Methods: We can treat the athletic secondary amenorrhea using the acupuncture. Results:The clinical trial experience has shown that it would be effective by using the acupuncture therapy in treating the athletic secondary amenorrhea. Conclu-sion:We know that the symptoms of athletic secondary amenorrhea prefer to happen to groups of fe-male athletes, they ofter participate a variety of training or games, after the high-intensity training and games, athletes would more easily develop symptoms like excessive psychological stress and endocrine dyscrasia, which all related to the cause of athletic secondary amenorrhea. Therefore, through the research, we can use acupuncture therapy to treat athletic secondary amenorrhea.

  12. Cytogenetics studies of 468 patients with primary amenorrhea%468例原发性闭经患者细胞遗传学分析

    Institute of Scientific and Technical Information of China (English)

    禹虹; 边旭明; 刘俊涛; 郝娜; 周京; 刘善英

    2011-01-01

    目的 分析原发性闭经患者染色体细胞核型与临床特征的关系.方法 原发闭经患者行外周血淋巴细胞培养,常规G显带染色体核型分析(必要时行C显带).结果 468例原发闭经患者中46,XX核型为255例(54.49%),41种异常核型213例(45.51%),包括X染色体异常143例、X-Y染色体异常4例、46,XY女性57例、常染色体异常8例、X-常染色体易位1例.75.52%身材矮小原发闭经患者X染色体异常,Xp11.1-11.4与Xp21-22缺失或断裂的患者均出现身材矮小.结论 人类细胞染色体异常是原发闭经的重要原因之一,应常规行细胞遗传学检查.临床表型与染色体特殊部位有一定关系,Xp11.1-11.4与Xp21-22可能与身高发育有关.%Objective To analyze the relationship between karyotypes and clinic features of patients with primary amenorrhea. Method Karyotype analysis of patients with primary amenorrhea was performed by using G-banding technique. Results Karyotype analysis of 468 patients with primary amenorrhea revealed that 255 patients (54. 49% ) had normal female karyotypes and 213 patients (45.51%) had abnormal karyotypes, including 143 patients with abnormal X chromosome, 4 patients with mosaic X -Y chromosome, 57 patients with 46, XY karyotype, 8 patients with abnormal autosome and one patient with Xautosome translocation. 75.52% primary amenorrhea patients with short stature had abnormal X chromosome, and all primary amenorrhea patients with deletion or break-up of Xp11. 1 - 11.4 and Xp21 - 22 were short statures. Conclusion One of the main reasons of primary amenorrhea was chromosome abnormity,especial heterosome abnormity. Karyotype analysis should be used to detect primary amenorrhea patients in regular. There might be relationship between height improvement and the abnormity of Xp11. 1 - 11.4 and Xp21 - 22.

  13. New method for the induction of therapeutic amenorrhea: low dose endometrial afterloading irradiation. Clinical and hormonal studies

    Energy Technology Data Exchange (ETDEWEB)

    Gronroos, M.; Turunen, T.; Raekallio, J.; Ruotsalinen, P.; Salmi, T. (Turku Univ. (Finland). Dept. of Obstetrics and Gynecology)

    1982-08-01

    The authors present a new method for the induction of therapeutic amenorrhea: low dose endometrial afterloading irradiation. The problem with this method has been how to inactivate the endometrium while maintaining the physiological function of the ovaries. In 5/29 young patients regular or irregular bleedings occurred after an endometrial dose of 11+-1 Gy. These subjects were given a repeat low dose intrauterine irradiation. Thereafter no bleedings were found in four out of five patients. Two to 9 years after the repeat irradiation the plasma levels of E/sub 1/, E/sub 2/, FSH and LH corresponded closely to those of healthy women in reproductive age in three out of five patients; some high plasma P levels indicated ovulation. In two patients the E/sub 1/, E/sub 2/, and P values were more likely postmenopausal but, on the other hand, FSH and LH values reproductive ones. 19 refs.

  14. A new method for the induction of therapeutic amenorrhea: low dose endometrial afterloading irradiation. Clinical and hormonal studies

    International Nuclear Information System (INIS)

    The authors present a new method for the induction of therapeutic amenorrhea: low dose endometrial afterloading irradiation. The problem with this method has been how to inactivate the endometrium while maintaining the physiological function of the ovaries. In 5/29 young patients regular or irregular bleedings occurred after an endometrial dose of 11+-1 Gy. These subjects were given a repeat low dose intrauterine irradiation. Thereafter no bleedings were found in four out of five patients. Two to 9 years after the repeat irradiation the plasma levels of E1, E2, FSH and LH corresponded closely to those of healthy women in reproductive age in three out of five patients; some high plasma P levels indicated ovulation. In two patients the E1, E2, and P values were more likely postmenopausal but, on the other hand, FSH and LH values reproductive ones. (author)

  15. Double-stimulation with LH-RH in primary amenorrhea caused by chronic internal hydrocephylus: a case study.

    Science.gov (United States)

    Moeslein, S; Dericks-Tan, J S; Lorenz, R; Taubert, H D

    1987-06-01

    A 19-year-old female patient with primary amenorrhea and pubertas tarda due to chronic internal hydrocephalus presented with normal hormonal findings except for low estradiol and a prepubertal type of reaction in the double-stimulation test with LH-RH. After successful operative treatment with a Spitz-Holter high-pressure valve, the intracranial decompression was promptly followed by pubertal development, she began to menstruate, and the LH-RH double-stimulation test showed an adult pattern of response. The results of the test support the view that a partial deficiency in the secretion of LH-RH is the cause of hypogonadism in such a case. PMID:3140582

  16. A case report of recovery of menstrual function following a nutritional intervention in two exercising women with amenorrhea of varying duration.

    Science.gov (United States)

    Mallinson, Rebecca J; Williams, Nancy I; Olmsted, Marion P; Scheid, Jennifer L; Riddle, Emily S; De Souza, Mary Jane

    2013-01-01

    Increasing caloric intake is a promising treatment for exercise-associated amenorrhea, but strategies have not been fully explored. The purpose of this case report was to compare and contrast the responses of two exercising women with amenorrhea of varying duration to an intervention of increased energy intake. Two exercising women with amenorrhea of short (3 months) and long (11 months) duration were chosen to demonstrate the impact of increased caloric intake on recovery of menstrual function and bone health. Repeated measures of dietary intake, eating behavior, body weight, body composition, bone mineral density, resting energy expenditure, exercise volume, serum metabolic hormones and markers of bone turnover, and daily urinary metabolites were obtained. Participant 1 was 19 years old and had a body mass index (BMI) of 20.4 kg/m(2) at baseline. She increased caloric intake by 276 kcal/day (1,155 kJ/day, 13%), on average, during the intervention, and her body mass increased by 4.2 kg (8%). Participant 2 was 24 years old and had a BMI of 19.7 kg/m(2). She increased caloric intake by 1,881 kcal/day (7,870 kJ/day, 27%) and increased body mass by 2.8 kg (5%). Resting energy expenditure, triiodothyronine, and leptin increased; whereas, ghrelin decreased in both women. Resumption of menses occurred 23 and 74 days into the intervention for the women with short-term and long-term amenorrhea, respectively. The onset of ovulation and regular cycles corresponded with changes in body weight. Recovery of menses coincided closely with increases in caloric intake, weight gain, and improvements in the metabolic environment; however, the nature of restoration of menstrual function differed between the women with short-term versus long-term amenorrhea. PMID:23914797

  17. Influence of ghrelin and adipocytokines on bone mineral density in adolescent female athletes with amenorrhea and eumenorrheic athletes.

    Science.gov (United States)

    Russell, Melissa; Misra, Madhusmita

    2010-01-01

    Adolescent female athletes are at increased risk for low bone mineral density (BMD) secondary to exercise-induced hypogonadism. Of particular concern is that the adolescent years are also a critical time for bone accrual, and deficits incurred during this period could lead to suboptimal peak bone mass acquisition and subsequent fracture risk in later life. Although weight-bearing exercise is typically associated with an increase in BMD, amenorrheic athletes have lower BMD than eumenorrheic athletes and nonathletic controls as a consequence of low energy availability and subsequent hypogonadism. It is important to recognize that critical interactions exist between net energy availability and the hypothalamo-pituitary-gonadal (H-P-G) axis that are key to the development of a hypogonadal state when energy intake cannot keep pace with expenditure. While the link between energy availability and gonadtotropin pulsatility patterns is well established, the actual metabolic signals that link the two are less clear. Decreased energy availability in athletes is associated with decreases in fat mass, and alterations in adipokines (such as leptin and adiponectin) and fat-regulated hormones (such as ghrelin and peptide YY). These hormones impact the H-P-G axis in animal models, and it is possible that in athletes alterations in fat-related hormones signal the state of energy availability to the hypothalamus and contribute to suppression of gonadotropin pulsatility, hypothalamic amenorrhea and consequent decreased BMD. A better understanding of pathways linking low energy availability with functional hypothalamic amenorrhea and low BMD is critical for the development of future therapeutic strategies addressing these issues in amenorrheic athletes. PMID:20956863

  18. Deletion of 7q34-q36.2 in two siblings with mental retardation, language delay, primary amenorrhea, and dysmorphic features

    DEFF Research Database (Denmark)

    Sehested, Line T; Møller, Rikke S; Bache, Iben; Andersen, Noemi B; Ullmann, Reinhard; Tommerup, Niels; Tümer, Zeynep

    We describe a chromosome rearrangement, ins(7;13)(q32q34;q32), which segregates in a three generation family, giving rise to three individuals with an unbalanced rearrangement. Two of the individuals, a sister and a brother, were investigated further in this study. They had minor facial dysmorphism...... and neuropsychiatric disorders including mental retardation, language delay and epilepsy. The sister had primary amenorrhea. Array CGH revealed a 12.2¿Mb deletion at 7q34-q36.2 including more than 60 genes where CNTNAP2 and NOBOX are of special interest. Comparison of the clinical and cytogenetic...... findings of our patients with previously reported patients, supports that haploinsuffiency of CNTNAP2 can result in language delay and/or autism spectrum disorder. Furthermore, we report on the second women with a deletion involving NOBOX who is affected by primary amenorrhea....

  19. A investigation in psychiatric outpatients with amenorrhea induced by antipsychotics%精神科门诊患者药源性闭经调查

    Institute of Scientific and Technical Information of China (English)

    罗维肖; 刘姝婷; 甘少兵; 覃宇; 谭健能

    2011-01-01

    Objective:To investigate the incidence of amenorrhea induced by antipsychotics and the related factors in female schizophrenia. Method :374 outpatients with schizophrenia taking antipsychotics were investigated by serf-made questionnaire. Results: Among the 374 outpatients, amenorrhea and galactorrhoea were reported by 99 and 31 patients, respectively, with amenorrhea incidence 26.5% and the incidence of amenorrhea companying with galactorrhoea 8.3%. The incidence of amenorrhea were 57.9% for combined antipsychotics use, which was the hi.est one and, 35.6% for sulpiride and 2.5.7% for risperidone which was the first and the second highest one for single antipaychotics use. The occurrence of amenorrhea induced by antipsychotics were not related to age, marriage, education level, illness course, time of medicine-taking, amounts of medicine-taking. The female schizophrenia who hadn't given birth to a child had the significantly higher incidence of amenorrhea compared with those female schizophrenia who had given birth to a child 69.7% vs 53.8% (P <0.01 ). Conclusion: Amenorrhea is very prevalent among patients with schizophrenia on antipaychotic medications. The therapeutic strategy for female schizophrenia is needed to avoid choosing sulpiride and risperidone in the long-term treatment; moreover, antipsychotic polypharmacy should be used as low as possible, espocially for those without reproduction.%目的:调查各种抗精神病药所致女性患者闭经的发生率及相关因素.方法:用自制调查表对门诊374例复诊的女性精神分裂症患者进行调查.结果:374例服用抗精神病药的女性患者中,99例出现闭经,发生率为26.5%;31例出现泌乳,闭经伴泌乳发生率为8.3%.闭经在联合用药中的发生率最高(57.9%),单一用药中闭经发生率最高的是舒必利(35.6%),其次是利培酮(25.7%).药源性闭经的发生与年龄、病程、服药时间、药量、学历、婚否等因素无关(P>0.05).

  20. Successful pregnancy after the treatment of primary amenorrhea in a patient with non-classical congenital adrenal hyperplasia.

    Science.gov (United States)

    Purwana, Indri N; Kanasaki, Haruhiko; Oride, Aki; Miyazaki, Kohji

    2013-01-01

    We describe a case of non-classical congenital adrenal hyperplasia (NCCAH) due to 21-hydroxylase deficiency in a 30-year-old Japanese woman who achieved pregnancy after treatment of primary amenorrhea. Hirsutism and clitoromegaly were present. Ultrasound examination showed polycystic appearance of the ovary. Luteinizing hormone-releasing hormone (LH-RH) test resulted in exaggerated LH response, showing a polycystic ovary syndrome (PCOS) pattern. The diagnosis was based on the elevated intial levels of 17-hydroxyprogesterone (55 ng/mL) and dihydroepiandosterone (7780 ng/mL). The first withdrawal bleeding occurred within 6 weeks after treatment with hydrocortisone (20 mg/day) combined with conjugated estrogens (1.25 mg/day) and medroxyprogesterone acetate (10 mg/day), which were continued for five courses. The bleeding remained cyclic every 28 days with maintenance doses of hydrocortisone. Subsequently, ovulation was induced using clomiphene citrate (100 mg/day). Pregnancy was achieved at the second attempt of ovulation induction and was within 10 months after initial presentation. Continuing hydrocortisone, the patient delivered a healthy baby at term. PMID:22672538

  1. Prognostic Effects of Adjuvant Chemotherapy-Induced Amenorrhea and Subsequent Resumption of Menstruation for Premenopausal Breast Cancer Patients.

    Science.gov (United States)

    Jeon, Se Jeong; Lee, Jae Il; Jeon, Myung Jae; Lee, Maria

    2016-04-01

    Chemotherapy-induced amenorrhea (CIA) is a side effect that occurs in patients with breast cancer (BC) as a result of chemotherapy. These patients require special treatments to avoid infertility and menopause. However, the factors controlling CIA, resumption of menstruation (RM), and persistence of menstruation after chemotherapy are unknown. The long-term prognosis for premenopausal patients with BC and the prognostic factors associated with CIA and RM are subject to debate. We performed a retrospective study by reviewing the medical records of 249 patients with BC (stage I to stage III) who were treated with cytotoxic chemotherapy. The median patient age was 43 (range, 26-55 years) and the median duration of follow-up was 64 months (range, 28-100 months). The medical records indicated that 219 patients (88.0%) scored as positive for the hormone receptor (HR); the majority of these patients completed chemotherapy and then received additional therapy of tamoxifen. Our analyses revealed that 88.0% (n = 219) of patients experienced CIA, and the percentage of RM during follow-up was 48.6% (n = 121). A total of 30 patients (12.0%) did not experience CIA. Disease-free survival (DFS) was affected by several factors, including tumour size ≥2 cm, node positivity, HR negative status, and body mass index ≥23 kg/m. Multivariate analysis indicated that tumour size ≥2 cm remained as a significant factor for DFS (hazard ratio = 3.3, P = 0.034). In summary, this study finds that the majority of premenopausal patients with BC (stage I to stage III) who receive chemotherapy experience CIA and subsequent RM. Although tumour size ≥2 cm is negatively associated with DFS, RM after CIA is not associated with poor prognosis. PMID:27057900

  2. Chromosome analysis of 427 cases with primary amenorrhea%原发性闭经427例患者染色体核型分析

    Institute of Scientific and Technical Information of China (English)

    彭琳; 王楠; 邓东锐; 左伟; 程琛; 党静; 郝海燕; 周媛; 蒋敏; 凌霞珍

    2012-01-01

    目的 对原发性闭经患者进行细胞遗传学分析,探讨原发性闭经与染色体异常的关系,用以指导临床诊断及处理.方法 对427例原发性闭经患者进行外周血淋巴细胞培养、染色体制备及核型分析.结果 427例原发性闭经患者中共检出染色体异常核型118例,异常检出率为27.6℅﹙118∕427﹚.性染色体异常中,X染色体数目异常59例、结构异常25例、嵌合体24例,其中有单纯X染色体与常染色体平衡易位1例,合并X的部分缺失2例.常染色体结构异常10例,包括染色体倒位﹙4例﹚、平衡易位﹙4例﹚以及染色体大小异常﹙2例﹚,涉及到第6、7、9、14、15、16、22号常染色体.结论 结合临床表现、影像学检查以及染色体核型检查,可以为原发性闭经患者寻找病因提供理论依据,同时有利于处理措施的制定.%Objective To carry out chromosome analysis of patients with primary amenorrhea and investigate the relationship between primary amenorrhea and chromosome abnormalities, so as to guide clinical diagnosis and treatment. Methods Peripheral blood lymphocyte culture, chromosome preparation and karyotype analysis were done to 427 cases of patients with primary amenorrhea. Results There were 118 cases of abnormal chromosome karyotype with primary amenorrhea, and the anomaly detection rate was 27. 6% ( 118/427 ). In cases with sex chromosome abnormalities, there were 59 patients with numerical abnormalities of X chromosome, 25 patients with X chromosome structural abnormality, and 24 cases of mosaicism. Among them, there was one case of simple reciprocal translocation between X chromosome and autosome, and two cases of consolidation with terminal deletion of X chromosome. There were cases of autosomal structural abnormalities, including chromosomal inversion ( 4 cases ), balanced translocation ( 4 cases ) and abnormal chromosome size ( 2 cases ). Autosomal abnormalities happened on the sixth, seventh, ninth

  3. [Rupture of non-communicating rudimentary pregnant uterine horn in a pseudo-unicornuate uterus at 23 weeks of amenorrhea. Case report].

    Science.gov (United States)

    Fuchs, F; Guillot, E; Cordier, A-G; Chis, C; Raynal, P; Panel, P

    2008-04-01

    Pregnancy in the rudimentary horn of a unicornuate uterus is an extremely rare form of ectopic gestation associated with a high risk of uterine rupture. We report the case of a pregnancy developed in a non communicating rudimentary horn of a unicornuate uterus complicated by horn rupture at 23 weeks of amenorrhea showing as an acute abdominal pain and massive hemoperitoneum. This patient's uterine abnormality was known before, as this woman has delivered two years before at term a healthy boy by cesarean section. This past pregnancy was located in the normal horn and the non communicating rudimentary horn seemed at this time normal. This uterine malformation is presented with its gynecological and obstetrical entailments as well as methods that could prevent such outcome. PMID:18424217

  4. The risk of amenorrhea is related to chemotherapy-induced leucopenia in breast cancer patients receiving epirubicin and taxane based chemotherapy.

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    Wenbin Zhou

    Full Text Available BACKGROUND: Chemotherapy-induced amenorrhea (CIA is common in young breast cancer patients. The incidence of CIA associated with regimens involving epirubicin and taxane was not well known. Furthermore, previous studies suggested leucopenia and amenorrhea may reflect inter-individual variations in pharmacokinetics. The purpose of this study was to investigate the association between leucopenia after first cycle of chemotherapy and CIA in young breast cancer patients receiving epirubicin and taxane based chemotherapy. Furthermore, the incidence of CIA was also assessed. METHODOLOGY AND PRINCIPAL FINDINGS: Between October 2008 and March 2010, 186 consecutive premenopausal patients, treated with epirubicin and taxane based chemotherapy, were recruited. Information about CIA was collected by telephone and out-patient clinic. Of these 186 patients, data from 165 patients were included and analyzed. Of all 165 patients, CIA occurred in 72 patients (43.64%. In multivariate analysis, age older than 40 y (OR: 16.10, 95% CI: 6.34-40.88, P0.05. The rate of CIA in leucopenia group (52.56% was significantly higher than that in normal leukocyte group (34.62% (P = 0.024. In patients treated with a FEC regimen (cyclophosphamide, epirubicin and 5-fluorouracil, the rate of CIA in leucopenia group (59.57% was significantly higher than that in normal leukocyte group (36.84% (P = 0.037. CONCLUSIONS: Age at diagnosis and previous childbearing were both found to significantly increase the risk of CIA, whereas additional taxane was not associated with increased rate of CIA. Importantly, leucopenia after first cycle of chemotherapy was associated with increased risk of CIA, which suggested that leucopenia may be an early predictor of chemotherapy-induced infertility.

  5. 汉族女性精神分裂症首发患者利培酮治疗所致闭经的危险因素%Risk factors for medication-induced amenorrhea in first-episode female Chinese patients with schizophrenia treated with risperidone

    Institute of Scientific and Technical Information of China (English)

    陈海支; 任丽华; 沈仲夏; 钱敏才; 沈鑫华; 杨胜良; 杨剑虹; 宋娟芬; 费小聪; 陶百平; 宋宝华

    2013-01-01

    Background:Amenorrhea is a common adverse effect of treatment with antipsychotic medications that influences both fertility and adherence to medication regimens. Most research suggests that medication-induced prolactinemia is the main cause of amenorrhea but few prospective studies have assessed this hypothesis. Aim:Identify risk factors for amenorrhea following treatment with antipsychotic medication. Methods:The study used a prospective, nested case-control design. First-episode, drug naïve female patients with schizophrenia who were in the middle of their menstrual cycle at the time of admission were enrolled. Serum levels of six reproductive hormones were assessed before and after a 12-week course of treatment with risperidone:progesterone, estradiol, prolactin, follicular stimulating hormone, luteinizing hormone, and testosterone. The hormone levels of 31 patients who had no menstruation during the entire 12 weeks of treatment (the amenorrhea group) were compared to those of 31 age-matched subjects who had normal menstrual periods over the 12 weeks of treatment (the control group). Results:We found a dramatic 4-fold increase in prolactin levels in women of childbearing age treated with risperidone, but the pretreatment and posttreatment levels of prolactin were not different between patients who did and did not develop amenorrhea with treatment. However, there were significantly lower pretreatment levels of estradiol and progesterone in patients who subsequently developed amenorrhea with risperidone treatment than in patients who did not develop amenorrhea. A conditional logistic regression analysis found that pretreatment levels of estradiol remained significantly associated with the development of amenorrhea during treatment even when adjusting for the pretreatment levels of the other five reproductive hormones assessed. Conclusion:These findings do not support the suggestion that amenorrhea associated with the use of antipsychotic medication is the result

  6. Secondary amenorrhea in a woman with spinocerebellar degeneration treated with thyrotropin-releasing hormone: a case report and in vitro analysis

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    Kanasaki Haruhiko

    2011-12-01

    Full Text Available Abstract Introduction While thyrotropin-releasing hormone is known to be a prolactin-release stimulating factor, thyrotropin-releasing hormone-tartrate and its derivative, taltirelin hydrate, are used for the treatment of spinocerebellar degeneration, a degenerative disease characterized mainly by motor ataxia. We report the case of a patient being treated with a thyrotropin-releasing hormone preparation for spinocerebellar degeneration who developed amenorrhea after a dose increase. Her hormonal background was analyzed and the effect of prolonged exposure to thyrotropin-releasing hormone on pituitary prolactin-producing cells was examined in vitro. Case presentation Our patient was a 36-year-old Japanese woman who experienced worsening of gait disturbance at around 23 years of age, and was subsequently diagnosed as having spinocerebellar degeneration. She had been treated with thyrotropin-releasing hormone-tartrate for four years. Taltirelin hydrate was added to the treatment seven months prior to her presentation, followed by an improvement in gait disturbance. Around the same period, she started lactating and subsequently developed amenorrhea three months later. Taltirelin hydrate was discontinued and she was referred to our hospital. She was found to have normal sex hormone levels. A thyrotropin-releasing hormone provocation test showed a normal response of thyroid-stimulating hormone level and an over-response of prolactin at 30 minutes (142.7 ng/mL. Resumption of menstruation was noted three months after dose reduction of thyrotropin-releasing hormone. In our in vitro study, following long-term exposure to thyrotropin-releasing hormone, cells from the rat pituitary prolactin-producing cell line GH3 exhibited an increased basal prolactin promoter activity but showed a marked decrease in responsiveness to thyrotropin-releasing hormone. Conclusions Physicians should be aware of hyperprolactinemia-associated side effects in patients receiving

  7. Magnetic resonance imaging of sella turcica: evaluation of patients with galactorrhea, amenorrhea and hyperprolactinemia; Ressonancia magnetica da sela turca: avaliacao de pacientes com galactorreia, amenorreia e hiperprolactinemia

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Alair Augusto Sarmet M.D. dos [Hospital Universitario Antonio Pedro, Niteroi, RJ (Brazil). Dept. de Radiologia; Moreira, Denise Madeira [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia; Andreiuolo, Pedro Angelo [Beneficencia Portuguesa de Niteroi, RJ (Brazil). Servico de Radiologia Santa Cruz Scan

    1999-08-01

    We have selected 135 cases of patients who have done magnetic resonance imaging of sella region, carried out from September, 1991 to August, 1996, who had galactorrhea (G), amenorrhea(A), and hyperprolactinemia (H), isolated or in association. The patients were divided in seven groups, according to the presence of these symptoms and signs. All examinations were made in a private clinic in the city of Rio de Janeiro, Brazil. Correlating these patients with the results of the magnetic resonance images, we found 57 micro adenomas, 31 normal examinations, 22 macro adenomas, 11 pituitary hyperplasias, 7 empty sella and 7 cases included in other aspects. The micro adenoma predominated in groups 1 (GAH), 2 (GH), 3 (HA) and 5 (H), that is, in all groups whose patients had hyperprolactinemia. In macro adenomas, a bright signal on T 1-weighted images indicates pituitary apoplexy with intratumoral hemorrhage. All in all, the magnetic resonance imaging is excellent method to be used in the evaluation of patients with changes in the hypothalamic-pituitary axis. (author)

  8. Amenorréia primária e cariótipo XY: identificando pacientes em risco Primary amenorrhea and XY karyotype: identifying patients in risk

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    Rafael Fabiano Machado Rosa

    2008-11-01

    ser rotineiramente avaliados em indivíduos com amenorréia primária. Dessa forma, haveria um reconhecimento mais precoce das pacientes 46,XY e, conseqüentemente, um adequado manejo clínico das mesmas.PURPOSE: to verify the prevalence and clinical characteristics of patients with primary amenorrhea and XY caryotype, evaluated in our Service, aiming at identifying findings which could help their recognition. METHODS: from January 1975 to November 2007, 104 patients with amenorrhea were evaluated. All the cases were analyzed by the caryotype by GTG bands. Among them, 21 (20.2% presented a XY 46 constitution. Nevertheless, two of them were excluded from the study, because of incomplete data in their patient's chart. Most of the 19 patients who formed the sample had been referred to us by the gynecology clinics (63.2%. Their ages varied from 16 to 41 years old (an average of 22.1. Data were collected about their family and previous history, physical examination and results of complementary exams and the information was taken into consideration to determine the diagnosis. RESULTS: the predominant diagnosis was resistance to androgens syndrome (n=12; 63.2%; five patients (25.3% presented XY pure gonadal dysgenesis (XY PGD, one (5.3% 17 alpha-hydroxylase deficiency, and one (5.3%, 5 alpha-reductase deficiency. Clinical findings frequently found in these patients included abnormal development of secondary sexual characters (n=19, uterine agenesia with a blind vagina (n=14, family history of amenorrhea (n=8, and palpable gonads in the inguinal canal (n=5. Two of them presented a history of inguinal hernia. Systemic arterial hypertension was only diagnosed in the patient with 17 alpha-hydroxylase deficiency, and gonadal malignization, in the one with XY PGD. CONCLUSIONS: the rate of patients with XY caryotype (20% was higher than the one described in the literature (3 to 11%. It is believed that this fact is related to the way patients are usually referred to our service

  9. Analysis of chromosomal karyotyp in 69 patients with primary amenorrhea in Xiamen%厦门地区69例原发闭经患者的染色体核型分析

    Institute of Scientific and Technical Information of China (English)

    刘芳; 史彩虹; 王厚照; 周友泉

    2012-01-01

    Objective To explore the distribution of abnormal chromosome karyotype in patients with primary amenorrhea in Xiamen area and its clinical signs and significance. Methods Karyotype analysis was performed by peripheral blood lymphocyte chromosomal culture techniques. Results In total 69 patients with primary amenorrhea, there were 28 cases of chromosomal abnormalities , abnormal detection rate was 40. 6% , of which the X chromosomes number abnormalities in 8 cases, accounting for 28. 6% ; number abnormalities and chimera in 6 cases, accounting for 21.4% ; structural abnormalities in 5 cases, accounting for 17.9% ; structural abnormalities and chimera in 3 cases, accounting for 10.7% ; chromosome inversion in 3 cases, accounting for 10.7% ; sex-reversed in 2 cases, accounting for 7.1 % ; autosomal translocation in 1 case, accounting for 3.6%. Conclusion Chromosomal abnormality is one of the major causes of primary amenorrhea, cytogenetic examination in primary amenorrhea patients is important to determine its causes and treatment options.%目的 探讨厦门地区原发性闭经患者各种异常染色体核型的分布情况及其有关临床体征和意义.方法 采用外周血淋巴细胞染色体培养技术进行染色体核型分析.结果 69例原发闭经患者共检出染色体异常28例,异常检出率为40.6%,其中X染色体数目异常8例,占28.6%;X染色体数目异常及嵌合体6例,占21.4%;X染色体结构异常5例,占17.9%;X染色体结构异常及嵌合体3例,占10.7%;染色体倒位3例,占10.7%;性反转2例,占7.1%;与常染色体易位1例,占3.6%.结论 染色体异常是导致原发性闭经的主要病因之一,对原发闭经患者进行细胞遗传学检查,对确定其病因及治疗方案具有重要意义.

  10. Clinical Analysis on the Treatment of Secondary Amenorrhea with Traditional Chinese Medicinal Herbarium%中药周期治疗女兵继发性闭经疗效观察与分析

    Institute of Scientific and Technical Information of China (English)

    周宁; 赵欣; 张莉亚

    2012-01-01

    目的:探讨女兵继发性闭经的原因,比较中药周期治疗与激素治疗疗效.方法:将123位就诊者随机选取为治疗组66例,采用中药周期治疗(经前期采用疏肝解郁活血通经,月经间期则重补肾健脾益气生血),对照组59例,采用激素治疗.结果:治疗组治愈率77.3%,有效率93.9%,均明显优于对照组的42.4%与74.6%(P<0.01).结论:肝气郁结气滞血瘀气血虚弱为女兵继发性闭经的主要原因;中药周期治疗与传统激素治疗比较,具有有效率高,尤其是治愈率较高,停药后反复率低,且副作用小的特点.%Objective: To discuss the secondary amenorrhea pathogeny of the femalsoliders.To compare the therapeutic efficacy of the traditional Chinese medicine herbarium with her menstrual cycle and the sex hormone sequential therapy. Method: In (his study the 66 patients were treated with traditional Chinese medicinal herbarium according her menstrual cycle ( In the menstrual early, Shu liver invigorate the circulation of blood; In the oviposit period and the luteral phase, nourishing qi and blood ) , Then 59 observers were treated with the sex hormone sequential therapy. Result: The effective rates after the treatment were 93.9% , there have no significant adverse reactions. Conclusion : Traditional Chinese Medicine herbarium with her menstrual cycle is effetive for secondary amenorrhea compare with the sex hormone sequential therapy.

  11. Breastfeeding and Postpartum Amenorrhea in Rural Guatemala

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    Pinto Aguirre, Guido

    2005-07-01

    Full Text Available The association between breastfeeding patterns and resumption of postpartum menstruation was examined in rural Guatemalan women from the INCAP longitudinal study (1969-1977. It was distinguished among women who experienced infant mortality before menses resumed, women who weaned before menses resumed, and women who had return of menses while still breastfeeding. Weaning and infant mortality before menses resumes are significant risk factors for resumption of postpartum menstruation. Among those women whose menses resumed while still nursing or who remained amenorrheic and nursing at lose to follow-up or the end of the study, low number of nursing bouts per 24-hr day and the early introduction of supplements to the child were significant risk factors for the return of postpartum menstruation.

  12. [Hypercarotenemia, amenorrhea and a vegetarian diet].

    Science.gov (United States)

    Martin-Du Pan, R C; Hermann, W; Chardon, F

    1990-01-01

    In order to analyse the role of hypercarotenemia in amenorrhoea, we have studied the ovarian function of 20 patients presenting with hypercarotenemia (serum carotene greater than 5 mumol/l). 12 of these were complaining of secondary amenorrhoea (group I), 7 with a normal weight (group I A) and 5 with a weight below 85% of ideal weight (group I B). Another group of 8 patients had normal menstrual cycles and a body weight within normal limits (group II). Group I presented an ovarian insufficiency of hypothalamic origin with an increase in the FSH/LH ratio. The patients in group I A although of normal weight differed from group II by a history of important weight variations, strenuous sports activity and an essentially vegetarian diet, the most likely reason for their hypercarotenemia. The high carotene levels however do not seem to be directly responsible for the amenorrhoea, in view of the normal menstrual cycles of the patients in group II. Hypercarotenemia can be considered as a biologic marker of weight loss with fat mobilisation and low T3 levels. It can also be due to a vegetarian diet. The latter may be an aetiological factor in anovulation by increasing faecal excretion of oestrogens and thus decreasing blood levels of oestradiol particularly when associated with other compounding factors such as excessive physical activity, loss of weight or affective problems. PMID:2345271

  13. What Are the Treatments for Amenorrhea?

    Science.gov (United States)

    ... resection can help restore the menstrual cycle. 7 Pituitary tumor . Medications may be recommended to shrink the tumor. ... surgery may be necessary to remove the tumor. Pituitary tumors are not cancerous, but they can cause problems ...

  14. Riesgo Cardiovascular en la Anorexia Nerviosa y en otras formas de Amenorrea Hipotalámica Funcional Relacionadas con la Desnutrición Cardiovascular risk in anorexia nerviosa and other forms of functional hypothalamic amenorrhea related to undernutrition

    Directory of Open Access Journals (Sweden)

    Leán Fiszlejder

    2012-03-01

    ón auricular y la bradicardia, no es estadísticamente significativa, la presencia de estas arritmias aumentan el RCV y la posibidad de una eventual muerte súbita.The imbalance between energy intake and energy expenditure observed in malnourished or frankly under-nourished women with functional hypothalamic amenorrhea triggers an increased activity of hypothalamic hormones and peripheral neuropeptides, at facilitating the availability of endogenous energy metabolites. Osteoporosis, immune depression, hypothalamic amenorrhea and increased cardiovascular risk can be interpreted as secondary effects of the homeosthatic adaptation reactions by central and peripheral hormones. The extent of somatotropic axis deficiency, hypoestrogenism and time of evolution condition the nature of coronary circulation alterations and myocardial structural and functional involvement. An unfavorable lipid profile (normal LDL/ low HDL and hypertriglyceridemia, the rise in peripheral markers of fibrinolytic and inflammatory processes, results in a proatherosclerotic and prothrombotic environment. A premature presence of atheroma plaques in carotid walls, intima media thickness and subsequent artery stiffness may be frequently observed. This makes blood flow difficult, leading to coronary ischemia and predisposition to stroke. Echocardiographic studies show a decrease in the muscle mass of the left ventricle walls and the interventricular septum. These structural changes correlate with a volume reduction in the post-stress systolic ejection fraction, which subsequently occurs at rest at rest.The reduction in diastolic filling volume can be observed if the course of the disease is relatively long, showing, a serious compromise of cardiac performance. Even if the incidence of supraventricular extrasystoles, atrial fibrillation and bradycardia is not statistically significant, the presence of such arrhythmias increases CVR and the possibility of potential sudden death.

  15. lnteracciones de la respuesta del eje somatotrófco en la amenorrea hipotalámica funcional relacionada con la desnutrición The activity of the somatotrophic function in Functional Hypothalamic Amenorrhea (FHA related to undernourishmant

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    L Fiszlejder

    2011-03-01

    ólisis que aporta glucosa. No obstante, el aumento de los ácidos grasos libres y eventualmente la aparición de cuerpos cetónicos cuando la alimentación es muy restringida, sugieren la presencia de acidosis metabólica. Este estadio clínico implica un aumento del riesgo cardiovascular y la posibilidad de muerte prematura o súbita, una eventualidad latente en las pacientes con AHF y desnutridas. El autor declara no poseer conflictos de intereses.The activity of the somatotropic function in Functional Hypothalamic Amenorrhea (FHA is increased at the central level, and paradoxically, the peripheral hormonal behaviour, intermediate metabolism and several clinical aspects may be similar to those observed in somatotropic axis deficiency. Baseline and daily GH secretion levels are high, but its pulsatile profile is irregular. This results in resistance to GH, i.e., downregulation of hormone receptors, which, together with the decrease in GH binding protein (GHBP, impair GH ability to stimulate the synthesis of IGF-I, IGFBP-3 and the acid-labile subunit in the liver. This causes a decrease in the availability of free IGF-I in tissues. In addition, IGFBP-1 and IGF-BP2 significantly increase. Even if these peptides are regulated by GH, their inverse correlation with insulin activity (which is decreased in these patients and the low protein diet, respectively, appear to be more important factors. The increase in the serum levels of these peptides also contributes to the decrease in free IGF-I. Alterations in secretory patterns lead to a decrease in leptin concentration (an adipokine and to an increase in Ghrelin, which, in turn, facilitates GH secretion and has a remarkable incidence in intermediate metabolism in these undernourished patients. These hormonal changes can be interpreted as a mechanism of homeostatic adaptation tending to preserve availability of energetic nutrients. Thus, there is an initial predominance of lypolisis followed by proteolysis at muscle level. If

  16. Analysis of genomic copy number variations in two sisters with primary amenorrhea and hyperandrogenism%原发性闭经伴高雄激素血症两姐妹基因组拷贝数变异的检测和分析

    Institute of Scientific and Technical Information of China (English)

    张艳亮; 徐秋月; 蔡雪梅; 李轶勋; 宋贵波; 王娟; 张容琛; 戴勇; 段勇

    2015-01-01

    Objective To analyze genomic copy number variations (CNVs) in two sisters with primary amenorrhea and hyperandrogenism.Methods G-banding was performed for karyotype analysis.The whole genome of the two sisters were scanned and analyzed by array-based comparative genomic hybridization (array-CGH).The results were confirmed with real-time quantitative PCR (RT-qPCR).Results No abnormality was found by conventional G-banded chromosome analysis.Array-CGH has identified 11 identical CNVs from the sisters which, however, overlapped with CNVs reported by the Database of Genomic Variants (http://projects.tcag.ca/variation/).Therefore, they are likely to be benign.In addition, a-8.44 Mb 9p11.1-p13.1 duplication (38 561 587-47 002 387 bp, hg18) and a -80.9 kb 4q13.2 deletion (70 183 990-70 264 889 bp, hg18) were also detected in the elder and younger sister, respectively.The relationship between such CNVs and primary amenorrhea and hyperandrogenism was however uncertain.RT-qPCR results were in accordance with array-CGH.Conclusion Two CNVs were detected in two sisters by array-CGH, for which further studies are needed to clarify their correlation with primary amenorrhea and hyperandrogenism.%目的 检测和分析原发性闭经伴高雄激素血症姐妹的基因组拷贝数变异(copy number variations,CNVs).方法 应用常规G显带法和微阵列比较基因组杂交(array-based comparative genomic hybridization,array-CGH)芯片对2例患者分别进行常规核型分析和全基因组高分辨率扫描,实时定量PCR验证array-CGH芯片检测结果的准确性.结果 常规G显带核型分析显示2例患者的核型均无异常.Array-CGH检测发现2例患者存在11个相同的CNVs,然而,这些CNVs与国际公共良性CNVs数据库已报道的CNVs相重叠,因此很可能是良性的.此外,姐姐的9p11.1-p13.1(chr9:38 561 587-47 002 387,hg18)还存在一约8.44Mb的微重复,妹妹的4q13.2 (chr4:70 183 990-70 264 889,hg18)还存在一约80.9 kb的微缺失,与

  17. Etiopatogenia de la amenorrea hipotalámica funcional: Interacción de las respuestas hormonales del sistema nervioso central y neuropéptidos periféricos Ethiopatogeniae of functional hypothalamic amenorrhea: Interactions of central nervous system and peripherical neuropeptides responses

    Directory of Open Access Journals (Sweden)

    L. Fiszlejder

    2008-06-01

    hipoestrogenismo es también uno de los factores de riesgo cardiovascular. No obstante, la administración de anticonceptivos que combinan estrógenos más progesterona, pueden aumentar significativamente los niveles de la proteína C reactiva, un reconocido y seguro marcador de riesgo cardiovascular. Ello induce a tomar precauciones en su utilización en estas amenorricas desnutridas. Asimismo, la administración de anticonceptivos no ha demostrado brindar un beneficio sustancial en el tratamiento de la osteosporosis de estas pacientes. El "circuito periférico", funcionalmente interrelacionado con el central, está principalmente compuesto por la leptina, adiponectina, ghrelin, insulina e IGF-1, péptidos provenientes del compartimiento graso ("adipocitokinas" tracto gastrointestinal superior, páncreas e hígado, respectivamente. Estos péptidos no sólo están involucrados en los mecanismos centrales del apetito y saciedad, sino que también participan en las respuestas de adaptación homeostática, tendientes a revertir los desvíos del metabolismo intermedio y fosfocálcico, que en grado variable afectan a estas pacientes. Conclusiones: la AHF relacionada en general con el estrés psicofísico prolongado y la mala nutrición, es un síndrome complejo, cuyas respuestas hormonales centrales y periféricas de adaptación, resultan primordiales en estas mujeres que padecen un cierto grado de compromiso nutritivometabólico general. Enfocando globalmente este abigarrado síndrome, estimamos que la AHF es, obviamente, un epifenómeno menos vital.Functional Hypothalamic Amenorrhea (FHA is a complex pathology produced by psicological stress, as observed in amenorrhea nervosa and bulimia or in intensive physical activity (athletas, competitions, classic dancing. Frequently, these factors are associated to quali-quantitative inadequated diets and therefore they induce alterations in the energetic balance (caloric intake, caloric expend and modification in body composition. These

  18. Fisiopatología de la disfunción gonadal en la Amenorrea Hipotalámica funcional (AHF y su relación con la activación del eje hipotálamo-hipófiso-adrenal Pathophysiology of gonadal dysfunction in functional Hypothalamic Amenorrhea (FHA and its relation to activation of the hypothalamic-pituitary-adrenal axis

    Directory of Open Access Journals (Sweden)

    León Fiszlejder

    2011-06-01

    cortisol sérico no son suprimidos por la administración de dexametasona y además la respuesta del ACTH postestímulo con CRH está atenuada. Estas observaciones sugieren una alteración de los mecanismos de "feedback" negativo del cortisol sobre la secreción del CRH-ACTH. Los mecanismos de esta resistencia al cortisol no están completamente dilucidados. Experiencias en animales sugieren que el estrés prolongado modifica la densidad y la relación de los receptores gluco/mineralocorticoideos y la actividad posreceptor. Por extrapolación se podría inferir que esta resistencia al cortisol en estas pacientes amenorreicas constituye un mecanismo tendiente a perpetuar la hiperactividad del eje adrenal. En adición, la activación del sistema simpático con el aumento de norepinefrina y epinefrina y su asociación con otros factores, produce un incremento en la liberación de glucosa y el aumento en la disponibilidad de NEFA, ácidos grasos libres y aminoácidos, mayor actividad cardíaca, estados de alerta y ansiedad. Estos aspectos pueden ser observados en estas pacientes con AHF, quienes frecuentemente presentan un importante componente psicosomático en su etiopatogenia. Conclusiones: la activación en el hipotálamo del NPY-CRH y sistemas opioide, serotoninérgico, GABAérgico, dopaminérgico y noradrenérgico, no solo afecta la función gonadal, sino que también puede estar involucrada en el desarrollo de osteoporosis y su riesgo de fracturas, inmunodepresión, aumento del riesgo cardiovascular y muerte súbita, una eventualidad latente en estas pacientes desnutridas con AHF.Functional Hypothalamic Amenorrhea (FHA is a secondary process to an adaptive response in women with inadequate diets and modified body composition. This process triggers hormonal reactions in the hypothalamus for preservation of metabolic homeostasis. It involves a "central circuit" made up of a network of hypothalamic hormones interrelated with a "peripheral circuit" made up of leptin and

  19. Lactação com amenorréia: experiência de enfermeiros e a promoção dessa opção contraceptiva Lactancia con amenorrea: experiencia de enfermeros y la promoción de esa opción anticonceptiva Lactational amenorrhea: nurses experience and the promotion of this alternative method of contraception

    Directory of Open Access Journals (Sweden)

    Escolástica Rejane Ferreira Moura

    2011-03-01

    varió de uno a seis meses, con media de 4,31 meses. Doce (19,6% usaron la LAM. El estudio demostró que la experiencia personal de enfermeros con la LAM no influenció en la promoción de este método a las pacientes atendidas por tales profesionales.This is a cross-sectional, field study that used a quantitative approach with the objectives to identify nurses' personal experiences with breastfeeding and with the Lactactional Amenorrhea Method (LAM; learn the reasons for not adhering to breastfeeding or adhering to mixed feeding; establish the relationship between nurses' personal experience with the LAM and their giving orientations about this contraceptive method to users of the Primary Health Care Center. Participants were 137 nurses with the Family Health Strategy in Fortaleza, Ceará, Brazil, and data collection was performed through interviews. Most participants were female; i.e., 121 participants (88.3%. The age range was 26 to 59 years, with an average of 38.3 years. Sixty-six participants (94.2% had a previous experience with breastfeeding, 61 (92.4% of which adhered to Exclusive Breastfeeding (EB, 5 (7.6% to Mixed Feeding (MF; and 4 (5.8% did not breastfeed. The time of EB ranged from one to six months, with an average 4.31 months. Twelve nurses (19.6% followed the LAM. The study showed that the nurses' personal experience with the LAM did not affect the promotion of this method to the clientele that they assist.

  20. Continuous Amenorrhea May Be Insufficient to Stop the Progression of Colorectal Endometriosis.

    Science.gov (United States)

    Millochau, Jenny-Claude; Abo, Carole; Darwish, Basma; Huet, Emmanuel; Dietrich, Gauthier; Roman, Horace

    2016-01-01

    We present the case of a patient in whom consecutive imaging assessment and surgery demonstrated the obvious progression of colorectal endometriosis under continuous medical therapy. A 26-year-old nullipara presented with secondary dysmenorrhea, deep dyspareunia, diarrhea, and constipation during menstruation. Magnetic resonance imaging (MRI) assessment revealed 2 right ovarian endometriomas, but no deep endometriosis lesion. Intraoperatively, we found a 2-cm length of thickened and congestive area of sigmoid colon, along with small superficial lesions arising in the small bowel and appendix. We performed ablation of ovarian endometriomas and appendectomy, and decided to not resect the bowel. Postoperative computed tomography-based virtual colonoscopy (CTC) revealed a slight abnormality of the sigmoid colon. Endorectal ultrasound identified a normal rectum and sigmoid colon. Despite long-term continuous medical treatment, the patient presented 4 years later with impaired digestion consisting in constipation alternating with diarrhea, bloating, dyschesia, and pelvic pain. MRI and CTC revealed an abnormal sigmoid colon from 42 to 50 cm above the anus, with digestive tract diameter reduced from 10 mm down to the virtual lumen, along with an overall rigid appearance. Laparoscopy revealed the extent of endometriosis lesions in the sigmoid colon and multiple implantations in the small bowel. We performed sigmoid and small bowel resection. This case demonstrates the obvious progression of deep rectal endometriosis despite 4 years of continuous hormonal therapy. PMID:27130533

  1. Amenorréia e osteoporose em adolescentes atletas Amenorrhea and osteosporosis in adolescents athletes

    OpenAIRE

    MANTOANELLI Graziela; Maria Sylvia de Souza VITALLE; AMANCIO Olga Maria Silverio

    2002-01-01

    A participação feminina no esporte foi crescendo ao longo dos anos. Trabalhos científicos têm mostrado os benefícios trazidos por esta prática para a saúde da mulher, mas quando se trata de esporte competitivo podem surgir problemas. A complicação mais comum descrita pela literatura é a "tríade da atleta", a qual envolve três processos: o distúrbio alimentar, a amenorréia e a osteoporose. A amenorréia atinge, nos Estados Unidos, até 66% das atletas de competição, e algumas de suas possíveis c...

  2. La amenorrea como criterio diagnóstico de la anorexia nerviosa / Amenorrhea as a Diagnostic Criterion for Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Santos Orejudo Hernández

    2013-06-01

    Full Text Available La amenorrea es un criterio para el diagnostico de la anorexia nerviosa (AN según el DSM-IV-TR. Sin embargo, al comparar grupos de pacientes que cumplen todos los criterios de este manual para la AN con grupos de mujeres que los presentan todos salvo la amenorrea, algunos estudios no han encontrado diferencias significativas en la psicopatología típicamente asociadas con la AN. El propósito de nuestro estudio ha sido comparar variables demográficas, antropométricas, psicológicas y psicopatológicas, en ambos grupos. No se observaron diferencias estadísticamente significativas entre ambos grupos en las variables evaluadas, pero el grupo con amenorrea tenía un índice de masa corporal significativamente más bajo. Nuestros datos apoyan la hipótesis de que la amenorrea podría no ser un criterio diagnóstico útil para la AN.

  3. Recurrence of Uterine Rupture in a Pseudo-Unicornuate Uterus at 17 Weeks of Amenorrhea: Case Report and Literature Review

    OpenAIRE

    S, Errarhay; S, Mahmoud; C, Bouchikhi; H, Châara; H, Bouguern; Melhouf MA; A, Banani

    2009-01-01

    Pregnancy in a rudimentary horn is a very rare condition. It is responsible for several complications. Prognosis is reserved because the natural evolution generally leads to a cataclysmic uterine rupture at the beginning of the second trimester. Classically, the treatment after foetal extraction consists of ablation of the rudimentary horn and associated fallopian tube. We report the obstetric outcome of a patient with history of rudimentary uterine horn rupture, the treatment of which was ab...

  4. Recurrence of uterine rupture in a pseudo-unicornuate uterus at 17 weeks of amenorrhea: case report and literature review.

    Science.gov (United States)

    Errarhay, S; Mahmoud, S; Bouchikhi, C; Châara, H; Bouguern, H; Melhouf, Ma; Banani, A

    2009-01-01

    Pregnancy in a rudimentary horn is a very rare condition. It is responsible for several complications. Prognosis is reserved because the natural evolution generally leads to a cataclysmic uterine rupture at the beginning of the second trimester. Classically, the treatment after foetal extraction consists of ablation of the rudimentary horn and associated fallopian tube. We report the obstetric outcome of a patient with history of rudimentary uterine horn rupture, the treatment of which was ablation of the rudimentary horn. PMID:21483504

  5. Recurrence of Uterine Rupture in a Pseudo-Unicornuate Uterus at 17 Weeks of Amenorrhea: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Banani A

    2009-01-01

    Full Text Available Pregnancy in a rudimentary horn is a very rare condition. It is responsible for several complications.Prognosis is reserved because the natural evolution generally leads to a cataclysmic uterine ruptureat the beginning of the second trimester. Classically, the treatment after foetal extraction consists ofablation of the rudimentary horn and associated fallopian tube. We report the obstetric outcome of apatient with history of rudimentary uterine horn rupture, the treatment of which was ablation of therudimentary horn.

  6. A new logical insight and putative mechanism behind fluoxetine-induced amenorrhea, hyperprolactinemia and galactorrhea in a case series

    OpenAIRE

    Mondal, Somnath; Saha, Indranil; Das, Saibal; Ganguly, Abhrajit; Das, Debasis; Tripathi, Santanu Kumar

    2013-01-01

    With the exception of fluoxetine, all selective serotonin reuptake inhibitors (SSRIs) commonly cause hyperprolactinemia through presynaptic mechanisms indirectly via 5-hydroxytryptamine (5-HT)-mediated inhibition of tuberoinfundibular dopaminergic neurons. However, there is little insight regarding the mechanisms by which fluoxetine causes hyperprolactinemia via the postsynaptic pathway. In this text, analysis of five spontaneously reported clinical cases of hyperprolactinemia resulting in ov...

  7. Policy considerations for the introduction and promotion of the lactational amenorrhea method: advantages and disadvantages of LAM.

    Science.gov (United States)

    Kennedy, K I; Kotelchuck, M

    1998-09-01

    Some attributes of LAM are unquestionably positive, such as the fact that it is effective. Clinical trials of LAM have upheld the Bellagio Consensus that the chance of pregnancy is less than 2% in the first 6 months postpartum in amenorrheic women who are fully or nearly fully breastfeeding. Secondary data analyses in numerous settings have drawn the same conclusion. Whether as a strategy or a method, used correctly or even if used imperfectly, LAM is a reliable way to avoid pregnancy. To the extent that LAM represents an additional contraceptive option, this is also clearly positive since a broad array of contraceptive options maximizes the likelihood of finding a good fit between user and method, and increases contraceptive use. Other characteristics of LAM represent potentially positive impacts. If LAM is shown to be an effective conduit to other modern methods, the implications are profoundly positive. If LAM is cost effective, for households and/or for programs, this will also make the method extraordinarily attractive. Conversely, some aspects of LAM are negative, such as the fact that it affords no protection against STDs, it requires counseling from a well-informed provider, and intensive breastfeeding can make heavy demands on the woman's time. Many of the remaining attributes of LAM may not be important to a policy decision about LAM promotion. For example, whether LAM is actualized as a strategy or a method may not be important to a decision to promote LAM, although it has a huge impact on how services are delivered. Some factors may be profound on a local or individual level. For example, one simple factor, such as the absence of full/nearly full breastfeeding, can rule out the method as an option, while another, such as the fact that it provides the needed waiting period during vasectomy counseling, can make LAM the method of choice. Although LAM seems unlikely to have widespread popularity in societies like the United States, within such settings are breastfeeding women for whom other contraceptive choices are not satisfactory and to whom LAM is attractive. Although clinicians cannot be expected to directly provide LAM education in every setting, women should be informed about LAM as an effective contraceptive choice, and clinicians should be prepared to make referrals to competent sources. The future of LAM, especially in terms of formal, programmatic initiatives, may continue to be focussed in transitional and less developed settings. Comparative cost/benefit analyses for both the family planning program and the household will contribute meaningfully to decisions about whether to use LAM and whether to include LAM in national and local family planning policies and programs. The most important call to action is to implement operations research designed to determine what factors, if any, will maximize the uptake of a second modern contraceptive method after LAM protection expires among never-users of family planning, to compare this with other contraceptive strategies, and to evaluate the cost aspects. If the potential of LAM to be a conduit to other modern contraceptive methods is effectively realized, the method can be profoundly important in the development of communities and in family formation. Because LAM is effective in preventing pregnancies, and because it extends the range of contraceptive choices, considering LAM on the policy level is always appropriate. Despite the array of drawbacks to LAM, as with any other family planning method, the potential assets of LAM, especially the promise to introduce nonusers to contraception, are sufficiently important to warrant the introduction of LAM within an operations research framework to both capitalize on its intrinsic strengths and determine its programmatic robustness. In the 10 years since the concept of LAM was pronounced as the Bellagio Consensus, claims have been made both for and against its use. During this time, program and policy leaders have been giv PMID:10205427

  8. Unique unbalanced X;X translocation (Xq22;p11.2) in a woman with primary amenorrhea but without Ullrich-Turner syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Letterie, G.S. [Virginia Mason Medical Center, Seattle, WA (United States)

    1995-12-04

    This is a report of a patient with delayed puberty and a previously unreported translocation 46,X,-X,+der(X),t(X;X) (q22;p11.2) without any manifestations of Ullrich-Turner syndrome. The relationship of this unbalanced translocation to the critical region hypothesis is discussed. 6 refs., 3 figs.

  9. [Hormonal regulation and hormone therapy in childhood and adolescence. Part 2: Therapeutic problems (tall stature, amenorrhea, delayed puberty, oligomenorrhea, precocious puberty, anorexia nervosa, anisomastia, hypermastia, acne etc)].

    Science.gov (United States)

    Lauritzen, C

    1979-05-17

    The most important therapeutic problems of female puberty and adolescence are discussed, including high stature, amenorrhoea, oligomenorrhea, pubertas tarda, anovulation, anorexia, anisomastia, hypermastia. Indications for treatment are given and the possibilities for a prophylactic medicine in this age group are stressed. PMID:156144

  10. A Clinical Analysis on Cases of Secondary Amenorrhea Inducecd by Anorexia Nervosa%神经性厌食症引起闭经的女性内分泌临床探讨

    Institute of Scientific and Technical Information of China (English)

    严春晓; 陈学军; 郑伟; 杨建华

    2009-01-01

    目的探讨对神经性厌食症引起闭经患者的临床特点,女性内分泌水平的改变及治疗方法,提高对这类患者的临床认识.方法对32例神经性厌食症引起闭经患者的临床资料、女性内分泌激素水平及相关指标的改变和治疗效果进行回顾性分析和随访.结果本病常见诱因为心理压力大和过分降体重;显著体重下降和闭经是神经性厌食症的主要临床特征.经过综合治疗后,大多数患者体重增加.一般状况改善,部分患者月经恢复正常,但人工周期治疗组与未接受人工周期治疗组之间无明显差异.结论神经性厌食症导致继发性闭经是由于下丘脑一垂体功能紊乱及体重减轻的共同作用引起的,其中体重减轻是重要诱因,体重恢复是月经恢复正常的重要条件.在治疗过程中,人工周期治疗仅为综合辅助治疗的一种手段,可根据体重恢复情况和卵巢功能情况来选择使用.

  11. The Effects of Swimming Aerobics on Blood Fat and Lipoprotein in Middle and Old Woman after Amenorrhea%游泳运动对于闭经后中老年人血脂和脂蛋白的影响

    Institute of Scientific and Technical Information of China (English)

    肖国强; 孙维新

    2004-01-01

    通过对10名游泳组受试者和10名不运动组受试者进行比较,结果发现两组最大吸氧量有显著性差异,但去脂体重却无显著性差异.游泳组的中性脂肪、总胆固醇浓度以及动脉硬化指数,在两组之间均没有显著性差异.结果显示,对于闭经后中老年女性采用长期有计划的游泳训练,对于提高有氧能力是有效的,但并不能充分改善其血脂和胆固醇的浓度.

  12. Mechanism of Functional Hypothalamic Amenorrhea Caused by Anorexia Nervosa%神经性厌食引起功能性下丘脑闭经的作用机制

    Institute of Scientific and Technical Information of China (English)

    王晨曦

    2013-01-01

    神经性厌食症(AN)是一类发病早、病程长、病死率高的疾病,至今病因尚不完全清楚.AN发病的生物学基础是下丘脑的功能异常,伴随着能量消耗增加和(或)能量摄入的减少,以及一系列神经内分泌功能的紊乱症状.此种病征患者90% ~95%为女性,营养缺乏和内分辨代谢障碍导致促性腺激素功能不足,其特征为循环中低促性腺激素水平及低雌激素水平,对功能性下丘脑闭经(FHA)的发生和发展起重要作用.

  13. Pernicious anemia

    Science.gov (United States)

    ... gravis Secondary amenorrhea Type 1 diabetes Testicular dysfunction Vitiligo Symptoms Some people do not have symptoms. Symptoms ... amenorrhea Stomach cancer Type 1 diabetes Vitamin B12 Vitiligo Update Date 2/1/2016 Updated by: Todd ...

  14. [Musculoskeletal rehabilitation and bone. Abnormal bone metabolism in female elite athletes].

    Science.gov (United States)

    Enatsu, Akiko

    2010-04-01

    Recently, female athletes are particularly well, the other hand, many athletes suffer from amenorrhea due to excessive training. Especially, in sports with weight restrictions, they suffer from "Female athlete triad" , eating disorders, amenorrhea and osteoporosis. Amenorrhea is nothing else than a lack of estrogen, action on bone resorption and promote bone formation, by neglect this, it lead to osteoporosis and a stress fracture, and they would often give up their career as elite athletes. So we should consider it as serious sports injury. The problems of amenorrhea is should be recognized as a deficiency of estrogen. A Case of amenorrhea in female athletes, it is necessary to consider the hormone replacement therapy based on the appropriate diagnosis. However, it is important to start the management of body fat and body weight and strength of exercises since adolescent for the prevention the amenorrhea. PMID:20354328

  15. Lactational Infertility- A Review

    OpenAIRE

    Ramachandran Prema

    1987-01-01

    Studies undertaken by the National Institute of Nutrition during the last 10 years indicate that prolonged breast-feeding is still the rule among rural and urban low income group population in Hyderabad. Lactation induced hyperprolactinaemia prolongs postpartum amenorrhea and inter pregnancy interval by about 6 months. Duration of lactational amenorrhea infants results in a fall of plasma prolactin levels and rapid return of menstruation and fertility. Lactational amenorrhea lasts longer in u...

  16. Nutrition for Women Athletes. Commonly Asked Questions.

    Science.gov (United States)

    Burke, N. Peggy

    1987-01-01

    Information on the nutritional needs of female athletes is presented. Among the topics discussed are proper eating habits, carbohydrate loading, amenorrhea, osteoporosis, anemia, vitamins, and minerals. (MT)

  17. Glossary

    Science.gov (United States)

    ... menstrual periods. Early amenorrhea caused by overtraining can cause bones to become brittle and break. Anorexia nervosa. An eating disorder characterized by an irrational fear of weight gain. ...

  18. Etiopatogenia de la amenorrea hipotalámica funcional: Interacción de las respuestas hormonales del sistema nervioso central y neuropéptidos periféricos Ethiopatogeniae of functional hypothalamic amenorrhea: Interactions of central nervous system and peripherical neuropeptides responses

    OpenAIRE

    L Fiszlejder

    2008-01-01

    La amenorrea hipotalámica funcional (AHF) es una patología compleja provocada generalmente por el estrés psicológico, o por alteraciones psicógenas como la depresión en otras entidades como la amenorrea nerviosa y bulimia o en la excesiva actividad física (atletas competitivas, bailarinas clásicas) entre las causas más frecuentes. Habitualmente, estos factores se presentan asociados a dietas cuali y cuantitativamente inadecuadas, originando alteraciones en el balance energético (consumo /gast...

  19. Fisiopatología de la disfunción gonadal en la Amenorrea Hipotalámica funcional (AHF) y su relación con la activación del eje hipotálamo-hipófiso-adrenal Pathophysiology of gonadal dysfunction in functional Hypothalamic Amenorrhea (FHA) and its relation to activation of the hypothalamic-pituitary-adrenal axis

    OpenAIRE

    León Fiszlejder

    2011-01-01

    La amenorrea hipotalámica funcional (AHF) constituye un proceso secundario de una respuesta de adaptación en mujeres que consumen dietas inadecuadas y presentan modificaciones en la composición corporal de su organismo. Ello origina reacciones hormonales en el hipotálamo destinadas a preservar la homeostasis metabólica. En este proceso de adaptación intervienen un "circuito central" constituido por una red de hormonas hipotalámicas que se interrelacionan con un "circuito periférico" integrado...

  20. Cardiometabolic abnormalities in the polycystic ovary syndrome : Pharmacotherapeutic insights

    NARCIS (Netherlands)

    Westerveld, H. E.; Hoogendoorn, M.; de Jong, A. W. F.; Goverde, A. J.; Fauser, B. C. J. M.; Dallinga-Thie, G. M.

    2008-01-01

    The polycystic ovary syndrome (PCOS) affects 5-10% of all premenopausal women. It is diagnosed by a combination of oligo-amenorrhea and hyperandrogenism (NIH criteria) or by the presence of two out of three of: oligo-amenorrhea, hyperandrogenism, polycystic ovaries on ultrasound (Rotterdam criteria)

  1. Diagnóstico y tratamiento de la amenorrea primaria en adolescentes. a propósito

    Directory of Open Access Journals (Sweden)

    Elsa J. Lara G.

    2011-04-01

    Full Text Available Diagnosis and treatment of primary amenorrhea in adolescents. A review of three clinicalcases.Primary amenorrhea is the absence of menstruation for tree months from the time of diagnosis; it isa symptom of either a functional or a structural problem, and the cause of consultation at theadolescent gynecology clinic. Amenorrhea can be primary or secondary; the primary type beingless frequent than the secondary one, but more difficult to diagnose. For this reason, thephysician must be well acquainted with the physiological phenomenon of puberty. Three cases ofprimary amenorrhea are reported, from different pathologies: Turner Syndrome, Genital TractMalformation (Vaginal Atresia and Morris Syndrome (complete insensitivity to androgens. Themost important clinical and paraclinical data for the final diagnosis of each of the three cases arediscussed, as well as the medical and surgical treatment after the diagnosis. It is concluded thatprimary amenorrhea during adolescence is not a common disorder in the clinical practice, and thatits diagnosis and treatment requires a multidisciplinary approach.

  2. Premature ovarian failure

    Directory of Open Access Journals (Sweden)

    Persani Luca

    2006-04-01

    Full Text Available Abstract Premature ovarian failure (POF is a primary ovarian defect characterized by absent menarche (primary amenorrhea or premature depletion of ovarian follicles before the age of 40 years (secondary amenorrhea. It is a heterogeneous disorder affecting approximately 1% of women e.g. Turner syndrome represent the major cause of primary amenorrhea associated with ovarian dysgenesis. Despite the description of several candidate genes, the cause of POF remains undetermined in the vast majority of the cases. Management includes substitution of the hormone defect by estrogen/progestin preparations. The only solution presently available for the fertility defect in women with absent follicular reserve is ovum donation.

  3. [Menstrual dysfunction in anorexia nervosa].

    Science.gov (United States)

    Jagielska, Gabriela; Wolańczyk, Tomasz; Osuch, Beata

    2010-01-01

    One of the symptoms of anorexia nervosa (a.n.) is cessation of pubescence or secondary amenorrhea. Their origin in anorexia nervosa is multifactorial, partly resulting from starvation-induced hipogonadism. Amenorrhea in a.n. may persist despite weight recovery and is often related to osteoporosis. The authors' present causes of amenorrhea and its persisting in a.n., pointing to the factors influencing prognosis according to resumption of menses. They also review reports of hormonal replacement therapy in this group of patients. PMID:20677446

  4. Osteoporosis and Women's Health

    Science.gov (United States)

    ... periods (amenorrhea) • Thin or small frame • Caucasian or Asian • Diet low in calcium and vitamin D • Little or no exercise • Cigarette smoking • Drinking too much alcohol • Therapy with a steroid (such as ...

  5. Lactational Infertility- A Review

    Directory of Open Access Journals (Sweden)

    Ramachandran Prema

    1987-01-01

    Full Text Available Studies undertaken by the National Institute of Nutrition during the last 10 years indicate that prolonged breast-feeding is still the rule among rural and urban low income group population in Hyderabad. Lactation induced hyperprolactinaemia prolongs postpartum amenorrhea and inter pregnancy interval by about 6 months. Duration of lactational amenorrhea infants results in a fall of plasma prolactin levels and rapid return of menstruation and fertility. Lactational amenorrhea lasts longer in undernourished women with low body weight and low fat fold rural women, duration of lactational amenorrhea is longer as compared to urban women. This might be partly attributable to the delay in introduction of supplements to the rural infants and partly to the lower body weight and fat fold thickness of rural women.

  6. Healthy Bones at Every Age

    Science.gov (United States)

    ... include walking and running, as well as team sports like soccer and basketball. AAOS does not endorse ... to cause hormonal changes that stop menstrual periods (amenorrhea). This loss of estrogen can cause bone loss ...

  7. Genetics Home Reference: type A insulin resistance syndrome

    Science.gov (United States)

    ... adolescence to cause abnormalities of the menstrual cycle, ovarian cysts , and other features of the disorder. This condition ... links) Encyclopedia: Acanthosis Nigricans Encyclopedia: Amenorrhea - Primary Encyclopedia: Ovarian Cysts Health Topic: Blood Sugar Health Topic: Diabetes Additional ...

  8. Polycystic ovary syndrome: from phenotype to genetype

    NARCIS (Netherlands)

    Y.V. Louwers (Yvonne)

    2014-01-01

    markdownabstract__Abstract__ oligomenorrhea or amenorrhea, hirsutism or hyperandrogenism and polycystic ovarian morphology. Later in life, adverse metabolic implications, such as obesity, insulin resistance, type 2 diabetes and cardiovascular disease, become more prominent. In this thesis, we aimed

  9. A rare case of congenital vesico-uterine fistula

    OpenAIRE

    Parul Sinha; Nisha Rani Agrawal

    2014-01-01

    Herein we report the case of a patient with primary amenorrhea and cyclical menouria. The patient was a 20 years female with primary amenorrhea. Clinical examination revealed normal external genitilia. A mature female pubic hair pattern was present, and axillary development was normal. Breast was normally developed. Intraoperatively, a congenital vesico-uterine fistulous tract was observed. Repair was done. The patient has been regularly menstruating since the operation. [Int J Reprod Contrac...

  10. Leptin levels in patients with anorexia nervosa are reduced in the acute stage and elevated upon short-term weight restoration

    DEFF Research Database (Denmark)

    Hebebrand, J; Blum, W F; Barth, N;

    1997-01-01

    Circulating leptin concentrations are known to be low in acute anorexia nervosa (AN), which is characterized by low weight, amenorrhea and specific psychopathological features. In this study plasma leptin concentrations were determined during inpatient treatment of 23 adolescent females with AN u......Circulating leptin concentrations are known to be low in acute anorexia nervosa (AN), which is characterized by low weight, amenorrhea and specific psychopathological features. In this study plasma leptin concentrations were determined during inpatient treatment of 23 adolescent females...

  11. PREVALENCE OF THE FEMALE ATHLETE TRIAD IN EDIRNE, TURKEY

    Directory of Open Access Journals (Sweden)

    Selma Arzu Vardar

    2005-12-01

    Full Text Available The aim of this study was to determine the prevalence of the female athlete triad, which is a clinical condition defined as the simultaneous occurrence of disordered eating, amenorrhea, and osteopenia and/or osteoporosis in female athletes. A total number of 224 female athletes from Edirne city participated in our study. Eating attitudes test (EAT 40 and a self-administered questionnaire were used to assess disordered eating behavior and menstrual status respectively. The participants having both disordered eating and amenorrhea were performed dual energy x-ray absorptiometry to evaluate bone mineral density. Thirty seven subjects (16.8% had disordered eating behavior and 22 subjects (9.8% were reported to have amenorrhea. Six athletes (2.7% met two criteria (disordered eating and amenorrhea of the triad. Of these, only three athletes met all components of the triad. We have found that the prevalence rate of female athlete triad was 1.36% among young Turkish female athletes. Female athletes have under considerable risk for the disordered eating and amenorrhea components of the triad

  12. Pituitary-ovarian function in breast cancer patients on adjuvant chemoimmunotherapy.

    Science.gov (United States)

    Samaan, N A; deAsis, D N; Buzdar, A U; Blumenschein, G R

    1978-06-01

    One hundred thirty-one patients with operable breast cancer were treated with adjuvant chemoimmunotherapy consisting of 5-fluorouracil, adriamycin, cyclophosphamide, and BCG (FAC-BCG). Fifty-five of 131 patients were premenopausal of which 71% (38/55) became amenorrheic. To determine the mechanism of amenorrhea, we measured the immunoreactive serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and plasma estradiol (E2) before and after intravenous administration of luteinizing hormone-releasing hormone (LH-RH) in 11 unselected premenopausal patients who developed amenorrhea and 11 unselected patients who did not. Serum prolactin (PRL) levels were also measured before and after iv administration of thyrotropin-releasing hormone (TRH). Our results showed that patients who developed amenorrhea had abnormally high serum LH and FSH levels at basal and after LH-RH stimulation and low plasma estradiol. Serum PRL levels were normal. Patients who developed amenorrhea were older than those who did not, but their serum LH and FSH levels were also significantly higher and plasma estrogens were significantly lower than that found in 11 normal women with regular menses of the same age range. These results indicate that amenorrhea that develops in some patients with breast cancer after FAC-BCG therapy is a result of primary ovarian failure. PMID:418867

  13. Menstrual suppression: current perspectives

    Directory of Open Access Journals (Sweden)

    Hillard PA

    2014-06-01

    Full Text Available Paula Adams Hillard Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA Abstract: Menstrual suppression to provide relief of menstrual-related symptoms or to manage medical conditions associated with menstrual morbidity or menstrual exacerbation has been used clinically since the development of steroid hormonal therapies. Options range from the extended or continuous use of combined hormonal oral contraceptives, to the use of combined hormonal patches and rings, progestins given in a variety of formulations from intramuscular injection to oral therapies to intrauterine devices, and other agents such as gonadotropin-releasing hormone (GnRH antagonists. The agents used for menstrual suppression have variable rates of success in inducing amenorrhea, but typically have increasing rates of amenorrhea over time. Therapy may be limited by side effects, most commonly irregular, unscheduled bleeding. These therapies can benefit women's quality of life, and by stabilizing the hormonal milieu, potentially improve the course of underlying medical conditions such as diabetes or a seizure disorder. This review addresses situations in which menstrual suppression may be of benefit, and lists options which have been successful in inducing medical amenorrhea. Keywords: menstrual molimena, amenorrhea, inducing amenorrhea, quality of life

  14. Pathophysiology of bone loss in the female athlete.

    Science.gov (United States)

    Lambrinoudaki, Irene; Papadimitriou, Dimitra

    2010-09-01

    Low bone mass is frequent among female athletes. The "female athlete triad" is a term that describes the interaction among energy availability, menstrual function, and bone metabolism that may lead to amenorrhea and osteopenia or osteoporosis. The main pathophysiologic mechanisms that lead to low bone mass in female athletes are low energy availability and functional hypothalamic amenorrhea. Increased energy expenditure and/or decreased energy intake, as well as the presence of eating disorders, are associated with low bone mass. In addition, menstrual dysfunction is quite common, especially among athletes competing in sports favoring leanness, and also associates with low bone mass. Screening for bone loss in female athletes should take place in the presence of amenorrhea or body mass index <18 kg/m(2) . Management of low bone mass aims to restore normal energy availability and nutritional habits. Hormone replacement therapy has no effect in abnormally underweight patients unless normal eating behaviors are restored. PMID:20840252

  15. Resumption of menses after 32 years in anorexia nervosa.

    Science.gov (United States)

    Gentile, M G; Manna, G M; Pastorelli, P; Oltolini, A

    2011-09-01

    In anorexia nervosa estrogen deficient amenorrhea is associated with reduced bone mineral density and increased fracture risk. We report a case of a 53 years old female patient affected with AN since the age of 17 years when also amenorrhea started. During the subsequent 31 years she refused to modify her body weight, she always remained with a BMI below 17, and amenorrhea persisted throughout all the period. In November 2005, when she was 48 years old (BMI 15.6 kg/m²), she came to the Eating Disorder Unit of Niguarda Hospital to treat surgical complication of lower limb wound persisting after two operation; she also presented a marked reduction of bone density. After 6 months of intensive day hospital treatment she got a normal body weight and resumption of menses; in the following four years she has still been well and with normal menses, and bone density showed an improvement. PMID:21606666

  16. A rare case of congenital vesico-uterine fistula

    Directory of Open Access Journals (Sweden)

    Parul Sinha

    2014-08-01

    Full Text Available Herein we report the case of a patient with primary amenorrhea and cyclical menouria. The patient was a 20 years female with primary amenorrhea. Clinical examination revealed normal external genitilia. A mature female pubic hair pattern was present, and axillary development was normal. Breast was normally developed. Intraoperatively, a congenital vesico-uterine fistulous tract was observed. Repair was done. The patient has been regularly menstruating since the operation. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1125-1126

  17. Testicular Feminization: Report of Three Cases in a Family

    OpenAIRE

    H Moayyeri

    2002-01-01

    Case of the complete syndrome of testicular feminization were reported early in the 19th century, but it was in 1950 that Lawson recognized the etiology in a patient with amenorrhea and failing pubic and axillary hair, which was unresponsive to testosterone therapy. The prevalence of androgen resistance is estimated to be between 1:20.000 and 1:64.000 men and the complete form is the 3rd most common cause of primary amenorrhea. Testicular feminization is transmitted as X-linked recessive trai...

  18. Repeated Stress Fractures in an Amenorrheic Marathoner: A Case Conference.

    Science.gov (United States)

    Sutton, John R.; Nilson, Karen L.

    1989-01-01

    Presents a case conference by 2 experts on the relationship between a 26-year-old marathoner's amenorrhea and her sustained unusual stress fractures in 4 ribs (plus previous similar fractures of the calcaneal, navicular, metatarsal, and tibial bones). The experts conclude that she suffers many manifestations of overtraining. (SM)

  19. Hyperprolactinemia in Women of Reproductive Age: Etiology, diagnosis, and management

    OpenAIRE

    Yuen, Basil Ho

    1992-01-01

    Galactorrhea-amenorrhea syndrome and infertility are manifestations of elevated prolactin levels. Numerous functional and tumorous conditions can cause hyperprolactinemia; prolactinoma is the most common tumor. The dopamine agonist agent bromocriptine controls hypersecretion, shrinks prolactinomas, and will restore menstruation and alleviate galactorrhea in most patients.

  20. Infertility as the onset of Cushing’s disease: is pasireotide a treatment option?

    OpenAIRE

    Valea Ana; Morar Andra; Dumitru D.P.; Carsote Mara; Ghemigian Adina; Dumitrache C.

    2015-01-01

    Introduction Cushing’s disease is a complex endocrine disorder characterized by excessive glucocorticoid secretion caused by an ACTH-secreting pituitary adenoma. Hyperandrogenism and menstrual disorders such as amenorrhea and oligomenorrhea complete the clinical picture of Cushing’s syndrome. Infertility is relatively common, involving complex pathogenetic mechanisms, which differ depending on the cause of hypercortisolism.

  1. Psychoneuroendocrinological aspects of anorexia nervosa: predictors of recovery

    NARCIS (Netherlands)

    Elburg, A.A. van

    2007-01-01

    Anorexia Nervosa (AN) is a psychosomatic eating disorder of unknown aetiology, which primarily affects adolescent girls and young women and is characterized by aberrant patterns of eating behaviour and weight regulation which result in weight loss and endocrine abnormalities such as amenorrhea, dist

  2. Turner Syndrome

    Directory of Open Access Journals (Sweden)

    Akcan AB.

    2013-06-01

    Full Text Available Turner syndrome is an important cause of short stature in girls and primer amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This topic will review the clinical manifestations, diagnosis and management of Turner syndrome.

  3. Successful Advanced Maternal Age Pregnancy with Mosaic Turner Syndrome Conceived after Ovulation Induction with Clomiphene Citrate: A Case Report

    Directory of Open Access Journals (Sweden)

    Masahiro Murakami

    2014-01-01

    Full Text Available Turner women typically experience gonadal dysfunction that results in amenorrhea and sterility. We encountered a case of mosaic Turner syndrome where conception was possible after ovulation induction with clomiphene citrate (CC. The patient’s ovaries were overresponsive to induction with CC. The challenges and successful outcome are reported.

  4. The Effects of Lei Gong Teng on Reproductive Hormones

    Institute of Scientific and Technical Information of China (English)

    顾江红; 朱彩凤; 王蔚; 王联欢

    2001-01-01

    The serum reproductive hormone levels were examined with radioimmunoassay in women of child-bearing age before and after treatment with the prescriptions containing Lei Gong Teng (雷公藤Radix Tripterygii Wilfordii). The results showed that Lei Gong Teng could induce amenorrhea, but it was reversible.

  5. Complementary Therapy in Polycystic Ovary Syndrome

    OpenAIRE

    Aquino, Carmen Imma; Nori, Stefania Lucia

    2014-01-01

    Polycystic Ovary Syndrome (PCOS) is an endocrine disease. PCOS afflicts 5 to 10 % of women of reproductive age. The symptoms are: amenorrhea, oligomenorrhea, hirsutism, obesity, infertility, chronic hyperandrogenic anovulation and acne. Other risk factors aggravate this condition: insulin resistance, obesity, hypertension, dyslipidemia, inflammation and subclinical cardiovascular disease. Anxiety, depression and reduced quality of life are also common. This review highlights the mechanisms an...

  6. Black cumin (Nigella sativa) and its constituent (thymoquinone): a review on antimicrobial effects

    OpenAIRE

    Fatemeh Forouzanfar; Bibi Sedigheh Fazly Bazzaz; Hossein Hosseinzadeh

    2014-01-01

    Nigella sativa seeds have wide therapeutic effects and have been reported to have significant effects against many ailments such as skin diseases, jaundice, gastrointestinal problems, anorexia, conjunctivitis, dyspepsia, rheumatism, diabetes, hypertension, intrinsic hemorrhage, paralysis, amenorrhea, anorexia, asthma, cough, bronchitis, headache, fever, influenza and eczema. Thymoquinone (TQ) is one of the most active constituent and has different beneficial properties. Focus on antimicrobial...

  7. Pregnancy and Delivery After Stimulation with rFSH of a Galatosemia Patient Suffering Hypergonadotropic Hypogonadism: Case Report

    OpenAIRE

    Menezo, Yves J. R.; Lescaille, Maryse; Nicollet, Bernard; Servy, Edouard J.

    2004-01-01

    Purpose: To determine if hypergonadotropic hypogonadism related to galactosemia could be linked to anomaly of the circulating FSH. A 26-year-old woman, suffering GALT (Galactoso-1-phosphate uridyltransferase) had a premature ovarian failure with amenorrhea since the age of 19. The circulating level for FSH was 83 and 34 mU/mL for LH.

  8. Common menstrual concerns of adolescents

    OpenAIRE

    Sacks, Diane

    1998-01-01

    Symptoms associated with menstruation are among the most common concerns of adolescent women. However, the factual information that adolescent women need is not always available to them. Physicians can do much to correct the myths and misinformation that the teenager may have concerning her menstrual cycle. This paper addresses clinical office concerns about normal menstruation, dysmenorrhea, amenorrhea and dysfunctional uterine bleeding.

  9. Low-energy density and high fiber intake are dietary concerns in female endurance athletes

    DEFF Research Database (Denmark)

    Melin, Anna Katarina; Tornberg, Å B; Skouby, Sven O.;

    2016-01-01

    Low or reduced energy availability (LEA) is linked to functional hypothalamic oligomenorrhea/amenorrhea (FHA), which is frequently reported in weight-sensitive sports. This makes LEA a major nutritional concern for female athletes. The aim of this study was to describe dietary characteristics...

  10. Energy Availability and Reproductive Function in Female Endurance Athletes

    DEFF Research Database (Denmark)

    Melin, Anna Katarina

    The overall aim of this PhD project was to study the prevalence and potential dietary risk factors and consequences of current low EA and oligomenorrhea/functionel hypothalamic amenorrhea (FHA) in a group of female elite endurance athletes. The results indicated that athletes with current low...

  11. The Female Athlete Triad

    Science.gov (United States)

    Sherman, Roberta Trattner; Thompson, Ron A.

    2004-01-01

    The Female Athlete Triad is a syndrome of the interrelated components of disordered eating, amenorrhea, and osteoporosis. Sometimes inadvertently, but more often by willful dietary restriction, many female athletes do not ingest sufficient calories to adequately fuel their physical or sport activities, which can disrupt menstrual functioning,…

  12. Controversies in Pediatric Sports Medicine (Commentary).

    Science.gov (United States)

    Dyment, Paul G.

    1989-01-01

    Discusses controversial issues that have arisen in children's sports, including infant exercise programs, trampolines, amenorrhea in the adolescent athlete, coed contact sports, and sport participation by children with Down Syndrome. Policy statements are included from the American Academy of Pediatrics. (JD)

  13. The Female Athlete Triad. Managing an Acute Risk to Long-Term Health.

    Science.gov (United States)

    Nattiv, Aurelia; Lynch, Linda

    1994-01-01

    Amenorrhea, disordered eating, and osteoporosis form an interconnected, potentially fatal triad that is not widely understood. Physician vigilance when treating young female athletes can lead to early recognition and prevention of serious consequences. Physicians must help athletic young women participate in their sports in the healthiest, safest…

  14. De eerste pasgeborene met congenitaal rubellasyndroom tijdens de rubella-epidemie in Nederland in 2004-'05

    NARCIS (Netherlands)

    Mol, A.C. de; Vrancken, S.L.A.G.; Eggink, A.J.; Verduyn Lunel, F.M.; Warris, A.

    2006-01-01

    A newborn male was diagnosed with congenital rubella syndrome. His 31-year-old mother had had erythematous exanthema during a period of amenorrhea lasting 7 weeks; she was not vaccinated and had never had a rubella infection. The infection was confirmed serologically. The mother gave birth to an ict

  15. The Physical Educator and Anorexia Nervosa.

    Science.gov (United States)

    Romeo, Felicia F.

    1984-01-01

    The physical education teacher is in an advantageous position to observe a student who may have anorexia nervosa. Severe weight loss, hyperactivity, body image delusion, and amenorrhea are symptoms of this behavior disorder. Implications for the physical education teacher and athletic coach are offered. (DF)

  16. Leptin levels in patients with anorexia nervosa are reduced in the acute stage and elevated upon short-term weight restoration

    DEFF Research Database (Denmark)

    Hebebrand, J; Blum, W F; Barth, N;

    1997-01-01

    Circulating leptin concentrations are known to be low in acute anorexia nervosa (AN), which is characterized by low weight, amenorrhea and specific psychopathological features. In this study plasma leptin concentrations were determined during inpatient treatment of 23 adolescent females with AN...

  17. Symptoms of hyperprolactinemia with normal serum prolactin: is treatment required?

    OpenAIRE

    Deepti Verma

    2016-01-01

    Galactorrhea with menstrual abnormalities like oligomenorrhea or amenorrhea point towards a provisional diagnosis of increased serum prolactin levels or hyperprolactinemia. However, as the prolactin hormone is heterogeneous with two forms- the bioactive and the immunoactive forms, patients can have all the features of hyperprolactinemia with normal serum prolactin levels. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000): 2041-2042

  18. A PRELIMINARY CLINICAL STUDY OF TAMOXIFEN PRIOR TO PROSTAGLANDIN FOR TERMINATION OF EARLY PREGNANCY

    Institute of Scientific and Technical Information of China (English)

    CHENGLi-Nan; ZHOUYu-Fen; CHUYun-Hong; JINzhao-Ying

    1989-01-01

    Thirty four healthy women with amenorrhea of less than 49 daya applied for legal abortion. Each patient received tamoxifen ( Tara ) tablets 20 mg twioe a day for 4 consecutive days orally. In the morning of the Frith day they were given a vaginal sponge con-taining

  19. Ovarian refractoriness to gonadotropins in cases of inappropriate lactation: restoration of ovarian function with bromocryptine.

    Science.gov (United States)

    Mroueh, A M; Siler-Khodr, T M

    1976-12-01

    In ten patients with amenorrhea-galactorrhea who had hyperprolactinemia, ovulation could not be induced clomiphene citrate or exogenous gonadotropins. Treatment with bromocryptine in eight of these patients resulted in suppression of PRL in all, cessation of galactorrhea and ovulation in seven and conception in five. PMID:1036743

  20. Nutrition Education for Elite Female Runners.

    Science.gov (United States)

    Clark, Nancy; And Others

    1988-01-01

    A survey of the dietary habits of 115 elite female runners revealed that some did not eat wisely, pointing out nutrition education needs for these subjects in the areas of sweets, vitamin and mineral supplementation, intake of red meat, body weight and body image, eating disorders, calorie intake, and amenorrhea and stress fractures. (Author/CB)

  1. Eating disorders

    Science.gov (United States)

    The incidence of eating disorders is increasing, and health care professionals are faced with the difficult task of treating these refractory conditions. The first clinical description of anorexia nervosa (AN) was reported in 1694 and included symptoms such as decreased appetite, amenorrhea, food av...

  2. Characteristics of the Female Athlete Triad in Collegiate Cross-Country Runners

    Science.gov (United States)

    Thompson, Sharon H.

    2007-01-01

    The Female Athlete Triad is a life-threatening syndrome defined by disordered eating, amenorrhea, and osteoporosis. Objective and Participants: The author's purpose in this study was to examine female cross-country runners' (N = 300) calcium consumption, along with the prevalence of 2 components of the triad: disordered eating and menstrual…

  3. EARLY PREGNANCY TERMINATION WITH RU 486 ALONE AND IN COMBINATION WITH ONO 802

    Institute of Scientific and Technical Information of China (English)

    DUMing-Kun; HUANGZi-Yun; ZHENGHuai-Mei

    1989-01-01

    One hundred and eighty seven pregnant women with less than 49 days of amenorrhea were treated with RU 486, an antiprogestin, at a single oral dose of 600 mg alone (group 1, 28 cases ) and in combination with a vaginal suppository Containing 1 mg of ONO 802

  4. Testicular Feminization or Androgen Insensitivity Syndrome (AIS in Iran: a Retrospective Analysis of 30-Year Data

    Directory of Open Access Journals (Sweden)

    Dariush. D FARHUD

    2016-02-01

    Full Text Available Background: Androgen insensitivity syndrome (AIS or testicular feminization is a partial or complete inability of cell response to androgen. The cause is enzymatic defect in synthesis of testosterone, resulting sexually immature phenotypically female, with primary amenorrhea. There are three categories of AIS, complete, partial and mild, depending on the degree of external genital masculinization. The aim of this study was to find out chromosomal abnormalities, and correlation between AIS and maternal/paternal age, parents' consanguineous marriage, family history and clinical observation, in Iranian AIS patients.  Method: This study includes a retrospective data analysis of 72,000 families' medical records in the Genetic Clinic in Tehran, during a 30-yr period (1984-2014. The essential basis for the patients' referral to the clinic by gynecologists was primary amenorrhea. Cytogenetic abnormalities has been confirmed by chromosome G-banding and conventional staining methods.Results: Seventy AIS female patients with 46XY pattern were cytogenetically diagnosed and the frequency of AIS syndrome was estimated about 0.05% (~70/140000. The results showed no association between AIS and maternal or paternal age nor were the marital pattern of the parents. The clinical findings illustrated that primary amenorrhea had the highest indication for referral of AIS patients for genetic counseling and cytogenetic study.Conclusion: No correlation was observed between AIS and maternal or paternal age or consanguineous marriages. Amenorrhea is the most clinically observed sign of AIS patients.  Keywords: Androgen insensitivity syndrome (AIS, Testicular feminization, Human androgen receptor (HAR, Amenorrhea, Iran

  5. Youssef’s Syndrome following Cesarean Section

    Directory of Open Access Journals (Sweden)

    Ozer Birge

    2015-01-01

    Full Text Available Youssef’s syndrome is characterized by cyclic hematuria (menouria, absence of vaginal bleeding (amenorrhea, and urinary incontinence due to vesicouterine fistula (VUF, the least common of the urogynecological fistulas. Youssef’s syndrome has a variable clinical presentation. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be appropriate in some cases, but surgery is the definitive treatment. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section. Diagnostic tests as well as necessary appropriate surgery should be performed on cases with suspected vesicouterine fistula. We present a 40-year-old multiparous woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence, hematuria, and amenorrhea 1 year after the birth. Here, we discuss our case with the help of previously published studies found in the literature.

  6. Women with anorexia nervosa should not be treated with estrogen or birth control pills in a bone-sparing effect.

    Science.gov (United States)

    Bergström, Ingrid; Crisby, Milita; Engström, Anne-May; Hölcke, Mats; Fored, Monika; Jakobsson Kruse, Pia; Of Sandberg, Ann-Marie

    2013-08-01

    Eating disorders are prevalent, serious conditions that affect mainly young women. An early and enduring sign of anorexia is amenorrhea. There is no evidence for benefits of hormone therapy in patients with anorexia; however, hormone medication and oral contraceptives are frequently prescribed for young women with anorexia as a prevention against and treatment for low bone mineral density. The use of estrogens may create a false picture indicating that the skeleton is being protected against osteoporosis. Thus the motivation to regain weight, and adhere to treatment of the eating disorder in itself, may be reduced. The most important intervention is to restore the menstrual periods through increased nutrition. Hormone and oral contraceptive therapy should not be prescribed for young women with amenorrhea and concurrent eating disorders. PMID:23682675

  7. Laparoscopic Gonadectomy for Complete Androgen Insensitivity Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Eraydın E et al.

    2011-10-01

    Full Text Available Objective: Our aim was to present and discuss a case with androgen insensitivity syndrome that underwent laparoscopic gonadectomy.Case: A 21 year-old women admitted to our clinic with the complaint of primary amenorrhea and infertility. She had sufficient breast maturation but have scanty pubic and axillar hair. In gynecologic examination vagina was 5 cm in length and ended blindly. In ultrasonographic examination uterus was absent, there were bilateral masses each 3 cm in diameter located near the internal os of the inguinal canals. Her karyotype was 46 XY.Results: The patient underwent laparoscopy. Pelvic inspection revealed no internal genitalia except bilateral gonads appearing as testis. The pedicle of gonads were coagulated with bipolar diathermy and cut with laparoscopic scissors and removed with endobags.Conclusions: Androgen insensitivity syndrome should be suspected in cases with primary amenorrhea and laparoscopic gonadectomy should be performed after puberty.

  8. Sheehan's syndrome with reversible dilated cardiomyopathy: A case report and brief overview.

    Science.gov (United States)

    Islam, A K M Monwarul; Hasnat, Mohammad A; Doza, Fatema; Jesmin, Humayra

    2014-04-01

    Sheehan's syndrome is a rare condition characterized by post-partal panhypopituitarism due to necrosis of adenohypophysis resulting from severe post-partum hemorrhage. Lethargy, amenorrhea and failure of lactation are the usual presenting features. Cardiac involvement in Sheehan's syndrome is rare. The case presented here describes dilated cardiomyopathy in a 36-year-old lady who failed to respond adequately to the standard anti-failure treatment. Further investigation revealed the diagnosis of Sheehan's syndrome. Besides other manifestations, cardiac function reverted to normal after giving replacement therapy with glucocorticoid, levothyroxine and sex hormone. Physicians, specially those in developing countries, should have high index of suspicion for the diagnosis of Sheehan's syndrome while dealing with a case of 'peripartal dilated cardiomyopathy'. Persistent amenorrhea and failure of lactation may be important clues in this context. Timely diagnosis and appropriate treatment can lessen the sufferings of the patients. PMID:24719543

  9. Neuroendokrine forstyrrelser ved anorexia nervosa - primoere eller sekundoere?

    DEFF Research Database (Denmark)

    Støving, R K; Hansen-Nord, M; Hangaard, J;

    1996-01-01

    Anorexia nervosa is associated with multiple endocrine abnormalities. Hypothalamic neuropeptides and monoamines are involved in the regulation of human appetite, and they are changed in several ways in anorexia nervosa. But it remains to be clarified whether these alterations are secondary...... or etiologic. Feeding behaviour in anorexia nervosa is characterised by a strong ambivalence and not by loss of appetite. Hypothalamic amenorrhea is a diagnostic criterion, and is not only secondary as it often precedes the weight loss and persists for a long time after weight and motor activity have returned...... to normal. Hypersecretion of corticotropin releasing hormone seems to be secondary to starvation, but at the same time it may keep up and intensify the anorexia, physical hyperactivity and amenorrhea. Low production of insulinlike growth factor-I and high growth hormone secretion reflects the nutritional...

  10. A review of endocrine changes in anorexia nervosa

    DEFF Research Database (Denmark)

    Støving, R K; Hangaard, J; Hansen-Nord, M;

    1999-01-01

    Anorexia nervosa is a syndrome of unknown etiology. It is associated with multiple endocrine abnormalities. Hypothalamic monoamines (especially serotonin), neuropeptides (especially neuropeptide Y and cholecystokinin) and leptin are involved in the regulation of human appetite, and in several ways...... they are changed in anorexia nervosa. However, it remains to be clarified whether the altered appetite regulation is secondary or etiologic. Increased secretion of corticotropin-releasing hormone and proopiomelanocortin seems to be secondary to starvation, however, there is evidence that it may maintain...... and intensify anorexia, excessive physical activity and amenorrhea. Hypothalamic amenorrhea, which is a diagnostic criterion in anorexia nervosa, is not solely related to the low body weight and exercise. Growth hormone resistance with low production of insulin-like growth factor I and high growth hormone...

  11. [A study on sexual dysfunction in female patients with alcoholics].

    Science.gov (United States)

    Seki, M; Yoshida, K; Kashimura, M

    1997-11-01

    Few investigations have been made concerning hormonal changes and dyspareunia in fertile aged women with alcoholics experiencing sexual dysfunction. Twenty-seven Japanese woman with alcoholics under 40 years of age excluded with liver cirrhosis were studied to describe alcohol drinking related to sexual dysfunction. Among 21 sexually active women, 20(95.2%) had both symptoms of dyspareunia and vaginal dryness, and only one had neither symptom. Most of patients have lower estradiol levels and 92.0% of patients have the moderately elevated prolactin levels. Eleven of them were having the second grade amenorrhea associated with hyperprolactinemia and hypergonadotropic hypogonadism and 14 were having the first grade amenorrhea. In this study alcoholic abuse women may have deeply related to the hyperprolactinemia, dyspareunia, amenorrhoea, vaginal dryness, ovarian dysfunction and fetal alcohol syndrome. PMID:9396309

  12. Endometrioid Endometrial Carcinoma Indirectly Caused by Pituitary Prolactinoma: A Case Report

    OpenAIRE

    Nishino, Kimihiro; Niwa, Yuri; Mizutani, Teruyuki; Shimizu, Ken; Hayashi, Kazumasa; Chaya, Jyunya; Kato, Noriko; YAMAMURO, OSAMU

    2013-01-01

    We present the case of a 44-year-old nulliparous woman who experienced irregular menstrual cycles for about 10 years and developed both pituitary prolactinoma and endometrioid endometrial carcinoma. In premenopausal women, hyperprolactinemia causes hypogonadism by inhibiting secretion of gonadotropin-releasing hormone and thus suppressing luteinizing hormone levels, which can cause menstrual disorders ranging from amenorrhea, oligomenorrhea and chronic anovulatory cycle to short luteal phase ...

  13. Ovarian mucinous cystadenocarcinoma in 17-year-old girl : a case report

    International Nuclear Information System (INIS)

    Malignant epithelial neoplasm usually occurs in postmenopausal women, with less than 10% of cases occurring in women under the age of 20. In patients below this age, the majority of ovarian tumors are of germ cell origin and malignant ovarian epithelial tumors are uncommon. We report US and CT imaging in a case of mucinous cystadenocarcinoma in a 17-year-old nullipara who complained of amenorrhea for 45 days and a palpable mass

  14. Polycystic ovary syndrome: from phenotype to genetype

    OpenAIRE

    Louwers, Yvonne

    2014-01-01

    markdownabstract__Abstract__ oligomenorrhea or amenorrhea, hirsutism or hyperandrogenism and polycystic ovarian morphology. Later in life, adverse metabolic implications, such as obesity, insulin resistance, type 2 diabetes and cardiovascular disease, become more prominent. In this thesis, we aimed to identify genetic factors for PCOS susceptibility using a candidate-gene approach and a hypothesis-free genome-wide approach. Moreover, we have identified several high-risk groups for long-term h...

  15. Polycystic ovary syndrome and hirsutism

    OpenAIRE

    Evliyaoğlu, Olcay

    2011-01-01

    Polycystic ovary syndrome is a multi factorial heterogenous disorder characterized by chronic anovulation and hyperandrogenism Diagnosis is based on clinical or laboratory evidence of nbsp; hyperandrogenism nbsp; For diagnosis at least two of the three Rotterdam criteria oligo anovulation clinical or biochemical signs of hyperandrogenism polycystic ovaries nbsp; should be ensured Clinical symptoms usually begin around menarche nbsp; Oligomenorrhea amenorrhea hirsutism acne alopecia can be ass...

  16. Hyperandrogenism-Insulin Resistance-Acanthosis Nigricans Syndrome

    OpenAIRE

    Dédjan, A. H.; A. Chadli; El Aziz, S.; Farouqi, A.

    2015-01-01

    Introduction. Female hyperandrogenism is a frequent motive of consultation. It is revealed by hirsutism, acne or seborrhea, and disorders in menstruation cycle combined or not with virilisation signs. Several etiologies are incriminated but the hyperandrogenism-insulin resistance-acanthosis nigricans syndrome is rare. Observation. A 20-year-old girl, having had a five-year-old secondary amenorrhea. The exam revealed a patient, normotensive with a body mass index at 30 kg/m2 and a waist measur...

  17. Hyperandrogenism-insulin resistance-acanthosis nigricans syndrome with PCOS and Hashimoto's thyroiditis: case report

    OpenAIRE

    Amarnath Kulkarni; Shashank Kumar Srivastav; Saraswathi Susarla; Usha Kulkarni; C. Ashok Kumar; Sunita Chikkala; Sheik Majeeda Tabassum

    2015-01-01

    Female hyperandrogenism is a frequent motive of consultation. It is revealed by hirsutism, acne or seborrhea, and disorders in menstruation cycle combined or not with virilisation signs. Several etiologies are incriminated but the hyperandrogenism-insulin resistance-acanthosis nigricans syndrome is rare. A 21-year female, having had a three-year-old secondary amenorrhea, known case of hypothyroidism since 4 years on medication. The exam revealed a patient, hypertensive with blood pressure at ...

  18. Congenital pouch colon in a girl associated with bilateral atresia of cervix uteri and uterus didelphys

    OpenAIRE

    Rajiv Chadha; Manju Puri; Rahul Saxena; Surendrakumar Agarwala; Archana Puri; Subhasis Roy Choudhury

    2013-01-01

    This report describes a girl with congenital pouch colon (CPC), uterus didelphys with septate vagina, and a cloacal anomaly. The girl underwent cloacal reconstruction at the age of 15 months. Subsequently, at puberty, the child had primary amenorrhea with severe cyclic abdominal pain due to endometriosis of both the uteruses and adnexal cysts with hematometra and hematosalpinx. Laparotomy with removal of both uteri and the left fallopian tube was performed. Both uteri had atresia of the cervi...

  19. Endocrine evaluation of reproductive function in girls during infancy, childhood and adolescence

    DEFF Research Database (Denmark)

    Juul, Anders; Hagen, Casper P; Aksglaede, Lise;

    2012-01-01

    a spectrum of disorders such as premature thelarche, premature adrenarche, central and peripheral precocious puberty, adolescent polycystic ovarian syndrome, functional ovarian hyperandrogenism, late-onset congenital adrenal hyperplasia, primary and secondary amenorrhea, and premature ovarian insufficiency....... Diagnosis of these reproductive disorders includes biochemical as well as clinical evaluation. The biochemical evaluation of reproductive function includes measurement of basal reproductive hormone levels and dynamic pituitary or adrenal hormone testing. Correct interpretation of such test results requires...

  20. Reproductive Hormones and the Menopause Transition

    OpenAIRE

    Santoro, Nanette; Randolph, John F.

    2011-01-01

    The hormonal correlates of reproductive aging and the menopause transition reflect an initial loss of the follicle cohort, while a responsive ovary remains, and an eventual complete loss of follicle response, with persistent hypergonadotropic amenorrhea. The physiology of the process is described, along with key findings of relevant studies, with an emphasis on SWAN, the Study of Women’s Health Across the Nation. A clinical framework is provided to help clinicians forecast the major milestone...

  1. An Ovarian Steroid Cell Tumor Causing Virilization and Massive Ascites

    OpenAIRE

    Kim, Young Tae; Kim, Sang Wun; Yoon, Bo Sung; Kim, Sung Hoon; Kim, Jae Hoon; Kim, Jae Wook; Cho, Nam Hoon

    2007-01-01

    Steroid cell tumors, not otherwise specified (NOS), are rare ovarian sex cord-stromal tumors with malignant potential. The majority of these tumors produce several steroids, particularly testosterone. Various virilizing symptoms such as hirsutism, temporal balding, and amenorrhea are common in these patients; however massive ascites is an infrequent symptom. A 52-year-old woman with the sudden onset of virilization and massive ascites presented for treatment at Severance Hospital. After clini...

  2. Persistence of an intact endometrial matrix and vessels structure in women exposed to VA-2914, a selective progesterone receptor modulator.

    OpenAIRE

    Ravet, Stéphanie; Munaut, Carine; Blacher, Silvia; Brichant, Géraldine; Labied, Soraya; Beliard, Aude; Chabbert-Buffet, N.; Bouchard, P.; Foidart, Jean-Michel; PINTIAUX, Axelle

    2008-01-01

    Background: VA-2914 is a selective progesterone receptor modulator with potential contraceptive activity that induces amenorrhea, whereas progestins cause endometrial spotting and bleeding. This abnormal bleeding due to progestins is a consequence of focal stromal proteolysis by an increase in naked vessel size and density. Objective: Our objective was to quantify the effects of VA-2914 on endometrial vascularization, fibrillar matrix, and vascular endothelial growth factor (VEGF)-A expr...

  3. Psychoneuroendocrinological aspects of anorexia nervosa: predictors of recovery

    OpenAIRE

    van Elburg, A A

    2007-01-01

    Anorexia Nervosa (AN) is a psychosomatic eating disorder of unknown aetiology, which primarily affects adolescent girls and young women and is characterized by aberrant patterns of eating behaviour and weight regulation which result in weight loss and endocrine abnormalities such as amenorrhea, disturbances in attitude and perception about weight and shape, and an intense fear of gaining weight. This thesis is based upon a follow up cohort study of 61 young girls and women consecutively refer...

  4. Endocrine Consequences of Anorexia Nervosa

    OpenAIRE

    Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Anorexia nervosa (AN) is prevalent in adolescents and young adults, and endocrine changes include hypothalamic amenorrhea, a nutritionally acquired growth hormone resistance with low insulin like growth factor-1 (IGF-1), relative hypercortisolemia, decreases in leptin, insulin, amylin and incretins, and increases in ghrelin, PYY and adiponectin. These changes in turn have deleterious effects on bone, and may affect neurocognition, anxiety, depression and eating disorder psychopathology. Low b...

  5. Physiology of leptin: energy homeostasis, neuroendocrine function and metabolism

    OpenAIRE

    Park, Hyeong-Kyu; Ahima, Rexford S.

    2014-01-01

    Leptin is secreted by adipose tissue and regulates energy homeostasis, neuroendocrine function, metabolism, immune function and other systems through its effects on the central nervous system and peripheral tissues. Leptin administration has been shown to restore metabolic and neuroendocrine abnormalities in individuals with leptin-deficient states, including hypothalamic amenorrhea and lipoatrophy. In contrast, obese individuals are resistant to leptin. Recombinant leptin is beneficial in pa...

  6. The Effects of Leptin Replacement on Neural Plasticity

    OpenAIRE

    Paz-Filho, Gilberto J.

    2016-01-01

    Leptin, an adipokine synthesized and secreted mainly by the adipose tissue, has multiple effects on the regulation of food intake, energy expenditure, and metabolism. Its recently-approved analogue, metreleptin, has been evaluated in clinical trials for the treatment of patients with leptin deficiency due to mutations in the leptin gene, lipodystrophy syndromes, and hypothalamic amenorrhea. In such patients, leptin replacement therapy has led to changes in brain structure and function in intr...

  7. Nonclassic congenital adrenal hyperplasia misdiagnosed as Turner syndrome

    OpenAIRE

    Mishra, Vineet V; Kumari Pritti; Rohina Aggarwal; Sumesh Choudhary

    2015-01-01

    We present a patient with nonclassic congenital adrenal hyperplasia (NCAH) misdiagnosed as mosaic Turner syndrome. She presented with complaints of primary infertility. Short stature, the presence of facial hair and hoarse voice was also noted. She had primary amenorrhea and was advised for karyotype at 16 years of age, which was reported as 45, X[20]/46, XX[80], stating her as a case of mosaic Turner syndrome. Clitoroplasty was done at 21 years of age for clitoromegaly, which was noticed dur...

  8. Dysgerminoma in a case of 46, XY pure gonadal dysgenesis (swyer syndrome): a case report

    OpenAIRE

    He Anguang; Dai Shundong; Li Qingchang; Wang Yan; Han Yang; Wang Enhua

    2011-01-01

    Abstract Simple 46, XY gonadal dysgenesis syndrome, also called Swyer syndrome, is known as pure gonadal dysgenesis. Individuals with the syndrome are characterized by 46, XY karyotype and phenotypically female with female genital appearance, normal Müllerian structures and absent testicular tissue. The condition usually first becomes apparent in adolescence with delayed puberty and primary amenorrhea due to the gonads have no hormonal or reproductive potential. Herein, we report a case of dy...

  9. Mensus-inducing drugs: their role in antique, medieval and renaissance gynecology and birth control.

    Science.gov (United States)

    Jöchle, W

    1974-10-01

    Antique medical texts describe the use of menses-inducing drugs; some drugs were used for abortions as well as for treating amenorrhea. A table presents a list of these drugs; 71 of the 161 drugs quoted are not now known for causing abortion. A safe and effective once a month pill was first described by Soranus and is still considered an important goal for modern birth control. PMID:4614935

  10. Spontaneous Heterotopic Pregnancy with Term Delivery of a Live Infant

    OpenAIRE

    Yeral, İlkin; Şimşek, Yavuz; Seçkin, Doğa; Danişman, Nuri

    2011-01-01

    Objective: The aim of this report is to present a case of heterotopic pregnancy occurring in spontaneous cycle and ended up in term delivery. Case: A 21 year-old primigravida admitted to the emergency clinic with the complaints of amenorrhea, abdominal pain and vaginal bleeding. Transvaginal ultrasound scan showed an 8 weeks old live intrauterine pregnancy and a left tubal ectopic pregnancy. Laparoscopic salpingostomy was performed for ectopic pregnancy and intrauterine pregnancy was cont...

  11. Umbilical KeyPort bilateral laparoscopic orchiectomy in patient with complete androgen insensitivity syndrome

    OpenAIRE

    Andrade, Felipe P.; Pedro M. Cabrera; Felipe Cáceres; Belen Gil; Rodríguez-Barbero, José M.; Javier C. Angulo

    2012-01-01

    MAIN FINDINGS: A 22-year-old woman with complete androgen insensitivity syndrome (CAIS) presenting with primary amenorrhea and normal female external genitalia was referred for laparoscopic gonadectomy. She had been diagnosed several years earlier but was reluctant to undergo surgery. CASE HYPOTHESIS: Diagnosis of this X-linked recessive inherited syndrome characterizes by disturbance of virilization in males with an AR mutation, XY karyotipe, female genitalia and severely undescended testis ...

  12. Constitutional Thinness and Anorexia Nervosa: A Possible Misdiagnosis?

    OpenAIRE

    Estour, Bruno; Galusca, Bogdan; Germain, Natacha

    2014-01-01

    Clinical and biological aspects of restrictive anorexia nervosa (R-AN) are well documented. More than 10,000 articles since 1911 and more than 600 in 2013 have addressed R-AN psychiatric, somatic, and biological aspects. Genetic background, ineffectiveness of appetite regulating hormones on refeeding process, bone loss, and place of amenorrhea in the definition are widely discussed and reviewed. Oppositely, constitutional thinness (CT) is an almost unknown entity. Only 32 articles have been p...

  13. Fracture risk is decreased in women with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Glintborg, Dorte; Nybo, Mads;

    2016-01-01

    Hyperandrogenism, obesity, and hyperinsulinemia may protect against osteoporosis, whereas amenorrhea, increased cortisol, and low growth hormone may be associated with higher fracture risk in polycystic ovary syndrome (PCOS). OBJECTIVE: To investigate fracture risk in PCOS. MATERIAL/METHODS: PCOS...... be greater in women who have not yet reached peak bone mass. Reduced participation in sports activities was probably not the reason for the reduced risk of fractures. This article is protected by copyright. All rights reserved....

  14. Psiloxylon mauritianum (Bouton ex Hook.f.) Baillon (Myrtaceae): A promising traditional medicinal plant from the Mascarene Islands

    OpenAIRE

    Mahomoodally, Mohamad Fawzi; Korumtollee, Housna Nazifah; Chady, Zaynab Zaina Banu Khan

    2014-01-01

    Psiloxylon mauritianum (PM) (Bouton ex Hook.f.) Baillon (Myrtaceae) is an evergreen endemic medicinal plant which has shown promising uses in traditional medicine from the Mascarene Islands (Mauritius and Réunion Islands). Folk use of this endemic plant in Mauritius and Réunion Islands has been geared toward the treatment and management of amenorrhea, dysentery and Type II diabetes mellitus. Recent findings from in vitro studies have led to the discovery of two potent acids namely corosolic a...

  15. A Case of Swyer Syndrome Associated with Advanced Gonadal Dysgerminoma Involving Long Survival

    OpenAIRE

    Da Silva Rios, Salete; Monteiro, Isabella Christina Mazzaro; Braz dos Santos, Larissa Gonçalves; Caldas, Natasha Garcia; Chen, Ana Carolina Rios; Chen, Juliana Rios; Silva, Helena Spindola Camargo

    2015-01-01

    Swyer syndrome is caused by abnormal sex differentiation during the embryonic period, resulting in incomplete intrauterine masculinization and undifferentiated gonads. The current case report describes a patient with Swyer syndrome associated with stage 3 gonadal dysgerminoma who has survived for 23 years. At age 18, this patient sought assistance for primary amenorrhea from the Gynecological Services Department of the University of Brasília Hospital. A physical examination revealed that the ...

  16. Different types of androgen receptor mutations in patients with complete androgen insensitivity syndrome

    OpenAIRE

    Shao, Jialiang; Hou, Jiangang; Li, Bingkun; Li, Dongyang; Zhang, Ning; Wang, Xiang

    2015-01-01

    Mutations of androgen receptor (AR) are the most frequent cause of 46, XY disorders of sex development and associated with a variety of phenotypes, ranging from phenotypic women (complete androgen insensitivity syndrome (CAIS)) to milder degrees of undervirilization (partial form or PAIS) or men with only infertility (mild form or MAIS). From 2009 to 2012, two young Chinese female individuals with CAIS from two families were referred to our hospital due to primary amenorrhea. Defects in testo...

  17. Smooth muscle relaxant activity of Crocus sativus (saffron) and its constituents: possible mechanisms

    OpenAIRE

    Amin Mokhtari-Zaer; Mohammad Reza Khazdair; Mohammad Hossein Boskabady

    2015-01-01

    Saffron, Crocus sativus L. (C. sativus) is rich in carotenoids and used in traditional medicine for treatment of various conditions such as coughs, stomach disorders, amenorrhea, asthma and cardiovascular disorders. These therapeutic effects of the plant are suggested to be due to its relaxant effect on smooth muscles. The effect of C. sativus and its constituents on different smooth muscles and the underlying mechanisms have been studied. Several studies have shown the relaxant effects of C....

  18. Polycystic ovary syndrome: Studies of affective symptoms in association with sex steroids and evaluation of electroacupuncture and physical exercise

    OpenAIRE

    Jedel, Elizabeth

    2010-01-01

    Polycystic ovary syndrome (PCOS) is a common heterogeneous condition in women of reproductive age, relating to both physical and mental health. Thoughts on primary pathological origins shift from the ovary to the adrenal gland. Insulin signaling pathways and sympathetic nerve activity are thought to be involved. PCOS features include signs of high androgen concentrations and oligo/amenorrhea. Affective symptoms such as depression and anxiety are prevalent among women with the syndrome and hav...

  19. Pregnancy in rudimentary horn of uterus.

    Science.gov (United States)

    Kulkarni, Kranti; Ajmera, Sachin

    2013-01-01

    A 20-year-old primigravida with 3 months amenorrhea presented with complaints of acute abdominal pain. Her vital systemic parameters were stable. On vaginal examination, the patient was provisionally diagnosed of right cornual ectopic pregnancy, which was confirmed sonographically, and taken up for surgery. There was moderate hemoperitoneum and rupture of right horn of uterus with products protruding. The rudimentary horn was excised. The patient was discharged and advised contraception and follow-up. PMID:24178341

  20. [Uterine rupture plugged by omentum in a rudimentary horn pregnancy: About a rare case].

    Science.gov (United States)

    Le Mitouard, M; Huissoud, C; Fichez, A; Roumieu, F; Allias, F; Rudigoz, R C; Caloone, J

    2016-05-01

    Pregnancy in a rudimentary horn of a pseudo-horned uterus is a rare obstetrical situation, for which, maternal-fetal prognosis is altered by the risk of uterine rupture. We report a rare case of pregnancy in a rudimentary horn with birth of a living child at 28 weeks of amenorrhea. During caesarean, uterine rupture plugged by the omentum was observed. We discuss from this case obstetric management of this pathology. PMID:27021927

  1. Pregnancy in rudimentary horn of uterus

    Directory of Open Access Journals (Sweden)

    Kranti Kulkarni

    2013-01-01

    Full Text Available A 20-year-old primigravida with 3 months amenorrhea presented with complaints of acute abdominal pain. Her vital systemic parameters were stable. On vaginal examination, the patient was provisionally diagnosed of right cornual ectopic pregnancy, which was confirmed sonographically, and taken up for surgery. There was moderate hemoperitoneum and rupture of right horn of uterus with products protruding. The rudimentary horn was excised. The patient was discharged and advised contraception and follow-up.

  2. Phenolic profile of wild Achillea millefolium L. obtained by HPLC-DADESI/MS.

    OpenAIRE

    Dias, Maria Inês; Barros, Lillian; Dueñas, Montserrat; Carvalho, Ana Maria; Oliveira, M.B.P.P.; Santos-Buelga, Celestino; Ferreira, Isabel C. F. R.

    2013-01-01

    Achillea millefolium L., commonly known as yarrow, belongs to Asteraceae family and it is very common in mountain meadows, pathways, crop fields and homegardens. It is widely used in Europe as an herbal remedy to treat digestive problems, diabetes, hepato-biliary diseases and amenorrhea, being also consumed for its antitumor, antimicrobial, anti-inflammatory and antioxidant properties [1,2]. Some studies related A. millefolium medicinal properties to the presence of phenolic compo...

  3. The Relationship between Menopausal Symptoms and Heart Rate Variability in Middle Aged Women

    OpenAIRE

    Lee, Jin Oh; Kang, Sung Goo; Kim, Se Hong; Park, Seo jin; Song, Sang Wook

    2011-01-01

    Background The study of the correlation of menopausal symptoms with heart rate variability (HRV) has not been adequate. The aim of this study was to investigate the relationship between postmenopausal symptoms measured by the menopause rating scale (MRS) and HRV. Methods We assessed postmenopausal symptoms (using MRS) with age, BMI, educational status, occupation, marital status, alcohol and caffeine consumption, smoking history, exercise, duration of sleep and amenorrhea, degree of anxiety a...

  4. Is osteoporosis risk in anorexia nervosa underestimated? A case report series

    OpenAIRE

    Bruno Pacciardi; Claudio Cargioli; Simone Belli; Biagio Cotugno; Samanta Augusto; Luca Di Paolo; Mauro Mauri

    2013-01-01

    Introduction: Anorexia nervosa (AN) is a mental disorder whose features are deliberate weight loss, disordered body image, and intrusive overvalued fears of gaining weight. Long-term consequences of AN include endocrine dysfunctions leading to secondary amenorrhea, bone loss and/or osteoporosis with an increased risk of bone fracture. Therefore young women with AN may develop a risk for bone fractures comparable to that of postmenopausal women. Methods: In this case rep...

  5. Perubahan Siklus Menstraasi dan Berat Badan pada Akseptor KB Suntik di Puskesmas Helvetia Medan

    OpenAIRE

    Listiorini, Tari

    2015-01-01

    One of popular contraception in Indonesia is Injectable Contraception. It's provided supply of combination (Cyclofem) and long action progestin or Depo Medroxi Progesteron Asetat (DMPA). The minus of injectable contraception is the disturbance on menstruation cycle and another menstruation disturbance like amenorrhea, menoragia, metroragia, spotting, and the increase of body weight. The purpose of this research is to know difference of the change in menstruation cycle and the change in body w...

  6. Hemoperitoneum: a diagnostic dilemma. A solid ovarian tumour mimicking ruptured ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Wills G. Sheelaa

    2013-04-01

    Full Text Available 39 year old sterilized women presented like ruptured ectopic pregnancy with 40 days amenorrhea, pain, and shock Urine Pregnancy Test negative. Culdocentesis was positive. Ultra sonogram confirmed hemoperitoneum and TO mass. Laparotomy revealed left solid ovarian tumour with tumour mass protruding from perforated site and hemoperitoneum. Histological diagnosis was granulosa cell (GC tumour Stage 1c. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000: 254-256

  7. A rare case of Turner's syndrome presenting with Mullerian agenesis

    OpenAIRE

    Suresh Vaddadi; Ramana S. V. Murthy; Rahul, C. H.; Kumar, Vinod L.

    2013-01-01

    Turner′s syndrome also called as Ullrich Turner′s syndrome, is a disease of unclear pathogenesis characterized by complete or partial absence of one sex chromosome, with or without cell line mosaicism in a phenotypic female with short stature. Various anomalies result in a constellation of features, of which the most disturbing is primary amenorrhea due to gonadal dysgenesis. Hormone therapy in these patients can often result in successful menstruation, and scope for subsequent pregnancy beca...

  8. Report of a case of Turner's syndrome with localized aggressive periodontitis

    OpenAIRE

    Suresh Kumar Kasagani; Ramesh Babu Mutthineni; Narendra Dev Jampani; Rajasekhar Nutalapati

    2011-01-01

    Turner′s syndrome is a disorder in females characterized by the absence of all or part of a normal second sex chromosome. It is typically characterized by the combination of physical features and cytogenetics in females. Physical features include short stature, primary amenorrhea, hypogonadism, low hair line at the back of the neck, and digital anomalies. Most affected patients have a 45XO monosomy, but the presence of an abnormal chromosome or mosaicism of 45X with another cell line can also...

  9. ROLE OF LACTATION IN FAMILY PLANNING

    OpenAIRE

    Surekha Kishore; B S Garg; P R Deshmukh; Pradeep Aggarwal

    2010-01-01

    Objectives: 1. To evaluate the role of Lactational Amenorrhea Method (LAM) as a spacing method. 2. To assess knowledge attitude and practices regarding breastfeeding. 3. To bring awareness regarding importance of breastfeeding on child health and as a method of family planning so that exclusive breast feeding is promoted. Study Design: Cross sectional study. Setting: In rural village of district Wardha. Study Universe : All the lactating mothers who had2 children (one of which was less than 3...

  10. Anorexia nervosa and bone metabolism

    OpenAIRE

    Fazeli, Pouneh K.; Klibanski, Anne

    2014-01-01

    Anorexia nervosa (AN) is a psychiatric disorder characterized by self-induced starvation with a lifetime prevalence of 2.2% in women. The most common medical co-morbidity in women with AN is bone loss, with over 85% of women having bone mineral density values more than one standard deviation below an age comparable mean. The low bone mass in AN is due to multiple hormonal adaptations to under nutrition, including hypothalamic amenorrhea and growth hormone resistance. Importa...

  11. PRİMER OVARİAN GEBELİK: OLGU SUNUMU VE LİTERATÜR DERLEMESİ

    OpenAIRE

    İTİL, İsmail Mete; ÖZCAN, Özge; Terek, Mustafa Coşan; AYGÜL, Senay

    2004-01-01

    Ovarian pregnancy is the most common type of non-tubal ectopic pregnancy. The diagnostic criteria for ovarian pregnacy were described by Spiegelberg. We report a 31-year-old patient with secondary amenorrhea after a first trimester pregnancy termination. The patient underwent laparoscopic operation for the right ovarian cyst and the mass on the posterior surface of the uterus. Subsequently histopathologic examination of the laparoscopically extirpated cyst revealed an ovarian pregnancy

  12. Cushing syndrome and the anesthesiologist, two case reports

    OpenAIRE

    Rudin Domi; Hektor Sula

    2011-01-01

    Cushing′s syndrome (CS) is associated with reduced life quality and increased mortality, mostly due to cardiovascular disease. The features of this syndrome are central obesity, moon facies, facial plethora, supraclavicular fat pads, buffalo hump, and purple striae. Other complications include hyperglycemia, hypertension, proximal muscle weakness, skin thinning, menstrual irregularities, amenorrhea and osteopenia. These make perioperative and anesthetic management difficult and present a chal...

  13. Pituitary hyperplasia: an uncommon presentation of a common disease

    OpenAIRE

    Neves, C P; Massolt, E T; Peeters, R P; Neggers, S J; de Herder, W. W.

    2015-01-01

    Summary A 21-year-old woman presented with amenorrhea, bilateral galactorrhea and fatigue. Visual acuity and visual fields were normal. Laboratory examination demonstrated hyperprolactinemia. Magnetic resonance imaging (MRI) of the pituitary showed a 19×17×12-mm sellar mass with supra- and parasellar extension, causing compression of the pituitary stalk and optic chiasm. Further examinations confirmed mild hyperprolactinemia, strongly elevated TSH (>500 mU/l), low free thyroxine (FT4), hypogo...

  14. Symptoms of hyperprolactinemia with normal serum prolactin: is treatment required?

    Directory of Open Access Journals (Sweden)

    Deepti Verma

    2016-06-01

    Full Text Available Galactorrhea with menstrual abnormalities like oligomenorrhea or amenorrhea point towards a provisional diagnosis of increased serum prolactin levels or hyperprolactinemia. However, as the prolactin hormone is heterogeneous with two forms- the bioactive and the immunoactive forms, patients can have all the features of hyperprolactinemia with normal serum prolactin levels. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 2041-2042

  15. Hyperprolactinemia with normal serum prolactin: Its clinical significance

    Directory of Open Access Journals (Sweden)

    Manika Agarwal

    2010-01-01

    Full Text Available Amenorrhea and infertility with an added feature of galactorrhea makes a provisional diagnosis of hyperprolactinemia. But again, normal serum prolactin with all clinical features of hyperprolactinemia might question the diagnosis and further management. The answer lies in the heterogeneity of the peptide hormone - the immunoactive and the bioactive forms. This has been further illustrated with the help of a case which had been treated with cabergoline.

  16. Reversible thyrotroph hyperplasia with hyperprolactinemia: A rare presenting manifestation of primary hypothyroidism

    OpenAIRE

    Rajesh Rajput; Ashish Sehgal; Deepak Gahlan

    2012-01-01

    Pituitary thyrotroph hyperplasia with hyperprolactinemia has been described as a rare presentation of primary hypothyroidism. Premenopausal females with this disorder can present with features of hypothyroidism, menstrual disturbances, galactorrhea, and visual field defects because of enlarged pituitary. Here we describe a 32-year-old female presenting to her gynecologist primarily with galactorrhea and secondary amenorrhea. She was found to have raised serum prolactin, and MRI brain showed e...

  17. Hyperprolactinemia with normal serum prolactin: Its clinical significance

    OpenAIRE

    Manika Agarwal; Ananya Das; Singh, Santa A.

    2010-01-01

    Amenorrhea and infertility with an added feature of galactorrhea makes a provisional diagnosis of hyperprolactinemia. But again, normal serum prolactin with all clinical features of hyperprolactinemia might question the diagnosis and further management. The answer lies in the heterogeneity of the peptide hormone - the immunoactive and the bioactive forms. This has been further illustrated with the help of a case which had been treated with cabergoline.

  18. Rheumatoid Arthritis, Kartagener's Syndrome, and Hyperprolactinemia: Who Started It?

    OpenAIRE

    Hussein Halabi; Israa Mulla

    2016-01-01

    We report a case of an 18-year-old girl who presented to our hospital with history of recurrent respiratory infections, amenorrhea, and symmetric polyarthritis. She was diagnosed with rheumatoid arthritis (RA), Kartagener’s syndrome (KS), and hyperprolactinemia. There have been very few case reports in the literature of RA occurring in the setting of KS, theoretically proposed to be due to chronic stimulation of the immune system by recurrent infections. Furthermore, hyperprolactinemia has be...

  19. Hyperprolactinemia

    OpenAIRE

    Majumdar, Abha; Mangal, Nisha Sharma

    2013-01-01

    Prolactin (PRL) is an anterior pituitary hormone which has its principle physiological action in initiation and maintenance of lactation. In human reproduction, pathological hyperprolactinemia most commonly presents as an ovulatory disorder and is often associated with secondary amenorrhea or oligomenorrhea. Galactorrhea, a typical symptom of hyperprolactinemia, occurs in less than half the cases. Out of the causes of hyperprolactinemia, pituitary tumors may be responsible for almost 50% of c...

  20. Every high prolactin level does not require treatment!

    OpenAIRE

    Eskicioglu, Fatma

    2014-01-01

    Hyperprolactinemia is a condition of elevated prolactin levels in blood. Pathological hyperprolactinemi presents as oligomenorrhea, amenorrhea, galactorrhea, decreased libido, infertility, and decreased bone mass. The prevalence of hyperprolactinemia ranges from 0.4% in general adult population to as high as 9-17% in women with reproductive diseases [1]. Hyperprolactinemia is usually defined as fasting levels of above 25 ng/ml in women at least 2 hours after waking up [2]. Unless the prolacti...

  1. РОЛЬ ГОРМОНОТЕРАПИИ В ПРОФИЛАКТИКЕ ПРИВЫЧНОГО НЕВЫНАШИВАНИЯ БЕРЕМЕННОСТИ У ЖЕНЩИН С ФУНКЦИОНАЛЬНОЙ ГИПЕРПРОЛАКТИНЕМИЕЙ

    OpenAIRE

    Лукошкина, И.; Федорович, О.

    2007-01-01

    Hyperplolactinemia is a common endocrine disorder, occurring in 15% to 20% of women with menstrual disturbances, 43% to 87% of women with both amenorrhea and galactorrhea, and 30% to 40% of infertile women. The progress of pregnancy at women with functional hyperprolactinemia has the most optimal in cases with pregravid treatment directed on the pharmacological compensation of the increase level of prolaktin and normalization of function of yellow body. Diagnostics of hyperprolactinemia at th...

  2. The pineal gland - Its possible roles in human reproduction

    Science.gov (United States)

    Brzezinski, Amnon; Wurtman, Richard J.

    1988-01-01

    The paper discusses the role of the pineal gland in controlling mammalian reproduction, with particular attention given to the role of melatonin in polyestrus mammals, like humans and laboratory rodents. Evidence is cited indicating the influence of melatonin production and blood content on the age of puberty, the timing of the ovulatory cycle, gonadal steriodogenesis, and patterns of reproductive behavior. It is suggested that abnormal patterns of melatonin might be associated with amenorrhea, anovulation, unexplained infertility, premature menopause, and habitual abortions.

  3. Reconstruction of vaginal agenesis.

    Science.gov (United States)

    Ozkan, Ozlenen; Erman Akar, Münire; Ozkan, Omer; Doğan, N Utku

    2011-06-01

    Vaginal ageneses are by no means rare anomalies. Complete Mullerian agenesis is the most common reason for vaginal agenesis requiring reconstruction. Patients usually present with pain, hematocolpos, or hematometra in puberty, and later with amenorrhea and dyspareunia. Detailed information is given here regarding etiologies, timing of surgery, and current treatment options for vaginal agenesis. Outcomes and short- and long-term complications of recent treatment options are also discussed. PMID:21372677

  4. Mycophenolate mofetil in the treatment of lupus nephritis

    OpenAIRE

    Patrick FK Yong; David P D’Cruz

    2008-01-01

    Patrick FK Yong1,2, David P D’Cruz21Department of Clinical Immunology, Kings College Hospital; 2The Lupus Research Unit, St Thomas’ Hospital, London, UKAbstract: Lupus nephritis is a complication of systemic lupus erythematosus, which has significant morbidity and mortality. The accepted standard of treatment for severe lupus nephritis is cyclophosphamide for induction of remission. This has significant adverse effects including severe infection and amenorrhea. In addition...

  5. Effects of Exercise on B-Endorphin and Follicle Stimulating Hormone Levels among Female Army Officer

    OpenAIRE

    Ruqaiyah Ruqaiyah; Retty Ratnawati; Edy Mustofa

    2014-01-01

    Purpose: This study aimed to investigate whether chronically high-intensity exercise can change B-endorphin and FSH level among female army officer. Material and Methods: Fourty six healthy female army officer volunteered for the study. All of them gave written consent regarding their participation. The subjects were categorized in two groups: high-intensity exercise (HE, 23 subjects) and non exercise (NE, 23 subjects). The inclusion criteria were amenorrhea, no consumption of reproductive...

  6. Effects of Exercise on B-Endorphin and Follicle Stimulating Hormone Levels among Female Army Officer

    OpenAIRE

    Ruqaiyah, Ruqaiyah; Ratnawati, Retty; Mustofa, Edy

    2014-01-01

    Purpose: This study aimed to investigate whether chronically high-intensity exercise can change B-endorphin and FSH level among female army officer. Material and Methods: Fourty six healthy female army officer volunteered for the study. All of them gave written consent regarding their participation. The subjects were categorized in two groups: high-intensity exercise (HE, 23 subjects) and non exercise (NE, 23 subjects). The inclusion criteria were amenorrhea, no consumption of reproductive h...

  7. Fetal outcome in repeat cervical encirclage in same pregnancy

    OpenAIRE

    Nirmala Sharma; Kana Ram; Anand Sharma

    2013-01-01

    A 30 year old sixth gravida patient having five spontaneous abortions between fifth and sixth months of amenorrhea. Patient had an incompetent cervix, cervical cerclage was done at 14 weeks of gestation by Mc Donald’s method. Pregnancy was uneventful for more than one month and patient reported back with complaints of bleeding per vaginum, and pain abdomen, cerclage was removed by duty doctor in emergency, but pains subsided. Ultrasound was done revealing low lying placenta reaching upto...

  8. Gonadal dysgenesis and the Mayer-Rokitansky-Kuster-Hauser Syndrome in a girl with a 46, XX karyotype: A case report and review of literature

    OpenAIRE

    Sahbi Kebaili; Kais Chaabane; Mouna Feki Mnif; Mahdi Kamoun; Faten Hadj Kacem; Nouha Guesmi; Hichem Gassara; Abdallah Dammak; Doulira Louati; Habib Amouri; Mohamed Guermazi

    2013-01-01

    Mayer-Rokitansky-Kuster-Hauser (MRKH) is a characteristic syndrome in which the Mullerian structures are absent or rudimentary. It is also associated with anomalies of the genitourinary and skeletal systems. Its association with gonadal dysgenesis is extremely rare and appears to be fortuitous, independent of chromosomal anomalies. We report such a case in a 21-year-old girl who presented primary amenorrhea and impuberism. The endocrine study revealed hypergonadotrophic hypogonadism. The kary...

  9. Menstrual cycle dysfunction and weight loss practices among college-age women

    OpenAIRE

    Michele D Lewis

    1996-01-01

    Secondary amenorrhea, ovulatory disturbances, and luteal phase deficiency occur in normal-weight women with sub-clinical eating disorders. The purpose of this investigation was to examine the influence of Eating Attitudes Test (EAT-26) scores, energy intake, and frequency of activity on ovarian hormone status in normal-weight, college-age women. Fourteen normal-weight female students, ages 19 - 24, who were attempting weight loss and did not currently meet diagnostic criteri...

  10. Wilson disease with thrombocytopenia (case report).

    Science.gov (United States)

    Zhvania, M; Gogberashvili, K; Gagoshidze, M; Uberi, E

    2014-12-01

    We present an adolescent patient with WD accompanied with secondary amenorrhea, and thrombocytopenia. NK, a 14 year-old girl, had amenorrhea for 5 months despite having had regular menses for 2 years. An abdominal ultrasound scan revealed ascitis and some ovarian cysts. On physical examination: slight jaundice, edema of lower extremities, skin purpuric rash, enlarged abdomen, dry skin. She had no hepatomegaly and no splenomegaly. Breast and pubic hair development was concomitant with Tanner stage 4. There was performed laboratory and instrumental investigations. The patient was diagnosed as WD owing to the low level of ceruloplasmin, with increased level of copper in 24-hour urine excretion and in dry liver tissue. The needle biopsy of liver showed severe hepatocellular necrosis, inflammatory changes and fibrosis. The platelet count was found to be low with lack of increased number of megakaryocytes in the bone marrow aspiration suggesting the thrombocytopenia was not exclusively owing to hypersplenism. The absence of antithrombocyte and other autoimmune and viral antibodies excluded respectively the diagnosis of autoimmune thrombocytopenia, other autoimmune diseases and viral infections. Thus, we support the recommendation that adolescents with amenorrhea or children with thrombocytopenia without any obvious cause should be evaluated for WD, because the early detection and treatment of WD is capable of reversing described changes and restoring a normal liver function. PMID:25617103

  11. An Unusual Presentation of 46,XY Pure Gonadal Dysgenesis: Spontaneous Breast Development and Menstruation.

    Science.gov (United States)

    Çatlı, Gönül; Alparslan, Caner; Can, P Şule; Akbay, Sinem; Kelekçi, Sefa; Atik, Tahir; Özyılmaz, Berk; Dündar, Bumin N

    2015-06-01

    46,XY pure gonadal dysgenesis (Swyer syndrome) is characterized by normal female genitalia at birth. It usually first becomes apparent in adolescence with delayed puberty and amenorrhea. Rarely, patients can present with spontaneous breast development and/or menstruation. A fifteen-year-old girl presented to our clinic with the complaint of primary amenorrhea. On physical examination, her external genitals were completely female. Breast development and pubic hair were compatible with Tanner stage V. Hormonal evaluation revealed a hypergonadotropic state despite a normal estrogen level. Chromosome analysis revealed a 46,XY karyotype. Pelvic ultrasonography showed small gonads and a normal sized uterus for age. SRY gene expression was confirmed by multiplex polymerase chain reaction. Direct sequencing on genomic DNA did not reveal a mutation in the SRY, SF1 and WT1 genes. After the diagnosis of Swyer syndrome was made, the patient started to have spontaneous menstrual cycles and therefore failed to attend her follow-up visits. After nine months, the patient underwent diagnostic laparoscopy. Frozen examination of multiple biopsies from gonad tissues revealed gonadoblastoma. With this report, we emphasize the importance of performing karyotype analysis, which is diagnostic for Swyer syndrome, in all cases with primary or secondary amenorrhea even in the presence of normal breast development. We also suggest that normal pubertal development in patients with Swyer syndrome may be associated with the presence of a hormonally active tumor. PMID:26316442

  12. Selective Determinants of Low Bone Mineral Mass in Adult Women with Anorexia Nervosa

    Science.gov (United States)

    Trombetti, Andrea; Richert, Laura; Herrmann, François R.; Chevalley, Thierry; Graf, Jean-Daniel; Rizzoli, René

    2013-01-01

    We investigated the relative effect of amenorrhea and insulin-like growth factor-I (sIGF-I) levels on cancellous and cortical bone density and size. We investigated 66 adult women with anorexia nervosa. Lumbar spine and proximal femur bone mineral density was measured by DXA. We calculated bone mineral apparent density. Structural geometry of the spine and the hip was determined from DXA images. Weight and BMI, but not height, as well as bone mineral content and density, but not area and geometry parameters, were lower in patients with anorexia nervosa as compared with the control group. Amenorrhea, disease duration, and sIGF-I were significantly associated with lumbar spine and proximal femur BMD. In a multiple regression model, we found that sIGF-I was the only significant independent predictor of proximal femur BMD, while duration of amenorrhea was the only factor associated with lumbar spine BMD. Finally, femoral neck bone mineral apparent density, but not hip geometry variables, was correlated with sIGF-I. In anorexia nervosa, spine BMD was related to hypogonadism, whereas sIGF-I predicted proximal femur BMD. The site-specific effect of sIGF-I could be related to reduced volumetric BMD rather than to modified hip geometry. PMID:23634145

  13. Anorexia nervosa in female adolescents: endocrine and bone mineral density disturbances.

    Science.gov (United States)

    Muñoz, M T; Argente, J

    2002-09-01

    Anorexia nervosa (AN) is a chronic childhood psychiatric illness that involves a reduction in caloric intake, loss of weight and amenorrhea, either primary or secondary. The diagnostic criteria for AN have been established by the American Psychiatric Association. The prevalence of this disease amongst adolescents and young adults is between 0.5 and 1% and the incidence of new cases per year is approximately 5-10/100,000 between 15 and 19 years of age.A number of endocrine and metabolic disturbances have been described in patients with AN including amenorrhea-oligomenorrhea, delayed puberty, hypothyroidism, hypercortisolism, IGF-I deficiency, electrolyte abnormalities, hypoglycemia and hypophosphatemia, among others. In addition to prolonged amenorrhea, osteopenia and osteoporosis are the most frequent complications leading to clinically relevant fractures and increased fracture risk throughout life. Patients exhibit an alteration in the hypothalamic-pituitary-gonadal axis, which is responsible for the menstrual disorders. The increase in gonadotropin secretion that can be observed after ponderal recuperation suggests that malnutrition could be the most important mechanism involved in the decrease in gonadotropin secretion. The loss of fat tissue as a consequence of nutrient restriction has been associated with hypoleptinemia and abnormal secretion of peptides implicated in food control (neuropeptide Y, melanocortins and corticotropin-releasing factor, among others).A review of the endocrine abnormalities, disturbances in neurotransmitters, as well as a detailed analysis of bone markers and bone mineral density in patients with AN is described. PMID:12213663

  14. Selective determinants of low bone mineral mass in adult women with anorexia nervosa.

    Science.gov (United States)

    Trombetti, Andrea; Richert, Laura; Herrmann, François R; Chevalley, Thierry; Graf, Jean-Daniel; Rizzoli, René

    2013-01-01

    We investigated the relative effect of amenorrhea and insulin-like growth factor-I (sIGF-I) levels on cancellous and cortical bone density and size. We investigated 66 adult women with anorexia nervosa. Lumbar spine and proximal femur bone mineral density was measured by DXA. We calculated bone mineral apparent density. Structural geometry of the spine and the hip was determined from DXA images. Weight and BMI, but not height, as well as bone mineral content and density, but not area and geometry parameters, were lower in patients with anorexia nervosa as compared with the control group. Amenorrhea, disease duration, and sIGF-I were significantly associated with lumbar spine and proximal femur BMD. In a multiple regression model, we found that sIGF-I was the only significant independent predictor of proximal femur BMD, while duration of amenorrhea was the only factor associated with lumbar spine BMD. Finally, femoral neck bone mineral apparent density, but not hip geometry variables, was correlated with sIGF-I. In anorexia nervosa, spine BMD was related to hypogonadism, whereas sIGF-I predicted proximal femur BMD. The site-specific effect of sIGF-I could be related to reduced volumetric BMD rather than to modified hip geometry. PMID:23634145

  15. Analysis of Chinese women with primary ovarian insufficiency by high resolution array-comparative genomic hybridization

    Institute of Scientific and Technical Information of China (English)

    LIAO Can; FU Fang; YANG Xin; SUN Yi-min; LI Dong-zhi

    2011-01-01

    Background Primary ovarian insufficiency (POI) is defined as a primary ovarian defect characterized by absent menarche (primary amenorrhea) or premature depletion of ovarian follicles before the age of 40 years. The etiology of primary ovarian insufficiency in human female patients is still unclear. The purpose of this study is to investigate the potential genetic causes in primary amenorrhea patients by high resolution array based comparative genomic hybridization (array-CGH) analysis.Methods Following the standard karyotyping analysis, genomic DNA from whole blood of 15 primary amenorrhea patients and 15 normal control women was hybridized with Affymetrix cytogenetic 2.7M arrays following the standard protocol. Copy number variations identified by array-CGH were confirmed by real time polymerase chain reaction.Results All the 30 samples were negative by conventional karyotyping analysis. Microdeletions on chromosome 17q21.31-q21.32 with approximately 1.3 Mb were identified in four patients by high resolution array-CGH analysis. This included the female reproductive secretory pathway related factor N-ethylmaleimide-sensitive factor (NSF) gene.Conclusions The results of the present study suggest that there may be critical regions regulating primary ovarian insufficiency in women with a 17q21.31-q21.32 microdeletion. This effect might be due to the loss of function of the NSF gene/genes within the deleted region or to effects on contiguous genes.

  16. Comparison and correlation of menstrual dysfunctions and regional fat distribution in female student athletes and non-athletes

    Directory of Open Access Journals (Sweden)

    Azam Zarneshan

    2014-03-01

    Full Text Available Background: In spite of the presence of menstrual dysfunctions in female student athletes, few studies have been conducted to analyse the reasons and athletic factors affecting them. Regional distribution of fat is one of the important factors that plays a role in causing menstrual disorders, and since menstrual cycle disorders can lead to many problems, the present study was aimed to compare and analyse the menstrual dysfunctions and regional patterns of fat distribution in female student athletes and non-athletes. Methods: The present study was descriptive analytical which was carried out on 206 female student athletes and non-athletes studying in Shahid Madani University of Azarbaijan selected through convenience sampling in 2013. Subcutaneous fat was measured using calipers and a questionnaire was given to subjects in order to collect their personal and their menstrual cycles’ information. The collected data were analysed by SPSS (version 16 statistical software. Results: The findings of the study revealed a significant difference between athletes and non-athletes in terms of the incidence of menstrual dysfunctions of amenorrhea, oligomenorrhea, menorrhagia, hypomenorhea and hypermenorrhea (p<0.05. Moreover, there was a negative relationship between thigh fat and amenorrhea (p=0.024, suprailiac and menorrhagia (p=0.015, chest and hypomenorhea (p=0.033, and waist circumference and hypermenorhea (p=0.011 in athletes. Conclusion: Overall, the findings of this study showed that prevalence of menstrual disorders was higher in athletes than non-athletes and low distribution of fat in the lower region of athletes’ body may be disturbed during menstrual periods (amenorrhea and low distribution of fat in the abdominal and upper parts of body may lead to irregular uterine bleeding (menorrhagia, hypomenorhea and hypermenorhea.

  17. Endometrial Histology of Depomedroxyprogesterone Acetate Users: A Pilot Study

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available Objective. To obtain pilot data on the endometrial histology of Depomedroxyprogesterone acetate (Depo-Provera, DMPA users experiencing breakthrough bleeding (BTB versus users with amenorrhea. To compare the endometrial histology of patients who used DMPA continuously for 3–12 months versus those who used it for 13 months or more. Methods. Cross-sectional study. Endometrial biopsy was obtained from all consenting patients who used DMPA for at least 3 months. Patients were divided into those with BTB in the last 3 months versus those with amenorrhea for at least 3 months. Histology results and duration of therapy were compared. Results. The proportion of women with chronic endometritis, uterine polyps, atrophic, proliferative, or progesterone-dominant endometrium did not differ between those DMPA users with BTB versus those with amenorrhea. Duration of therapy did not correlate with symptoms of BTB or endometrial histology. Chronic endometritis was the most common histologic finding (10/40, 25% and occurred more often in women experiencing BTB (35% versus 15% (RR 1.62 CI 0.91–2.87. Moreover, 45% of women with BTB had received DMPA for more than 12 months. Conclusions. BTB was more common than previously reported in women using DMPA for more than 12 months. Chronic endometritis, which may indicate an underlying infectious or intracavitary anatomic etiology, has not been previously reported as a frequent finding in DMPA users, and may be related to ethnic or other sociodemographic characteristics of our patient population. Further study to elucidate the etiology of chronic endometritis in these patients is warranted.

  18. Tamoxifen and ovarian function.

    Directory of Open Access Journals (Sweden)

    Martine Berliere

    Full Text Available BACKGROUND: Some studies suggest that the clinical parameter "amenorrhea" is insufficient to define the menopausal status of women treated with chemotherapy or tamoxifen. In this study, we investigated and compared the ovarian function defined either by clinical or biological parameters in pre-menopausal breast cancer patients treated with tamoxifen administered as adjuvant therapy. MATERIALS AND METHODS: Between 1999 and 2003, 138 premenopausal patients consecutively treated for early breast cancer were included. Sixty-eight received tamoxifen in monotherapy as the only adjuvant systemic treatment (Group I and 70 were treated with tamoxifen after adjuvant chemotherapy (Group II. All patients had a confirmed premenopausal status based on clinical parameters and hormonal values at study entry. They were followed prospectively every 3 months for 3 years: menses data, physical examination and blood tests (LH, FSH, 17-beta-estradiol. Vaginal ultrasonography was carried out every 6 months. After 3 years, prospective evaluation was completed and monitoring of ovarian function was performed as usual in our institution (1x/year. All data were retrospectively evaluated in 2011. RESULTS: Three patients were excluded from the study in group I and 2 were excluded in group II. Patients were divided into 4 subgroups according to clinical data, i.e. menses patterns. These patterns were assessed by questionnaires. a: Regular menses (>10 cycles/year b: Oligomenorrhea (5 to 9 cycles/year c: Severe oligomenorrhea (1 to 4 cycles/year d: Complete amenorrhea Estrogen levels did not appear to have any impact on disease-free survival rates after 3 or 8 years. FSH values were also documented and analyzed. They exhibited the same profile as estradiol values. CONCLUSIONS: Amenorrhea is an insufficient parameter to define menopausal status in patients receiving tamoxifen. Low estradiol levels must be coupled with other biological parameters to characterize endocrine status

  19. Ten-year literature review of global endometrial ablation with the NovaSure® device

    Directory of Open Access Journals (Sweden)

    Gimpelson RJ

    2014-03-01

    Full Text Available Richard J Gimpelson Mercy Clinic, Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Mercy Hospital St Louis, St Louis, MO, USA Abstract: This review examines the peer-reviewed literature describing prospective studies that report amenorrhea rates, patient satisfaction, and surgical reintervention rates following the NovaSure® endometrial ablation procedure. A search of the English-language literature published from 2000 to 2011 was conducted using PubMed. Ten prospective studies, six single-arm NovaSure trials, and four randomized controlled trials comparing the NovaSure procedure with other global endometrial ablation modalities met the inclusion criteria and were reviewed. The follow-up periods ranged from 6 to 60 months. Amenorrhea rates for the NovaSure procedure ranged from 30.0% to 75.0%. Patients who reported being satisfied with the NovaSure procedure ranged from 85.0% to 94.0%. In randomized controlled trials with other global endometrial ablation modalities, amenorrhea rates at 12 months with the NovaSure procedure ranged from 43.0% to 56.0%, while other modalities ranged from 8% to 24%. In addition, this manuscript reviews the following: the NovaSure technology; use of the NovaSure procedure in the office setting; intraoperative and postoperative pain; effects on premenstrual syndrome (PMS; dysmenorrhea; special circumstances, including presence of uterine disease, history of cesarean delivery, coagulopathy, or use of anticoagulant medication; post-procedure uterine cavity assessment and cancer risk; contraception and pregnancy; and safety. Keywords: abnormal uterine bleeding, menorrhagia, endometrial ablation, NovaSure®

  20. Lack of tumor reduction in hyperprolactinemic women with extrasellar macroadenomas treated with bromocriptine

    Energy Technology Data Exchange (ETDEWEB)

    Boulanger, C.M.; Mashchak, C.A.; Chang, R.J.

    1985-10-01

    Three patients with hyperprolactinemia and large extrasellar pituitary macroadenomas were treated with bromocriptine, 10 mg daily, for 8 weeks. In spite of correction of their amenorrhea, galactorrhea, and hyperprolactinemia, radiologic evaluation by CT scan failed to show evidence of tumor shrinkage. After surgical resection, histologic examination revealed that PRL-secreting cells comprised only a small portion of the tumor cell population in two patients and in the third patient were completely absent. These cases illustrate that large nonfunctional pituitary tumors may mimic signs and symptoms of a prolactinoma and stress the importance of adequate radiologic evaluation during medical management. 8 references, 3 figures.

  1. CT studies in hyperprolactinemia; Badania KT w hiperprolaktynemii

    Energy Technology Data Exchange (ETDEWEB)

    Gradzki, J.; Paprzycki, W.; Krzyzagorska, E.; Wasko, R.; Warenik-Szymankiewicz, A. [Akademia Medyczna, Poznan (Poland)

    1993-12-31

    Computerized tomography studies in 62 patients (55 females and 7 males) with hyperprolactinemia are presented. The female patients had secondary amenorrhea and galactorrhea, whereas the male patients suffered from impotency, gynaecomastia and very rarely galactorrhea. In 39 cases CT revealed a pituitary adenoma (prolactinoma), in 14 cases of them microadenoma, as the cause of hormonal and clinical disturbances. In 21 cases an empty sella with rudimentary pituitary surrounded by cerebrospinal fluid or lack of pituitary mass were found. In one case suprasellar and intrasellar calcifications were present. (author). 17 refs, 4 figs.

  2. Health-related Quality of Life in Women with Polycystic Ovary Syndrome

    Directory of Open Access Journals (Sweden)

    Belén Carazo Hernández

    2014-04-01

    Full Text Available Polycystic ovary syndrome is the most frequent endocrine and metabolic disorder in women of reproductive age. Its characteristic signs and symptoms are menstrual irregularities, amenorrhea, acne, hirsutism, obesity and infertility. Polycystic ovary syndrome has major effects on long-term health, which can lead to psychological morbidity and decreased quality of life. This paper reviews the current literature on polycystic ovary syndrome and health-related quality of life; in addition, it assesses how some clinical manifestations of polycystic ovary syndrome affect the quality of life of women who suffer this disorder.

  3. Clinical meanings of determination of serum β-HCG levels in the management of drug abortion for family planning

    International Nuclear Information System (INIS)

    Objective: To study the clinical meanings of determination of serum β-HCG levels in the management of drug abortion for birth control. Methods: Serum β-HCG levels were determined with CLIA in 254 pregnant women asking for drug abortion and 102 women with ectopic gestation. Results: The serum β-HCG levels in women with normal pregnancy were significantly higher than those in women with ectopic gestation (P0.05). Conclusion: For drug abortion in those pregnant women with amenorrhea over 45 days and serum β-HCG levels over 50000mlU/ml, a larger dose of misoprostol may be desirable. (authors)

  4. Congenital pouch colon in a girl associated with bilateral atresia of cervix uteri and uterus didelphys

    Directory of Open Access Journals (Sweden)

    Rajiv Chadha

    2013-01-01

    Full Text Available This report describes a girl with congenital pouch colon (CPC, uterus didelphys with septate vagina, and a cloacal anomaly. The girl underwent cloacal reconstruction at the age of 15 months. Subsequently, at puberty, the child had primary amenorrhea with severe cyclic abdominal pain due to endometriosis of both the uteruses and adnexal cysts with hematometra and hematosalpinx. Laparotomy with removal of both uteri and the left fallopian tube was performed. Both uteri had atresia of the cervix uteri. This report emphasizes the need for comprehensive evaluation and a long-term management strategy for associated gynecologic anomalies in girls with CPC, especially with regard to patency of the outflow tract.

  5. Neural circuits underlying hyperactivity in an animal model for anorexia nervosa

    OpenAIRE

    Verhagen, L.A.W.

    2009-01-01

    Anorexia nervosa (AN) means literally “a nervous loss of appetite” and is characterized by reduced food intake, extreme body weight loss, hypothermia, amenorrhea and emaciation. The average prevalence of AN has been reported to be 0.3% and has the highest mortality rate (>10%) of all psychiatric disorders. Excessive physical activity is demonstrated by many, if not most, patients with AN at some point in the course of the disorder, and has been described as a hallmark feature of the syndrome....

  6. Bilateral Gonadal Cysts and Late Diagnosis of Androgen Insensitivity Syndrome Treated by Laparoscopic Gonadectomy

    OpenAIRE

    Tourlakis, D.; Fersis, N; Schnabel, J.

    2011-01-01

    Background. Complete androgen insensitivity syndrome is a rare syndrome in which the uterus is absent and testes rather than ovaries are present. Patients usually visit a gynecologist due to primary amenorrhea. Case. A forty-eight-year-old woman with lower abdominal pain and anamnesis of uterus agenesis was operated on due to bilateral cystic masses. A 5 × 3 × 1.2 cm left adnexal cyst revealed the presence of a serous cyst with a hypoplastic ductus deferens. A smaller cyst of the right adnexa...

  7. Dysgerminoma in a female with turner syndrome and Y chromosome material: A case-based review of literature

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Kota

    2012-01-01

    Full Text Available We report a 17-year-old girl evaluated for primary amenorrhea. Cytogenetic analysis of the peripheral blood lymphocytes revealed normal autosomes with 46X inv (Y confirming the diagnosis of Turner′s syndrome with Y cell line. Treatment was initiated with conjugated estrogen while recommending bilateral prophylactic oophorectomy to the patient. One year later the patient presented with abdominal mass, biopsy of the specimen following resection confirmed dysgerminoma originating from right ovary with no invasion or metastasis. The literature is reviewed with regard to the various pathogenetic mechanisms proposed for the development of germ cell tumors in ovary, the cytogenetic findings and recommendations to handle such scenario.

  8. Severe Hemoperitoneum Following Rupture of Uterine Diverticulum due to Pregnancy: a Case Report

    Directory of Open Access Journals (Sweden)

    Yaghmaei Minoo

    2009-06-01

    Full Text Available Uterovaginal malformations, occur in 0.16% of women and contribute to the problems of infertility, recurrent pregnancy loss, dysmenorrhea, dyspareunia, amenorrhea and a poor outcome in pregnancy. True diverticulum is an exceedingly rare anomaly and is like a tubular formation connected to uterine cavity that ends in a cul-de sac and It is not classified as any of mullerian duct anomalies. In this article a case of uterine diverticulum rupture due to pregnancy in a 19 years old woman with nausea, vomiting and abdominal pain is reported. Although rare, in complicated pregnancy we should think to genital tract anomalies.

  9. Dietary zinc intake of vegetarian and nonvegetarian patients with anorexia nervosa.

    Science.gov (United States)

    Bakan, R; Birmingham, C L; Aeberhardt, L; Goldner, E M

    1993-03-01

    Anorexia nervosa (AN) and zinc deficiency, found most frequently in young females, have a number of symptoms in common. These include weight loss, alterations in taste and appetite, depression, and amenorrhea. Approximately half of anorexia nervosa patients (ANs) are vegetarian (VANs), a practice that may increase their risk for zinc deficiency. This study compared the dietary intake of zinc and related nutrients in 9 outpatient VANs with that of 11 outpatient nonvegetarian patients with anorexia nervosa (NVANs). VANs reported significantly lower (p zinc, fat, and protein, and a significantly higher (p zinc intake should be routinely assessed in VANs and that zinc supplementation of their diets may be indicated. PMID:8477292

  10. The female runner: gender specifics.

    Science.gov (United States)

    Lynch, Stacy L; Hoch, Anne Z

    2010-07-01

    There has been a tremendous increase in the number of female runners of all ages and abilities in the past 35 years. Women who participate in running and sports are generally healthier and have higher self-esteem. However, unique medical and orthopedic issues exist for the female runner. This article reviews the history of women in sports, physiologic and biomechanic differences between genders, the pregnant runner, knee osteoarthritis, an update on the female athlete triad and the relationship between amenorrhea and endothelial dysfunction associated with athletics. PMID:20610034

  11. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report.

    Science.gov (United States)

    Okamoto, Shinichi; Arai, Yuji; Hara, Kunio; Tsuzihara, Takashi; Kubo, Toshikazu

    2010-01-01

    This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad. PMID:20205723

  12. The female athlete triad and endothelial dysfunction.

    Science.gov (United States)

    Lanser, Erica M; Zach, Karie N; Hoch, Anne Z

    2011-05-01

    A tremendous increase in the number of female athletes of all ages and abilities has occurred in the past 35 years. In general, sports and athletic competition produce healthier and happier women. However, explosion in participation has revealed clear gender-specific injuries and medical conditions unique to the female athlete. This article focuses on the latest advances in our knowledge of the female athlete triad and the relationship between athletic-associated amenorrhea and endothelial dysfunction. Treatment of vascular dysfunction with folic acid is also discussed. PMID:21570034

  13. Adolescent idiopathic scoliosis in athletes: is there a connection?

    Science.gov (United States)

    Kenanidis, Eustathios I; Potoupnis, Michael E; Papavasiliou, Kyriakos A; Sayegh, Fares E; Kapetanos, George A

    2010-06-01

    The potential relationship between adolescent idiopathic scoliosis (AIS) and sports is rather vague. Sports have often been considered to be a causative factor of, or a treatment option for the former, particularly among adolescent athletes who are engaged in certain athletic activities. The highly repetitive nature of sports, amenorrhea, exercise-related exerted stress on the immature spine of professional adolescent athletes, and the joint laxity that may coexist during adolescence, have also been associated with an increased incidence of AIS. The purpose of this article is to discuss the potential connection between sports and AIS by reviewing the existing literature. PMID:20631476

  14. Advances in management of the female athlete triad and eating disorders.

    Science.gov (United States)

    Zach, Karie N; Smith Machin, Ariane L; Hoch, Anne Z

    2011-07-01

    Although there are numerous benefits to women from athletic participation, a complex combination of endocrine and metabolic factors exaggerates risk for a serious health concern: the female athlete triad. The purpose of this article is to provide updates on new issues related to the triad, specifically the relationship between athletic-associated amenorrhea and endothelial dysfunction-a potential fourth component to the triad that is a concern for future cardiovascular risk, public health issues, and athletic performance. Folic acid should be considered a potential safe and inexpensive therapeutic treatment to restore endothelial-dependent vasodilation. PMID:21658548

  15. Ruptured rudimentary horn pregnancy at sixteen weeks.

    Science.gov (United States)

    Zeqiri, Fehmi; Paçarada, Myrvete; Kongjeli, Niltene; Zeqiri, Vlora; Kongjeli, Gyltene; Krasniqi, Burim

    2010-01-01

    Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures, leading to life -threatening intraperitoneal hemorrhage. A 22-year-old second gravida patient presented at the Emergency Center of the University Clinical Center of Kosova with a 16-week history of amenorrhea and acute onset of severe abdominal pain. She was resuscitated and taken for an emergency laparotomy under general anesthesia. Intraoperatively, there was a massive hemoperitoneum with a ruptured right rudimentary horn Given their rarity, ruptured rudimentary horn pregnancies are of interest. PMID:24591927

  16. Radiation Therapy of Pituitary Tumors

    International Nuclear Information System (INIS)

    Radiation treatment results were analyzed in a retrospective analysis of 47 patients with pituitary adenoma treated with radiation alone or combined with surgery from 1974 through 1987 at the Department of Therapeutic Radiology of Kyung Hee University. The 5-year overall survival rates for all patients was 80.4%. Radiation therapy was effective for improving visual symptoms and headache, but could not normalize amenorrhea and galactorrhoea. There was no difference of survival rate between radiation alone and combination with surgery. Prognostic factors such as age, sex, disease type, visual field, headache and surgical treatment were statistically no significant in survival rates of these patients

  17. Karotinaemi hos patient med excessivt betakarotinfødeindtag og dysreguleret diabetes mellitus

    DEFF Research Database (Denmark)

    Mikkelsen, Carsten Sauer; Mikkelsen, Dorthe Bisgaard; Lindegaard, Hanne Merete

    2009-01-01

    A case of carotinaemia in a patient with excessive beta-carotene food-intake, diabetes mellitus and physiological amenorrhea is reported. The patient developed yellow discolouration in the palms and the soles of her feet. Blood samples showed a significantly increased lever of serum beta......-carotene, but normal vitamine A value and liver enzymes. The patient reported an excessive intake of carrots (approximately 1 kg per day). The status of physiological amenorrhoea and dysregulated diabetes mellitus may have deteriorated the yellow discolouration of the skin. Udgivelsesdato: 2009-Jan-26...

  18. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report

    Directory of Open Access Journals (Sweden)

    Okamoto Shinichi

    2010-03-01

    Full Text Available Abstract This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad.

  19. An isodicentric X chromosome with gonadal dysgenesis in a lady without prominent somatic features of Turner's syndrome. A case report.

    Science.gov (United States)

    Yu, Tse-Ya; Lin, Huan-Sheng; Chen, Pei-Lung; Huang, Tien-Shang

    2015-01-01

    Isodicentric X chromosomes in general have phenotypes characteristic of the resultant X deletions. Gonadotropin levels in Turner's syndrome (TS) girls are high, but have a normal biphasic pattern. Here, we report a 21-year-old lady with primary amenorrhea. Clinical examination revealed a short neck but no other typical stigmata of Turner's syndrome. The levels of gonadotropin were not raised to post-menopausal levels. A chromosome study showed a 45,X/46,X,idic(X)(q22) karyotype. She was diagnosed as having Turner's syndrome. PMID:25618587

  20. [Turner's syndrome 45,X/46Xdel(X)(q21): a case report].

    Science.gov (United States)

    Aiassa, Delia; Bosch, Beatriz; Castellano, Mónica

    2013-01-01

    Turner's syndrome was described by Otto Ullrich (1930) and Henry Turner (1938). An estimated 1 from 2,000 to 3,000 female babies and 1% of the conceptions of female embryos and fetuses have this condition, and 95 to 99% of them result in miscarriage during the first trimester. The case presented concerns a 15 y/o girl who consulted due to primary amenorrhea. The karyotype was 45,X[6]/46Xdel(X)(q21)[14]. Her mother had experienced premature ovarian failure and her karyotype was: 46Xdel(X)(q21)[3]/46,XX[35]. PMID:23381712

  1. Dysgerminoma in a female with turner syndrome and Y chromosome material: A case-based review of literature.

    Science.gov (United States)

    Kota, Sunil Kumar; Gayatri, Kotni; Pani, Jaya Prakash; Kota, Siva Krishna; Meher, Lalit Kumar; Modi, Kirtikumar D

    2012-05-01

    We report a 17-year-old girl evaluated for primary amenorrhea. Cytogenetic analysis of the peripheral blood lymphocytes revealed normal autosomes with 46X inv (Y) confirming the diagnosis of Turner's syndrome with Y cell line. Treatment was initiated with conjugated estrogen while recommending bilateral prophylactic oophorectomy to the patient. One year later the patient presented with abdominal mass, biopsy of the specimen following resection confirmed dysgerminoma originating from right ovary with no invasion or metastasis. The literature is reviewed with regard to the various pathogenetic mechanisms proposed for the development of germ cell tumors in ovary, the cytogenetic findings and recommendations to handle such scenario. PMID:22629515

  2. Ultrasonography and MRI features of the Mayer–Rokitansky–Küster–Hauser syndrome

    International Nuclear Information System (INIS)

    Although Mayer–Rokitansky–Küster–Hauser syndrome is a rare condition with a reported incidence of 1/4500 female live births, it represents the second most common cause of primary amenorrhea and has psychologically devastating consequences. The radiologist plays a pivotal role in both making the accurate initial diagnosis of this condition and assessing findings that may contribute to treatment planning. The purpose of this article is to provide an overview of the capabilities of ultrasound and magnetic resonance imaging (MRI) for the diagnosis and management of this syndrome with emphasis on the relevant clinical and surgical findings and to describe potential associated abnormalities and differential diagnosis

  3. Coexistence of gonadal dysgenesis and Mayer-Rokitansky-Kuster-Hauser syndrome in 46, XX female: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Viral N Shah

    2013-01-01

    Full Text Available The association of gonadal dysgenesis and Mayer-Rokitansky-Kuster-Hauser syndrome is very rare. We report a 21-year-old phenotypical female who presented with primary amenorrhea and underdeveloped secondary sexual characteristics. Hormonal evaluation revealed hypergonadotropic hypogonadism. Her karyotype was 46XX. Laparoscopy of pelvis revealed absent uterus, normal fallopian tubes and bilateral streak ovaries, which were biopsied and histopathology was consistent with the findings of gonadal dysgenesis. We searched PubMed for similar reports in the literature and details of all the cases were analyzed and reported here.

  4. Lack of tumor reduction in hyperprolactinemic women with extrasellar macroadenomas treated with bromocriptine

    International Nuclear Information System (INIS)

    Three patients with hyperprolactinemia and large extrasellar pituitary macroadenomas were treated with bromocriptine, 10 mg daily, for 8 weeks. In spite of correction of their amenorrhea, galactorrhea, and hyperprolactinemia, radiologic evaluation by CT scan failed to show evidence of tumor shrinkage. After surgical resection, histologic examination revealed that PRL-secreting cells comprised only a small portion of the tumor cell population in two patients and in the third patient were completely absent. These cases illustrate that large nonfunctional pituitary tumors may mimic signs and symptoms of a prolactinoma and stress the importance of adequate radiologic evaluation during medical management. 8 references, 3 figures

  5. CT studies in hyperprolactinemia

    International Nuclear Information System (INIS)

    Computerized tomography studies in 62 patients (55 females and 7 males) with hyperprolactinemia are presented. The female patients had secondary amenorrhea and galactorrhea, whereas the male patients suffered from impotency, gynaecomastia and very rarely galactorrhea. In 39 cases CT revealed a pituitary adenoma (prolactinoma), in 14 cases of them microadenoma, as the cause of hormonal and clinical disturbances. In 21 cases an empty sella with rudimentary pituitary surrounded by cerebrospinal fluid or lack of pituitary mass were found. In one case suprasellar and intrasellar calcifications were present. (author)

  6. Hypopituitarism as unusual sequelae to central nervous system tuberculosis

    Directory of Open Access Journals (Sweden)

    S Mageshkumar

    2011-01-01

    Full Text Available Neurological tuberculosis can very rarely involve the hypophysis cerebri. We report a case of an eighteen year old female who presented with five months duration of generalised apathy, secondary amenorrhea and weight gain. She was on irregular treatment for tuberculosis of the central nervous system for the last five months. Neuroimaging revealed sellar and suprasellar tuberculomas and communicating hydrocephalus requiring emergency decompression. Endocrinological investigation showed hypopituitarism manifesting as pituitary hypothyroidism, hypocortisolism, hypogonadotropic hypogonadism, and hyperprolactinemia. Restarting anti-tuberculosis treatment, hormone replacement therapy, and a ventriculo-peritoneal shunt surgery led to remarkable improvement in the general condition of the patient.

  7. A de novo Reciprocal X; 9 Translocation in A Patient with Premature Ovarian Failure

    OpenAIRE

    Faezeh Azizi; Soraya Saleh Gargari; Mir Davood Omrani

    2013-01-01

    Premature ovarian failure (POF) causes hypergonadotrophic amenorrhea in 1-3% of females, occurring before the age of 40 among women with chromosomal rearrangements in the long arm of the X chromosome 'critical region'. In this article, we report a case of POF and primary amenorrheain a girl with a de novo reciprocal translocation between chromosomes X and 9. The proband was a 17 years old girl with a history of irregular menstruation and high level of follicle-stimulating hormone (FSH) (151 m...

  8. The role of zinc in anorexia nervosa: etiology and treatment.

    Science.gov (United States)

    Bakan, R

    1979-07-01

    Zinc deficiency may play a role in the etiology of anorexia nervosa. The symptoms of anorexia nervosa and zinc deficiency are similar in a number of respects, e.g., weight loss, loss of appetite, amenorrhea in females, impotence in males, nausea and skin lesions. In both conditions females under 25 are most at risk. Stress, estrogen and dietary habits may also be involved in the complex of factors which create or exacerbate a zinc deficiency and result in anorexia nervosa. It is proposed that effectiveness in the treatment of anorexia nervosa. PMID:514114

  9. Radiological and orthopedic abnormalities in Satoyoshi syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Haymon, M.L. [Children`s Hospital, New Orleans, LA (United States). Dept. of Radiology; Willis, R.B. [Children`s Hospital, New Orleans, LA (United States). Dept. of Orthopedics; Ehlayel, M.S. [Div. of Genetics, Dept. of Pediatrics, Louisiana State Univ. Medical Center, Orleans, LA (United States)]|[Louisiana State Medical Center, New Orleans, LA (United States). Center for Molecular and Human Genetics; Lacassie, Y. [Div. of Genetics, Dept. of Pediatrics, Louisiana State Univ. Medical Center, Orleans, LA (United States)]|[Louisiana State Medical Center, New Orleans, LA (United States). Center for Molecular and Human Genetics]|[Children`s Hospital, New Orleans, LA (United States). Dept. of Pediatrics

    1997-05-01

    Satoyoshi syndrome is a are disorder on unknown etiology characterized by progressive, painful intermittent muscle spasms, serve skeletal abnormalities mimicking a skeletal dyplasia, malabsorption, alopecia, and amenorrhea. We further report on a 20{sup 1}/{sub 2}-year-old Caucasian woman whith characteristic manifestation of the syndrome. Since the establishment of the diagnostic 1 year ago, she has been treated with prednisone with good response. However, treatment of the multiple deformities and fractures has been difficult and challenging. The early recognition and treatment of this disorder is of utmost importance, as the skeletal deformities and fractures seem to be secondary to the muscular spasms, as suggested by Satoyoshi.

  10. Unusual presentation of lipemia retinalis in pregnancy

    Directory of Open Access Journals (Sweden)

    A M Raja

    2014-01-01

    Full Text Available A 27-year-old female with 6 months amenorrhea and pregnancy induced hypertension was referred from Obstetrics Department for routine fundus examination. Vision and anterior segment were normal. Fundus examination showed media clear and disc normal. Vessels showed yellowish orange in color, becoming more paler toward periphery and no distinction between arteries and veins. On suspecting lipemia retinalis, we advised lipid profile, which showed very high triglyceride levels. The patient was referred to endocrinologist for opinion. Even if it is asymptomatic condition, it should not be ignored and we should advise immediate treatment to prevent cardiovascular complications and fetal anomalies.

  11. Pregnancy in a patient with hypopituitarism following surgery and radiation for a pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Thomas V

    2005-01-01

    Full Text Available This is a case of partial hypopituitarism resulting from surgery and radiation for a non- functioning pituitary macroadenoma. The patient had amenorrhea which was secondary to hypogonadotrophic hypogonadism and had been on L-thyroxine for central hypothyroidism. For pregnancy, ovulation was induced by gonadotrophins and this was followed by an intrauterine insemination. The antenatal period was uneventful and a Caesarean section was done at 33 weeks when the patient presented with preterm labour. Both infant and mother are well, eight months after delivery.

  12. Selective Determinants of Low Bone Mineral Mass in Adult Women with Anorexia Nervosa

    OpenAIRE

    Andrea Trombetti; Laura Richert; François R. Herrmann; Thierry Chevalley; Jean-Daniel Graf; René Rizzoli

    2013-01-01

    We investigated the relative effect of amenorrhea and insulin-like growth factor-I (sIGF-I) levels on cancellous and cortical bone density and size. We investigated 66 adult women with anorexia nervosa. Lumbar spine and proximal femur bone mineral density was measured by DXA. We calculated bone mineral apparent density. Structural geometry of the spine and the hip was determined from DXA images. Weight and BMI, but not height, as well as bone mineral content and density, but not area and geom...

  13. Dysgerminoma in a case of 46, XY pure gonadal dysgenesis (swyer syndrome: a case report

    Directory of Open Access Journals (Sweden)

    He Anguang

    2011-09-01

    Full Text Available Abstract Simple 46, XY gonadal dysgenesis syndrome, also called Swyer syndrome, is known as pure gonadal dysgenesis. Individuals with the syndrome are characterized by 46, XY karyotype and phenotypically female with female genital appearance, normal Müllerian structures and absent testicular tissue. The condition usually first becomes apparent in adolescence with delayed puberty and primary amenorrhea due to the gonads have no hormonal or reproductive potential. Herein, we report a case of dysgerminoma diagnosed in a dysgenetic gonad of a 21-year-old patient with Swyer syndrome.

  14. Pseudocyesis in a non-infertile Indian woman: a case report

    Directory of Open Access Journals (Sweden)

    Priyajyoti Chakma

    2016-01-01

    Full Text Available Pseudocyesis, seen in non-psychotic woman without true gestation, is a common event in developing countries. Pseudocyesis results from multidimensional factors. Our case was a 46 years, Hindu, married, literate, non-infertile woman of middle socioeconomic status, from urban part of Tripura, India. She presented with amenorrhea, distended abdomen, and breast engorgement. Diagnosis of pseudocyesis was made, and further sessions with the husband and wife were carried out. She was managed with supportive psychotherapy and low dose of clonazepam.

  15. A Case with 46,XX,dup(X(q21.3q24 karyotype

    Directory of Open Access Journals (Sweden)

    Selda Şimşek

    2010-03-01

    Full Text Available The relationship between phenotype and Xq duplicationsin females remains unclear. Some females are normal;some have short stature; and others have features suchas microcephaly, developmental delay/mental retardation,body asymmetries, and gonadal dysgenesis. Somefeatures in these females resemble those in Turner syndrome.We, herein, presented a 15 years-old girl withshort stature and primary amenorrhea, who was referredto cytogenetic laboratory. Through karyotipe analysis performedby Giemsa banding technique, the patient wasdetermined to have positive Barr body and 46,XX,dup(X(q21.3q24 chromosomal constitution. Case was discussedaccording to information of present literatures.

  16. Heterophilic antibodies interfering with radioimmunoassay. A false-positive pregnancy test

    International Nuclear Information System (INIS)

    A young woman with amenorrhea had a consistently positive pregnancy test result (serum radioimmunoassay measurement of #betta#-human chorionic gonadotropin hormone). No fetal or placental tissue was found after uterine curettage and exploratory laparotomy. The false-positive pregnancy test result was due to heterophilic antibovine and antigoat antibodies in the patient's serum. These antibodies interfered with radioimmunoassays using goat antibodies. This case shows that serum heterophilic antibodies can interfere with immunoassays and result in unnecessary diagnostic procedures and/or unnecessary treatment

  17. Congenital pouch colon in a girl associated with bilateral atresia of cervix uteri and uterus didelphys.

    Science.gov (United States)

    Chadha, Rajiv; Puri, Manju; Saxena, Rahul; Agarwala, Surendrakumar; Puri, Archana; Choudhury, Subhasis Roy

    2013-04-01

    This report describes a girl with congenital pouch colon (CPC), uterus didelphys with septate vagina, and a cloacal anomaly. The girl underwent cloacal reconstruction at the age of 15 months. Subsequently, at puberty, the child had primary amenorrhea with severe cyclic abdominal pain due to endometriosis of both the uteruses and adnexal cysts with hematometra and hematosalpinx. Laparotomy with removal of both uteri and the left fallopian tube was performed. Both uteri had atresia of the cervix uteri. This report emphasizes the need for comprehensive evaluation and a long-term management strategy for associated gynecologic anomalies in girls with CPC, especially with regard to patency of the outflow tract. PMID:23798813

  18. Is radiation-induced ovarian ablation in breast cancer an obsolete procedure? Results of a meta-analysis

    Science.gov (United States)

    Asiri, Mushabbab Al; Tunio, Mutahir A; Abdulmoniem, Reham

    2016-01-01

    Background A meta-analysis was conducted to assess the impact of radiation-induced ovarian ablation (RT-OA) on amenorrhea cessation rates, progression-free survival, and overall survival in pre/perimenopausal women with breast cancer. Materials and methods The Medline, CANCERLIT, and Cochrane Library databases and search engines were searched to identify randomized controlled studies comparing RT-OA with control for early or metastatic breast cancer. Further, radiotherapy doses, techniques, and associated side effects were evaluated. Results Six controlled trials with a total patient population of 3,317 were identified. Pooled results from these trials showed significant amenorrhea rates (Pwomen with metastatic breast cancer, or if luteinizing hormone-releasing hormone analogs are contraindicated, or in patients in whom fertility preservation is not an issue. Radiation dose of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions showed more efficacies. However, further studies incorporating three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are warranted. PMID:27307764

  19. Cytogenetic evaluation of patients with clinical spectrum of Turner syndrome

    Science.gov (United States)

    Moka, Rajasekhar; Sreelakshmi, Kodandapani; Gopinath, Puthiya Mundyat; Satyamoorthy, Kapettu

    2013-01-01

    AIM: The objective of this study was to correlate the genotype, of female patients, withshort stature and primary amenorrhea. MATERIALS AND METHODS: One hundred and forty-six subjects were recruited during 2005-2012. Microscopic and automated karyotyping analyses were done by using chromosomes isolated from the lymphocytes using Giemsa banding (GTG) to identify chromosome abnormalities. RESULTS: A total of 146 clinically suspected Turner syndrome (TS) subjects were recruited for the study, of which, 61 patients were identified to have chromosome abnormalities. The chromosomal abnormalities detected were as follows: Monosomy X (n = 19, 13.01%), triple X syndrome (n = 4, 2.7%), mosaic TS (n = 12, 8.21%), XY gonadal dysgenesis (n = 13, 8.9%), and structural abnormalities including X chromosome (n = 15, 10.27%) and one patient each with autosomal changes involving 9qh inversion and translocation of chromosomes 12 and 14. CONCLUSION: Karyotype abnormalities accounting for 46% in this study emphasize the need for karyotype testing in cases of short stature with primary amenorrhea. PMID:24082654

  20. Metabolic fuel and clinical implications for female reproduction.

    Science.gov (United States)

    Mircea, Carmen N; Lujan, Marla E; Pierson, Roger A

    2007-11-01

    Reproduction is a physiologically costly process that consumes significant amounts of energy. The physiological mechanisms controlling energy balance are closely linked to fertility. This close relationship ensures that pregnancy and lactation occur only in favourable conditions with respect to energy. The primary metabolic cue that modulates reproduction is the availability of oxidizable fuel. An organism's metabolic status is transmitted to the brain through metabolic fuel detectors. There are many of these detectors at both the peripheral (e.g., leptin, insulin, ghrelin) and central (e.g., neuropeptide Y, melanocortin, orexins) levels. When oxidizable fuel is scarce, the detectors function to inhibit the release of gonadotropin-releasing hormone and luteinizing hormone, thereby altering steroidogenesis, reproductive cyclicity, and sexual behaviour. Infertility can also result when resources are abundant but food intake fails to compensate for increased energy demands. Examples of these conditions in women include anorexia nervosa and exercise-induced amenorrhea. Infertility associated with obesity appears to be less related to an effect of oxidizable fuel on the hypothalamic-pituitary-ovarian axis. Impaired insulin sensitivity may play a role in the etiology of these conditions, but their specific etiology remains unresolved. Research into the metabolic regulation of reproductive function has implications for elucidating mechanisms of impaired pubertal development, nutritional amenorrhea, and obesity-related infertility. A better understanding of these etiologies has far-reaching implications for the prevention and management of reproductive dysfunction and its associated comorbidities. PMID:17977492

  1. Chromosome territories, X;Y translocation and Premature Ovarian Failure: is there a relationship?

    Directory of Open Access Journals (Sweden)

    Betri Enrico

    2009-09-01

    Full Text Available Abstract Background Premature ovarian failure (POF is a secondary hypergonadotrophic amenorrhea occurring before the age of 40 and affecting 1-3% of females. Chromosome anomalies account for 6-8% of POF cases, but only few cases are associated with translocations involving X and Y chromosomes. This study shows the cytogenetic and molecular analysis of a POF patient came to our attention as she developed a left ovary choriocarcinoma at the age of 10 and at 14 years of age she presented secondary amenorrhea with elevated levels of gonadotropins. Results Breakpoint position on X and Y chromosomes was investigated using Fluorescent In Situ Hybridisation (FISH with a panel of specific BAC probes, microsatellite analysis and evaluation of copy number changes and loss of heterozigosity by Affymetrix® GeneChip platform (Santa Clara, CA, USA. Patient's karyotype resulted 46, X, der(Yt(X;Y(q13.1;q11.223. X inactivation study was assessed by RBA banding and showed preferential inactivation of derivative chromosome. The reciprocal spatial disposition of sexual chromosome territories was investigated using whole chromosome painting and centromeres probes: patient's results didn't show a significant difference in comparison to normal controls. Conclusion The peculiar clinical case come to our attention highlighted the complexity of POF aetiology and of the translocation event, even if our results seem to exclude any effect on nuclear organisation. POF phenotype could be partially explained by skewed X chromosome inactivation that influences gene expression.

  2. Congenital malformation of fetus in a pregnancy following spontaneous ovulation in a case of premature ovarian failure

    Directory of Open Access Journals (Sweden)

    Priya Selvaraj

    2010-01-01

    Full Text Available Premature ovarian failure (POF, that is, amenorrhea before 40 years of age can be attributed to a variety of etiologies. Approximately 1% of women before 30 years are diagnosed with POF. Spontaneous ovulation leading to pregnancy in POF is even a rarer entity. We report a case where congenital malformations were diagnosed in a fetus following spontaneous ovulation in a case of POF. A 33-year-old woman presented to our center with primary infertility. On complete work up, she was diagnosed with POF and conceived with hormone replacement therapy and donor oocyte program. She delivered a healthy female baby through caesarean section. The patient reviewed later with amenorrhea of 40 days and pregnancy was confirmed. However, during antenatal follow-up congenital anomalies in fetus were diagnosed sonographically. The decision for termination of pregnancy was taken. To conclude, we recommend large-scale retrospective analysis that would define medical guidelines in cases of pregnancy following spontaneous ovulation in POF.

  3. The young female athlete.

    Science.gov (United States)

    Hurvitz, Michal; Weiss, Ram

    2009-12-01

    Participation of adolescents and young women in strenuous sports activity may lead to various metabolic and psychological derangements of clinical relevance to the endocrinologist. The most common manifestations encountered in practice are primary and secondary amenorrhea, reduced bone mineral density and eating disorders. The occurrence of all three together has been named "the athletic triad". The underlying hormonal drivers that lead to some of these manifestations are the reduced leptin level as well as the persistent low grade stress response commonly observed in such females. "Exercise-related female reproductive dysfunction" (ERFRD), can possibly include short-term (infertility) and long-term (osteoporosis) consequences. Functional hypothalamic amenorrhea, a manifestation of ERFRD in adolescence, is an integrated response to the combination of excessive physical and emotional stress, exercise, and/or reduced food intake characterized by decreased endogenous GNRH secretion. The primary aim of treating these athletes should be the prevention of the development of any component of the triad as well as the whole complex by educating athletes, trainers, parents and health care professionals about proper nutrition and safe training. The long term prognosis is good. However, significant long term morbidity may affect these young women later in life. PMID:20118893

  4. Body Composition, Hemodynamic and Biochemical Parameters in Young Female Normal-Weight Oligo-amenorrheic and Eumenorrheic Athletes and Non-athletes

    Science.gov (United States)

    Singhal, Vibha; de Lourdes Eguiguren, Maria; Eysenbach, Lindsey; Clarke, Hannah; Slattery, Meghan; Eddy, Kamryn; Ackerman, Kathryn E.; Misra, Madhusmita

    2014-01-01

    Aims Low-weight hypogonadal conditions such as anorexia nervosa are associated with marked changes in body composition, hemodynamic and hematological parameters, and liver enzymes. The impact of athletic activity in normal-weight adolescents with/without amenorrhea on these parameters has not been assessed. Our aim was to examine these parameters in normal-weight athletes and non-athletes and determine any associations of body composition, oligo-amenorrhea and exercise intensity. Methods We assessed vital signs, complete blood counts, liver enzymes, and regional body composition in 43 oligo-amenorrheic athletes (OAA), 24 eumenorrheic athletes (EA) and 23 non-athletes 14-21 years of age. Results BMI was lower in OAA than EA. Systolic and pulse pressure, and temperature were lowest in OAA. Blood counts did not differ among groups. AST was higher in both groups of athletes, while ALT was higher in OAA than EA and non-athletes. Total and regional fat was lower in OAA than other groups, positively associated with heart rate and inversely with liver enzymes. Conclusions Athletic activity is associated with higher AST, whereas menstrual dysfunction is associated with lower total and regional fat and higher ALT. Higher liver enzymes are associated with reductions in total and regional fat. PMID:25376841

  5. Functional hypothalamic amenorrhoea — diagnostic challenges, monitoring, and treatment.

    Science.gov (United States)

    Sowińska-Przepiera, Elżbieta; Andrysiak-Mamos, Elżbieta; Jarząbek-Bielecka, Grażyna; Walkowiak, Aleksandra; Osowicz-Korolonek, Lilianna; Syrenicz, Małgorzata; Kędzia, Witold; Syrenicz, Anhelli

    2015-01-01

    Functional hypothalamic amenorrhoea (FHA) is associated with functional inhibition of the hypothalamic-pituitary-ovarian axis. Causes of FHA can be classified into the three groups: 1) stress-related factors, 2) consequences of weight loss and/or underweight, and 3) consequences of physical exercise or practicing sports. Diagnosis of FHA should be based on a history of menstrual disorders. During physical examination, patients with FHA present with secondary and tertiary sex characteristics specific for the pubertal stage preceding development of the condition and with the signs of hypoestrogenism. Laboratory results determine further management of patients with amenorrhea, and thus their correct interpretation is vital for making appropriate therapeutic decisions. Treatment of chronic anovulation, menstrual disorders, and secondary amenorrhea resulting from hypothalamic disorders should be aimed at the elimination of the primary cause, i.e. a decrease in psycho-emotional strain, avoidance of chronic stressors, reduction of physical exercise level, or optimisation of BMI in patients who lose weight. If menses do not resume after a period of six months or primary causative treatment is not possible, neutralisation of hypoestrogenism consequences, especially unfavourable effects on bone metabolism, become the main issue. Previous studies have shown that oestroprogestagen therapy is useful in both the treatment of menstrual disorders and normalisation of bone mineral density. Hormonal preparations should be introduced into therapeutic protocol on an individualised basis. PMID:26136135

  6. Collagen type I alpha 1 gene polymorphism in premature ovarian failure

    Directory of Open Access Journals (Sweden)

    Vujović Svetlana

    2013-01-01

    Full Text Available Introduction. Premature ovarian failure (POF is characterized by amenorrhea, hypergonadotropism and hypoestrogenism in women bellow 40 years. Osteoporosis is one of the late complications of POF. Objective. To correlate collagen type I alpha1 (COLIA1 gene polymorphism with bone mineral density (BMD in women with POF. Methods. We determined the COLIA1 genotypes SS, Ss, ss in 66 women with POF. Single nucleotide polymorphism (G to T substitution within the Sp 1-binding site in the first intron of the COLIA1 gene was assessed by polymerase chain reaction (PCR followed by single-stranded conformation polymorphism (SSCP analysis. Bone mineral density (BMD was measured at the lumbar spine region by dual X-ray absorptiometry. Statistics: Kruskal-Wallis ANOVA, Chisquare test, Spearman correlation test. Results. The relative distribution of COLIA1 genotype alleles was SS - 54.4%, Ss - 41.0% and ss - 4.5%. No significant differences were found between genotype groups in body mass index, age, duration of amenorrhea or BMD. A significant positive correlation was observed between BMI and parity. Conclusion. The COLIA1 gene is just one of many genes influencing bone characteristics. It may act as a marker for differences in bone quantity and quality, bone fragility and accelerated bone loss in older women. However, in young women with POF, COLIA1 cannot identify those at higher risk for osteoporosis. [Projekat Ministarstva nauke Republike Srbije, br. ON 173056

  7. Homozygous Inactivating Mutation in NANOS3 in Two Sisters with Primary Ovarian Insufficiency

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    Mariza G. Santos

    2014-01-01

    Full Text Available Despite the increasing understanding of female reproduction, the molecular diagnosis of primary ovarian insufficiency (POI is seldom obtained. The RNA-binding protein NANOS3 poses as an interesting candidate gene for POI since members of the Nanos family have an evolutionarily conserved function in germ cell development and maintenance by repressing apoptosis. We performed mutational analysis of NANOS3 in a cohort of 85 Brazilian women with familial or isolated POI, presenting with primary or secondary amenorrhea, and in ethnically-matched control women. A homozygous p.Glu120Lys mutation in NANOS3 was identified in two sisters with primary amenorrhea. The substituted amino acid is located within the second C2HC motif in the conserved zinc finger domain of NANOS3 and in silico molecular modelling suggests destabilization of protein-RNA interaction. In vitro analyses of apoptosis through flow cytometry and confocal microscopy show that NANOS3 capacity to prevent apoptosis was impaired by this mutation. The identification of an inactivating missense mutation in NANOS3 suggests a mechanism for POI involving increased primordial germ cells (PGCs apoptosis during embryonic cell migration and highlights the importance of NANOS proteins in human ovarian biology.

  8. Hyperprolactinemia

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    Abha Majumdar

    2013-01-01

    Full Text Available Prolactin (PRL is an anterior pituitary hormone which has its principle physiological action in initiation and maintenance of lactation. In human reproduction, pathological hyperprolactinemia most commonly presents as an ovulatory disorder and is often associated with secondary amenorrhea or oligomenorrhea. Galactorrhea, a typical symptom of hyperprolactinemia, occurs in less than half the cases. Out of the causes of hyperprolactinemia, pituitary tumors may be responsible for almost 50% of cases and need to be investigated especially in the absence of history of drug induced hyperprolactinemia. In women with hyperprolactinemic amenorrhea one important consequence of estrogen deficiency is osteoporosis, which deserves specific therapeutic consideration. Problem in diagnosing and treating hyperprolactinemia is the occurrence of the ′big big molecule of prolactin′ that is biologically inactive (called macroprolactinemia, but detected by the same radioimmunoassay as the biologically active prolactin. This may explain many cases of very high prolactin levels sometimes found in normally ovulating women and do not require any treatment. Dopamine agonist is the mainstay of treatment. However, presence of a pituitary macroadenoma may require surgical or radiological management.

  9. Reduced bone density and major hormones regulating calcium metabolism in anorexia nervosa.

    Science.gov (United States)

    Kiriike, N; Iketani, T; Nakanishi, S; Nagata, T; Inoue, K; Okuno, M; Ochi, H; Kawakita, Y

    1992-11-01

    Bone density of lumbar vertebrae (L2 to L4) and the whole body in 29 patients with anorexia nervosa were measured by dual photon absorptiometry, and the results were compared with those of 10 age-matched normal controls. The patients had significantly lower bone mineral density (BMD) in L3 and L2-4 than controls. However, there was no difference in whole-body BMD. L3 and L2-4 BMD was positively correlated with body weight and was negatively correlated with duration of illness and amenorrhea. Patients who had been more active 6 months before the time of the study had significantly higher L3 BMD than the less active patients. Most patients had an abnormally low serum estrogen level, whereas the mean serum levels of thyroid hormone (T3, T4), cortisol, calcitonin, parathyroid hormone and vitamin D were within the normal range. No correlation was found between L3 or L2-4 BMD and the levels of these hormones. These results suggest that severe weight loss, low physical activity, longer duration of amenorrhea and deficiency of estrogen contribute to bone loss in patients with anorexia nervosa, whereas calcium-regulating hormones such as parathyroid hormone, calcitonin and vitamin D are unlikely to be a primary contributor to bone loss. PMID:1485525

  10. RECOVERY OF BONE MINERAL DENSITY AND FERTILITY IN A FORMER AMENORRHEIC ATHLETE

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    Karen Hind

    2008-09-01

    Full Text Available Inadequate dietary intake and prolonged amenorrhea in women athletes can lead to bone loss, particularly at the spine, which may be irreversible. This report presents the case of a woman endurance runner, followed prospectively over 6 years after presenting with the female athlete triad. Bone mineral density (BMD and body composition were assessed by dual-energy X-ray absorptiometry. At baseline, lumbar spine (LS, total hip and total body (TB BMD Z-scores were -2.2, -0.5 and -0.3 respectively. At 6 years, following a recovery plan of cognitive behavioural therapy (CBT, weight gain, improved dietary intake and reduced training load, the athlete regained menstrual function and BMD. LS, TB and hip BMD Z-scores improved to -0.6, -0.1 and 0.1 respectively. Restoration of fertility was indicated by pregnancy, following only 4 months of regular menstruation. This case report suggests that bone density and fertility may not be completely jeopardised in formerly amenorrheic and osteopenic athletes, providing recovery through diet, weight gain, and return of menstruation is achieved within the third decade. Longitudinal studies tracking bone changes in women with amenorrhea and low BMD are required and would have important implications for the treatment of the female athlete triad

  11. Uterine morphology and peristalsis in women with polycystic ovary syndrome

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    Leonhardt, Henrik; Hellstroem, Mikael [Department of Radiology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg (Sweden)], E-mail: henrik.leonhardt@vgregion.se; Gull, Berit; Nilsson, Lars; Janson, Per O. [Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg (Sweden); Kishimoto, Keiko [Department of Radiology, St Marianna University School of Medicine, Kanagawa (Japan); Kataoka, Masako [Department of Radiology, Kyoto University Hospital, Kyoto (Japan); Stener-Victorin, Elisabet [Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg (Sweden)

    2012-12-15

    Background. Polycystic ovary syndrome (PCOS) is associated with chronic oligo-anovulation and high circulating sex hormone levels. Women with PCOS have an increased risk of developing endometrial cancer. In anovulatory women with PCOS a positive relationship between endometrial thickness and endometrial hyperplasia has been observed. Uterine peristalsis, which has been suggested to be of importance for female fertility, has not previously been studied in PCOS. Purpose. To assess whether women with PCOS have altered endometrial thickness, uterine wall morphology, and peristalsis. Material and Methods. In this prospective case-control study 55 women with PCOS (mean age, 29.5 years {+-} 4.5 SD) and 28 controls (27.6 {+-} 3.2) were examined using magnetic resonance imaging (MRI), assessing thickness of endometrium, junctional zone (JZ), and myometrium, and evaluating the occurrence, frequency (waves/min), strength (amplitude), pattern, and direction of peristalsis. Uterine morphology was also assessed by transvaginal ultrasonography (TVUS). Results. The endometrium was thinner in PCOS with oligo-amenorrhea compared to controls, also after adjustments for age and BMI (adjusted P = 0.043). There was no difference in thickness of the JZ or the myometrium in cases versus controls. Uterine peristalsis was less commonly observed in women with PCOS than in controls (adjusted P = 0.014). Conclusion. There were no differences in myometrial morphology between PCOS and controls, but the endometrium was thinner in PCOS with oligo-amenorrhea. Based on cine MRI, uterine peristalsis was less common in PCOS than in controls.

  12. Rare case of leiomyoma in Mayer-Rokitansky-Kuster-Hauser syndrome

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    Sonal A. Bhuyar

    2014-04-01

    Full Text Available Mayer-Rokitansky-Kuster-Hauser (MRKH syndrome is a cause for primary amenorrhea. It is characterized by the presence of XX karyotype, normal ovarian function and blind vaginal pouch. The uterus is usually represented by bilateral rudimentary primordia. Presence of functioning endometrial tissue may lead to development of hematometra in one or both primordia. Rarely myomas, neoplasms and adenomyosis can develop in the rudimentary bulbs. MRKH syndrome is frequently associated with urologic and skeletal abnormalities. In this case, a 45 year old patient presented with primary amenorrhea and lower abdominal pain. On examination, she had a blind vaginal pouch and a pelvic mass. She was investigated and taken for laparotomy with a provisional diagnosis of hematometra or ovarian tumor. The mass turned out to be leiomyoma in one of the rudimentary bulbs which was confirmed on histopathology. Our patient had vertebral abnormalities too. The incidence of MRKH syndrome is less and its association with pelvic tumor is even rarer. Hence this case is reported. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 488-490

  13. Uterine morphology and peristalsis in women with polycystic ovary syndrome

    International Nuclear Information System (INIS)

    Background. Polycystic ovary syndrome (PCOS) is associated with chronic oligo-anovulation and high circulating sex hormone levels. Women with PCOS have an increased risk of developing endometrial cancer. In anovulatory women with PCOS a positive relationship between endometrial thickness and endometrial hyperplasia has been observed. Uterine peristalsis, which has been suggested to be of importance for female fertility, has not previously been studied in PCOS. Purpose. To assess whether women with PCOS have altered endometrial thickness, uterine wall morphology, and peristalsis. Material and Methods. In this prospective case-control study 55 women with PCOS (mean age, 29.5 years ± 4.5 SD) and 28 controls (27.6 ± 3.2) were examined using magnetic resonance imaging (MRI), assessing thickness of endometrium, junctional zone (JZ), and myometrium, and evaluating the occurrence, frequency (waves/min), strength (amplitude), pattern, and direction of peristalsis. Uterine morphology was also assessed by transvaginal ultrasonography (TVUS). Results. The endometrium was thinner in PCOS with oligo-amenorrhea compared to controls, also after adjustments for age and BMI (adjusted P = 0.043). There was no difference in thickness of the JZ or the myometrium in cases versus controls. Uterine peristalsis was less commonly observed in women with PCOS than in controls (adjusted P = 0.014). Conclusion. There were no differences in myometrial morphology between PCOS and controls, but the endometrium was thinner in PCOS with oligo-amenorrhea. Based on cine MRI, uterine peristalsis was less common in PCOS than in controls

  14. Breast cancer in young women. Retrospective analysis of a population of 38 patients

    International Nuclear Information System (INIS)

    Introduction. There is no uniform definition of breast cancer (B C) in young women, but all authors agree to consider under 50 years. While 25% of cancers are diagnosed in premenopausal women, only 0.5% of patients (pts) is less than 40 years. These figures by themselves demonstrate the relevance of the topic. Methods. Clinical cases of 38 pts with CM diagnosed in less than 41 years were reviewed. The information recorded was age at diagnosis, reason for consultation, the consultation time from first symptoms, time to diagnosis, family history (A F), stage, histological type, hormone receptor status: estrogen (E R) and progesterone (P R) surgical treatment: modified radical mastectomy (MR M) or conservative surgery (C S), adjuvant treatment: radiotherapy (R T), chemotherapy (CT), hormone therapy (H T), clinical status at the time of last access, or no induction of amenorrhea and treatment received in patients who relapsed. Results. 42 cases of CM, corresponding to 38 pts were analyzed. 4 pts had a bilateral metácrono CM. The median age at diagnosis was 32 years (range 24-40). The consultation in 20 cases was early, and late on 5 pts (after year). The diagnosis was established in the first 3 months from the consultation in 23 cases and in 7 the diagnosis was established after 6 months (range 0-36). 29 pts debuted in early stages (I and II). 15 pts had A F CM. All but two cases corresponded to infiltrating ductal carcinomas NOS. In 24 cases the surgical treatment consisted of MR M in 15 C C, and one simple mastectomy. In two cases, no surgery was performed. 39 axillary dissections were performed. The average number of lymph nodes removed was 25 had a 16 (average 6.7 nodes involved) positive axilla. Adjuvant chemotherapy received 36 pts, additional adjuvant R T and H T 29 21 pts. 20 cases were E R and P R positive, 4 cases only E R or P R positive, 8 cases were E R and P R negative and in 10 the status was unknown. Developed amenorrhea 4 sts, 2 received adjuvant

  15. Is radiation-induced ovarian ablation in breast cancer an obsolete procedure? Results of a meta-analysis

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    Al Asiri M

    2016-05-01

    Full Text Available Mushabbab Al Asiri,1,* Mutahir A Tunio,1,* Reham Abdulmoniem,2,*1Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 2Radiation Oncology, National Cancer Institute, Cairo, Egypt *These authors contributed equally to this work Background: A meta-analysis was conducted to assess the impact of radiation-induced ovarian ablation (RT-OA on amenorrhea cessation rates, progression-free survival, and overall survival in pre/perimenopausal women with breast cancer. Materials and methods: The Medline, CANCERLIT, and Cochrane Library databases and search engines were searched to identify randomized controlled studies comparing RT-OA with control for early or metastatic breast cancer. Further, radiotherapy doses, techniques, and associated side effects were evaluated. Results: Six controlled trials with a total patient population of 3,317 were identified. Pooled results from these trials showed significant amenorrhea rates (P<0.00001 and increase in progression-free survival in patients treated with RT-OA (P<0.00001. However, there was no difference in overall survival (P=0.37. The majority of patients were treated with larger field sizes with parallel-opposed anteroposterior and posteroanterior pelvic fields. RT-OA was generally well tolerated. Radiotherapy doses of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions were associated with excellent amenorrhea rates. The resultant funnel plot showed no publication bias (Egger test P=0.16. Conclusion: RT-OA is cost-effective and can safely be used in pre/perimenopausal women with metastatic breast cancer, or if luteinizing hormone-releasing hormone analogs are contraindicated, or in patients in whom fertility preservation is not an issue. Radiation dose of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions showed more efficacies

  16. Turner syndrome: contemporary thoughts and reproductive issues.

    Science.gov (United States)

    Reindollar, Richard H

    2011-07-01

    Turner syndrome is a common genetic disorder that has been classically associated with a 45,X karyotype. Several X-chromosomal abnormalities have been identified in these patients, many of which involve mosaicism. These patients have variable but predictable phenotypic findings and are at risk for development of endocrine, autoimmune, and structural abnormalities. As many as 1.5% of the population with Turner syndrome may develop dissection and rupture of the ascending aorta; the presence of abnormalities of the cardiac tree and hypertension increase this risk, but their absence does not preclude it. Rupture has occurred at aortic diameters smaller than previously reported for other patient populations. Five percent or more of women with Turner syndrome may have abbreviated menstrual function before developing amenorrhea and hypergonadotropic hypogonadism. An estimated 1 to 2% of all patients may become pregnant. Only three patients with Turner syndrome (and two of them with streak ovaries) have ever been reported to become pregnant after developing amenorrhea and elevated gonadotropin levels. Pregnancy, either spontaneous or more commonly from donor oocyte, increases maternal mortality rate for these women by an estimated ≥100 fold. It appears that all Turner women are at risk of rupture; neither prior spontaneous menses nor age >30 years provides protection. In addition, the literature suggests that the physiological changes of pregnancy may increase the risk of rupture in future years after delivery for those Turner women who seemingly made it safely through pregnancy. The use of the term PRIMARY OVARIAN INSUFFICIENCY (POI) for Turner syndrome gives me some discomfort. For women with 46,XX hypergonadotropic hypogonadism, POI accurately provides the suggestion that follicular depletion is often not complete (although remissions are usually self-limiting and the vast majority of patients will not spontaneously become pregnant). I clearly understand the need to

  17. Concomitant Cushing's Disease and Marked Hyperprolactinemia: Response to a Dopamine Receptor Agonist.

    Science.gov (United States)

    Shiraishi, Jun; Koyama, Hidenori; Shirakawa, Manabu; Ishikura, Reiichi; Okazaki, Hirokazu; Kurajoh, Masafumi; Shoji, Takuhito; Moriwaki, Yuji; Yamamoto, Tetsuya; Namba, Mitsuyoshi

    2016-01-01

    A 38-year-old woman was admitted to our hospital because of amenorrhea, multiple bone fractures, and a Cushingoid appearance. Endocrinological investigations revealed that she had co-existing Cushing's disease and prolactinoma, with a serum level of prolactin (PRL) at 1,480 ng/mL, corticotropin (ACTH) at 81.3 pg/mL, and cortisol at 16.6 μg/dL. Due to the lack of indication for transsphenoidal surgery, cabergoline monotherapy was initiated. A 6-month course of treatment resulted in only subtle amelioration of hypercortisolism, while hyperprolactinemia was dramatically improved. In 5 cases of bihormonal (ACTH/PRL) pituitary macroadenoma reported in the English literature, 2 were initially treated with dopaminergic agonists with substantial effectiveness for both PRL and ACTH. We herein report an extremely rare case of bihormonal macroadenoma in which only PRL was responsive to treatment. PMID:27086808

  18. Endometrioid Endometrial Carcinoma Indirectly Caused by Pituitary Prolactinoma:A Case Report

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    Kimihiro Nishino

    2013-01-01

    Full Text Available We present the case of a 44-year-old nulliparous woman who experienced irregular menstrual cycles for about 10 years and developed both pituitary prolactinoma and endometrioid endometrial carcinoma. In premenopausal women, hyperprolactinemia causes hypogonadism by inhibiting secretion of gonadotropin-releasing hormone and thus suppressing luteinizing hormone levels, which can cause menstrual disorders ranging from amenorrhea, oligomenorrhea and chronic anovulatory cycle to short luteal phase of the menstrual cycle. A chronic anovulatory menstrual cycle is the most common cause of long-term exposure of the endometrium to endogenous estrogen without adequate opposition from progestins, which can lead to endometrioid endometrial carcinoma. In this case, pituitary prolactinoma may have caused the chronic anovulatory cycle and indirectly led to the endometrioid endometrial carcinoma. In patients for whom the cause of irregular menstruation and chronic anovulatory cycle is suspected to be hyperprolactinemia, explorations of both the hypophysis and endometrium are essential.

  19. Evaluation on the safety of transcatheter uterine artery embolization for uterine myoma

    International Nuclear Information System (INIS)

    Objective: To observe complications of transcatheter uterine artery embolization (TUAE) for uterine fibroids and to evaluate its long-term safety. Methods: One hundred and ninety-eight women with uterine fibroids were treated by TUAE. The bilateral TUAE were performed using lipiodol-pingyangmycineemulsion (LPE) and gelatin sponge particles in 186 women. Among them, 138 patients were followed up for 1 to 3 year and complications were observed. Results: Complications included ecchymosis and ulceration on buttock (n=1); ulcer of labia minora (n=1); urinary retention (n=12); urinary tract infection (n=1); expelling of necrotic fibroids via vagina (n=5); secondary infection of chocolate cyst of ovary (n=1); increasing in endometrial thickness and calcification (n=1) and amenorrhea (n=2). Conclusion: TUAE is a treatment with long-term safety, while severe complications or sequelae may occur to a few patients, so strict indication should be insisted in patient selection. (authors)

  20. Mayer-Rokitansky-Küster-Hauser Syndrome with Alopecia: A Rare Case Report with Review of Literature.

    Science.gov (United States)

    Choudhary, Sanjiv V; Choudhari, Uday V

    2016-01-01

    A 17-year-old girl presented with alopecia involving lateral margins of the scalp with primary amenorrhea. There was no history of parental consanguinity, and no other siblings were having similar complaints. Her secondary sexual characters were well developed with hypoplastic vagina. Histopathological findings from scalp biopsy showed features of alopecia areata. Ultrasonography of abdomen and pelvis revealed the absence of uterus and the right kidney. Follicle-stimulating hormone, luteinizing hormone, estradiol, testosterone, and thyroid function test was within normal limits. The patient had normal 46, XX Karyotype. Till date, only four case reports of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with alopecia has been reported. We are reporting the first case of MRKH syndrome with alopecia with normal gonadal function in world's literature. PMID:27625567

  1. Postpartum Vaginal Stenosis Due to Chemical Vaginitis.

    Science.gov (United States)

    Kaur, Gurcharan; Sinha, Maruti; Gupta, Ridhima

    2016-05-01

    Acquired vaginal stenosis is a rare obstructing anomaly, which can be caused by use of chemicals in the vagina. A 21-year-old gravida 1 para 1, presented with secondary amenorrhea and inability to have sexual intercourse, after normal spontaneous vaginal delivery complicated by post partum bleeding. The delivery was conducted by untrained traditional birth attendant at home. The wash cloth soaked with caustic soda was packed in the patient's vagina and was left in situ for 10 days, which ultimately led to the severe scarring and stenosis of the vagina. Patient underwent surgical management and the extensive vaginal adhesions were excised and a patent vagina was reconstructed. Patient then reported successful vaginal intercourse without dyspareunia. Post partum vaginal stenosis due to chemical vaginitis is rare. These cases can be prevented by adequate training of untrained health care workers. PMID:27437311

  2. Fine-needle aspiration cytology of ovarian steroid cell tumor: A rare case report.

    Science.gov (United States)

    Agrawal, Nidhi; Vardhan, Harsh; Khokhar, Singh; Rai, Naresh; Saxena, Rajeev; Riyaz, Shahida

    2015-01-01

    Steroid cell tumors (SCTs) of the ovary are a rare subgroup of sex cord tumors that account for less than 0.1% of all ovarian tumors. These tumors can produce steroids, especially testosterone, which produces symptoms such as hirsutism, amenorrhea/oligomenorrhea, and male patterned voice. For evaluation of the androgen excess, testosterone and dehydroepiandrosterone sulfate (DHEA-S) are the first laboratory tests to be measured. Abdominal ultrasound and magnetic resonance imaging (MRI) are useful radiologic imaging techniques. Although SCTs are generally benign, the risk of malignant transformation is always present. Surgical excision of tumor is the most important and hallmark treatment. The present case signifies the early preoperative diagnosis of a virilizing SCT, based on cytological features and its careful correlation with clinicopathological and radiological findings. PMID:26811582

  3. Steroid Cell Tumor of the Ovary in an Adolescent: A Rare Case Report

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    Gokhan Boyraz

    2013-01-01

    Full Text Available Steroid cell tumors (SCTs of the ovary are a rare subgroup of sex cord tumors, account for less than 0.1% of all ovarian tumors, and also will present at any age. These tumors can produce steroids, especially testosterone, and may give symptoms like hirsutism, hair loss, amenorrhea, or oligomenorrhea. For the evaluation of androgen excess, testosterone and dehydroepiandrosterone sulfate (DHEA-S are the first laboratory tests to be measured. A pelvic ultrasound and a magnetic resonance imaging are useful radiologic imaging techniques. Although steroid cell tumors are generally benign, there is a risk of malignant transformation and clinical malignant formation. Surgery is the most important and hallmark treatment.

  4. Fine-needle aspiration cytology of ovarian steroid cell tumor: A rare case report

    Directory of Open Access Journals (Sweden)

    Nidhi Agrawal

    2015-01-01

    Full Text Available Steroid cell tumors (SCTs of the ovary are a rare subgroup of sex cord tumors that account for less than 0.1% of all ovarian tumors. These tumors can produce steroids, especially testosterone, which produces symptoms such as hirsutism, amenorrhea/oligomenorrhea, and male patterned voice. For evaluation of the androgen excess, testosterone and dehydroepiandrosterone sulfate (DHEA-S are the first laboratory tests to be measured. Abdominal ultrasound and magnetic resonance imaging (MRI are useful radiologic imaging techniques. Although SCTs are generally benign, the risk of malignant transformation is always present. Surgical excision of tumor is the most important and hallmark treatment. The present case signifies the early preoperative diagnosis of a virilizing SCT, based on cytological features and its careful correlation with clinicopathological and radiological findings.

  5. Polycystic Ovarian Syndrome: A Diagnostic and Therapeutic Challenge

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    Manmohan K Kamboj

    2010-01-01

    Full Text Available Polycystic ovarian syndrome (PCOS is the commonest endocrinopathy in women with a multi-factorial etiology, and presents not just a diagnostic dilemma but also a therapeutic challenge as well. The clinical features of the syndrome in adolescents result from hyperandrogenemia and oligo/anovulation. Most women presenting with non-pregnancy related secondary amenorrhea, oligomenorrhoea, acne, hirsutism, and infertility have PCOS. Consensus diagnostic criteria have been developed by the United States National Institutes of Health (NIH, and the European Society of Human Reproduction and Embryology and American Society of Reproduction (Rotterdam criteria. PCOS needs to be suspected, recognized, and treated to prevent some long term complications. Treatment modalities need to be individualized to address the specific concerns of each female presenting with this entity. This article reviews the diagnosis and principles of management of PCOS.

  6. Androgen dependence of hirsutism, acne, and alopecia in women: retrospective analysis of 228 patients investigated for hyperandrogenism.

    Science.gov (United States)

    Karrer-Voegeli, Sandra; Rey, François; Reymond, Marianne J; Meuwly, Jean-Yves; Gaillard, Rolf C; Gomez, Fulgencio

    2009-01-01

    Hirsutism, acne, alopecia, and oligo-amenorrhea are clinical expressions of hyperandrogenism, one of the most frequent endocrine disorders in women of reproductive age. Women referred to our endocrine clinics for skin symptoms of hyperandrogenism underwent a laboratory workup to evaluate hormone measurements and received antiandrogen therapy. We retrospectively analyzed the outcome of 228 consecutive patients investigated over 6 years.Patients with hirsutism had higher levels of androstenedione, dehydroepiandrosterone sulfate (DHEAS), and salivary testosterone; lower levels of sex hormone-binding globulin (SHBG); and a higher prevalence of oligo-amenorrhea than patients with alopecia, while patients with acne showed intermediate values. Hirsutism score correlated positively with androstenedione, DHEAS, and salivary testosterone, and correlated negatively with SHBG; salivary testosterone showed the highest correlation coefficient. Total testosterone was not significantly different among patients with hirsutism, alopecia, or acne, and did not significantly correlate with hirsutism score. Hirsutism and oligo-amenorrhea were the most sensitive symptoms of hyperandrogenism, and no androgenic parameter alone allowed us to identify all cases of hyperandrogenism.Patients of central European origin sought consultation with milder hirsutism scores than patients of southern European origin. There was, however, no difference in the clinical-biological correlation between these groups, arguing against differences in skin sensitivity to androgens.Polycystic ovary syndrome, defined as hyperandrogenism (hirsutism or elevated androgens) and oligo-amenorrhea, was diagnosed in 63 patients (27.6%), an underestimate compared with other reports that include systematic ovarian ultrasound studies. Neither pelvic ultrasound, used in a limited number of cases, nor the luteinizing hormone/follicle-stimulating hormone ratio helped to distinguish patients with polycystic ovary syndrome from

  7. Bilateral Gonadal Cysts and Late Diagnosis of Androgen Insensitivity Syndrome Treated by Laparoscopic Gonadectomy

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    D. Tourlakis

    2011-01-01

    Full Text Available Background. Complete androgen insensitivity syndrome is a rare syndrome in which the uterus is absent and testes rather than ovaries are present. Patients usually visit a gynecologist due to primary amenorrhea. Case. A forty-eight-year-old woman with lower abdominal pain and anamnesis of uterus agenesis was operated on due to bilateral cystic masses. A 5 × 3 × 1.2 cm left adnexal cyst revealed the presence of a serous cyst with a hypoplastic ductus deferens. A smaller cyst of the right adnexa revealed immature testis tissue with Leydig-cell hyperplasia. After karyotype and hormonal examinations, laparoscopic gonadectomy was performed. Conclusion. Attention should be paid in all cyst-removing operations in cases of uterus agenesis, due to the high incidence of malignancy. Not of less importance is the issue of informing the patient in the most appropriate way.

  8. Polycystic ovary syndrome: update on diagnosis and treatment.

    Science.gov (United States)

    Setji, Tracy L; Brown, Ann J

    2014-10-01

    Polycystic ovary syndrome is now a well-recognized condition affecting 6%-25% of reproductive-aged women, depending on the definition. Over the past 3 decades, research has launched it from relative medical obscurity to a condition increasingly recognized as common in internal medicine practices. It affects multiple systems, and requires a comprehensive perspective on health care for effective treatment. Metabolic derangements and associated complications include insulin resistance and diabetes, hyperlipidemia, hypertension, fatty liver, metabolic syndrome, and sleep apnea. Reproductive complications include oligo-/amenorrhea, sub-fertility, endometrial hyperplasia, and cancer. Associated psychosocial concerns include depression and disordered eating. Additionally, cosmetic issues include hirsutism, androgenic alopecia, and acne. This review organizes this multi-system approach around the mnemonic "MY PCOS" and discusses evaluation and treatment options for the reproductive, cosmetic, and metabolic complications of this condition. PMID:24859638

  9. Ovarian failure and cancer treatment: Incidence and interventions for premenopausal women

    International Nuclear Information System (INIS)

    Ovarian failure may be a long-term consequence of cancer treatment for premenopausal women. Caused by several treatments, including radiation therapy and the alkylating agents, it produces signs and symptoms associated with menopause: hot flashes, amenorrhea, dyspareunia, loss of libido, and irritability. Critical factors that determine ovarian functioning after treatment for cancer are the patient's age at the time of therapy, the amount of radiation that the ovaries received, and the dose of the antineoplastic agent(s). Medical interventions, such as hormonal therapy and surgical repositioning of the ovaries, may maintain ovarian function for some women. Nursing intervention includes assessment, education, and counseling. Counseling focuses on how the prematurely menopausal patient feels about herself as indicated by self-esteem, body image, and sexuality

  10. A patient with Cushing disease lateralizing a pituitary adenoma by inferior petrosal sinus sampling using desmopressin: a case report.

    Science.gov (United States)

    Lim, Joo Hee; Kim, Soo Jung; Jung, Mo Kyung; Kim, Ki Eun; Kwon, Ah Reum; Chae, Hyun Wook; Kim, Duk Hee; Kim, Ho-Seong

    2016-03-01

    A 14-year-old girl was referred for evaluation of the etiology of Cushing syndrome. During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain. Random serum cortisol level, 24-hour urinary free cortisol excretion, and overnight and low-dose dexamethasone suppression tests suggested Cushing syndrome. Midnight adrenocorticotropic hormone (ACTH) level and high-dose dexamethasone suppression test confirmed Cushing disease. Pituitary magnetic resonance imaging was suspicious for microadenoma. To eliminate ectopic ACTH syndrome, and lateralize the pituitary tumor, inferior petrosal sinus sampling (IPSS) was performed by desmopressin use to stimulate ACTH. Finally, the patient was diagnosed with Cushing disease due to ACTH-secreting pituitary microadenoma, lateralized to the left side; subsequently underwent transsphenoidal surgery. Here we report a case of a 14-year-old girl diagnosed with Cushing disease with a pituitary tumor lateralized by IPSS using desmopressin, which is very rare in pediatric Cushing disease. PMID:27104179

  11. A rare case of Turner′s syndrome presenting with Mullerian agenesis

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    Suresh Vaddadi

    2013-01-01

    Full Text Available Turner′s syndrome also called as Ullrich Turner′s syndrome, is a disease of unclear pathogenesis characterized by complete or partial absence of one sex chromosome, with or without cell line mosaicism in a phenotypic female with short stature. Various anomalies result in a constellation of features, of which the most disturbing is primary amenorrhea due to gonadal dysgenesis. Hormone therapy in these patients can often result in successful menstruation, and scope for subsequent pregnancy because of anatomically normal uterus and vagina. Coexisting Mullerian agenesis in these patients can jeopardize the chances of future pregnancy as they have associated structural abnormalities of the uterus and vagina. We report a rare case of middle-aged female with Turner′s syndrome and Mullerian agenesis having absent secondary sexual characters and missing uterus with incompletely formed vagina.

  12. Report of a case of Turner′s syndrome with localized aggressive periodontitis

    Directory of Open Access Journals (Sweden)

    Suresh Kumar Kasagani

    2011-01-01

    Full Text Available Turner′s syndrome is a disorder in females characterized by the absence of all or part of a normal second sex chromosome. It is typically characterized by the combination of physical features and cytogenetics in females. Physical features include short stature, primary amenorrhea, hypogonadism, low hair line at the back of the neck, and digital anomalies. Most affected patients have a 45XO monosomy, but the presence of an abnormal chromosome or mosaicism of 45X with another cell line can also fulfill the criteria. Features seen in the oral cavity of patients diagnosed with Turner′s syndrome include high palatal vault, hypoplastic mandible, prematurely erupting teeth, and orthodontic anomalies. A case of Turner′s syndrome with localized aggressive periodontitis has been reported here.

  13. Ovarian hyperstimulation syndrome in a spontaneous pregnancy with invasive mole: report of a case.

    Science.gov (United States)

    Rachad, Myriam; Chaara, Hikmat; Zahra Fdili, Fatim; Bouguern, Hakima; Melhouf, Abdilah

    2011-01-01

    It is known that most cases of Ovarian Hyperstimulation Syndrome (OHSS) are associated with the therapies for ovulation induction. However, OHSS may rarely be associated with a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism or polycystic ovary syndrome. We report a case of severe OHSS in spontaneous pregnancy with invasive mole in a 34 years old woman. The clinical picture showed abdominal pain, massive ascites, nausea, dyspnea and amenorrhea. After imaging examinations and laboratory tests, the diagnosis was established. The patient was managed expectantly with no complications. Although spontaneous ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious complications, which may develop rapidly. PMID:22355432

  14. Pure Androgen-Secreting Adrenal Adenoma Associated with Resistant Hypertension

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    René Rodríguez-Gutiérrez

    2013-01-01

    Full Text Available Pure androgen-secreting adrenal adenoma is very rare, and its diagnosis remains a clinical challenge. Its association with resistant hypertension is uncommon and not well understood. We present an 18-year-old female with a 10-year history of hirsutism that was accidentally diagnosed with an adrenal mass during the evaluation of a hypertensive crisis. She had a long-standing history of hirsutism, clitorimegaly, deepening of the voice, and primary amenorrhea. She was phenotypically and socially a male. FSH, LH, prolactin, estradiol, 17-hydroxyprogesterone, and progesterone were normal. Total testosterone and DHEA-S were elevated. Cushing syndrome, primary aldosteronism, pheochromocytoma, and nonclassic congenital adrenal hyperplasia were ruled out. She underwent adrenalectomy and pathology reported an adenoma. At 2-month followup, hirsutism and virilizing symptoms clearly improved and blood pressure normalized without antihypertensive medications, current literature of this unusual illness and it association with hypertension is presented and discussed.

  15. STANDARDIZATION AND PRELIMINARY PHYTOCHEMICAL INVESTIGATION ON CYPERUS ROTUNDUS LINN RHIZOME

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    Rai Puneet kumar

    2010-12-01

    Full Text Available Cyperus rotundus Linn vernacularly called “Nagarmotha” is a medicinal plant belonging to the family of the Cyperaceae and was widely distributed in the Mediterranean basin areas. This plant, which grows naturally in tropical, subtropical and temperate regions, is widespread in northeast appearing among Indian, Chinese, Japanese natural drugs used as home remedy against spasms, stomach disorders and irritation of bowel. Cyperus rotundus has many different uses and used as cooling, intellect promoting, nervine tonic, diuretic, antiperiodic, diarrhoea, dysentery, leprosy, bronchitis, amenorrhea, blood disorders, analgesic, anti-inflammatory and antipyretic activity. The present study was aimed to evaluate the parameter to determine the quality of the Cyperus rotundus rhizome. These studies comprise to investigate macroscopy, powder analysis, physicochemical parameters, preliminary phytochemical screening and fluorescence characteristics. The studies will provide referential information for the correct identification of the crude drug.

  16. Ethnobotany, phytochemistry and pharmacology of Biophytum sensitivum DC

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    Abinash C Bharati

    2012-01-01

    Full Text Available Medicinal plants are widely being used by the traditional medical practitioners for curing various diseases in their day-to-day practice. Biophytum sensitivum DC (Oxalidaceae is used as a traditional folk medicine in ailments such as inflammation, arthritis, wounds, tumors and burns, gonorrhea, stomach ache, asthma, cough, degenerative joint disease, urinary calculi, diabetes, snake bite, amenorrhea and dysmenorrhea. It is a small, flowering, annual herb with sensitive leaves. It grows throughout tropical Africa and Asia, especially in Philippines and the hotter parts of India and Nepal. Phytochemical studies have shown that the major pharmacologically active constituents are amentoflavone and a polysaccharide fraction, BP100 III. Recent pharmacological study shows that it has antioxidant, immunomodulatory, anticancer, anti-inflammatory, chemoprotective, antidiabetic and wound healing potential. This review attempts to describe the ethnobotany, pharmacognosy, traditional uses, chemical constituents, and various pharmacologic activities and other aspects of B. sensitivum.

  17. [Specific factors of sex behavior in patients with anorexia nervosa and bulimia].

    Science.gov (United States)

    Oleĭnikov, A N

    2000-01-01

    65 patients were examined. They were divided into three groups. Group 1 consisted of patients with anorexia nervosa (AN) without bulimia, complicated by cachexia and amenorrhea. Epileptoid personality masculinous body built and behaviour, essential disturbances of sexual self-identification prevailed in this group. 3 patients had homoerotic tendencies, while a syndrome of sex negation developed in 5 cases. In group 2 bulimia was a stage of AN development. The patients had frequently initial endocrinopathy (obesity, dysmenorrhea), experiences of phobia and anxiety, asynchronous disharmonious type of psychosexual ontogenesis. Group 3 of patients was characterized by predomination of bulimia symptoms as a variation of the disease course. Normostenic body built, normal somatoendocrine and psychosexual development were combined with hysteric personal characteristics, mood and sexual fluctuations. PMID:10849961

  18. Constitutional thinness and anorexia nervosa: a possible misdiagnosis?

    Science.gov (United States)

    Estour, Bruno; Galusca, Bogdan; Germain, Natacha

    2014-01-01

    Clinical and biological aspects of restrictive anorexia nervosa (R-AN) are well documented. More than 10,000 articles since 1911 and more than 600 in 2013 have addressed R-AN psychiatric, somatic, and biological aspects. Genetic background, ineffectiveness of appetite regulating hormones on refeeding process, bone loss, and place of amenorrhea in the definition are widely discussed and reviewed. Oppositely, constitutional thinness (CT) is an almost unknown entity. Only 32 articles have been published on this topic since 1953. Similar symptoms associating low body mass index, low fat, and bone mass are reported in both CT and R-AN subjects. Conversely, menses are preserved in CT women and almost the entire hormonal profile is normal, except for leptin and PYY. The aim of the present review is to alert the clinician on the confusing clinical presentation of these two situations, a potential source of misdiagnosis, especially since R-AN definition has changed in DSM5. PMID:25368605

  19. Anorexia nervosa and bone metabolism.

    Science.gov (United States)

    Fazeli, Pouneh K; Klibanski, Anne

    2014-09-01

    Anorexia nervosa (AN) is a psychiatric disorder characterized by self-induced starvation with a lifetime prevalence of 2.2% in women. The most common medical co-morbidity in women with AN is bone loss, with over 85% of women having bone mineral density values more than one standard deviation below an age comparable mean. The low bone mass in AN is due to multiple hormonal adaptations to under nutrition, including hypothalamic amenorrhea and growth hormone resistance. Importantly, this low bone mass is also associated with a seven-fold increased risk of fracture. Therefore, strategies to effectively prevent bone loss and increase bone mass are critical. We will review hormonal adaptations that contribute to bone loss in this population as well as promising new therapies that may increase bone mass and reduce fracture risk in AN. PMID:24882734

  20. Committee Opinion No. 668: Menstrual Manipulation for Adolescents With Physical and Developmental Disabilities.

    Science.gov (United States)

    2016-08-01

    For an adolescent with physical disabilities, intellectual disabilities, or both, and for her caregivers, menstruation can present significant challenges. If, after an evaluation, the adolescent, her family, and the obstetrician-gynecologist have decided that menstrual intervention is warranted, advantages and disadvantages of hormonal methods should be reviewed and individualized to each patient's specific needs. Complete amenorrhea may be difficult to achieve, and realistic expectations should be addressed with the patient and her caregivers. The goal in menstrual manipulation should be optimal suppression, which means a reduction in the amount and total days of menstrual flow. Menstrual suppression before menarche and endometrial ablation are not recommended as treatments. Optimal gynecologic health care for adolescents with disabilities is comprehensive; maintains confidentiality; is an act of dignity and respect toward the patient; maximizes the patient's autonomy; avoids harm; and assesses and addresses the patient's knowledge of puberty, menstruation, sexuality, safety, and consent. PMID:27454732

  1. Committee Opinion No. 668 Summary: Menstrual Manipulation for Adolescents With Physical and Developmental Disabilities.

    Science.gov (United States)

    2016-08-01

    For an adolescent with physical disabilities, intellectual disabilities, or both, and for her caregivers, menstruation can present significant challenges. If, after an evaluation, the adolescent, her family, and the obstetrician-gynecologist have decided that menstrual intervention is warranted, advantages and disadvantages of hormonal methods should be reviewed and individualized to each patient's specific needs. Complete amenorrhea may be difficult to achieve, and realistic expectations should be addressed with the patient and her caregivers. The goal in menstrual manipulation should be optimal suppression, which means a reduction in the amount and total days of menstrual flow. Menstrual suppression before menarche and endometrial ablation are not recommended as treatments. Optimal gynecologic health care for adolescents with disabilities is comprehensive; maintains confidentiality; is an act of dignity and respect toward the patient; maximizes the patient's autonomy; avoids harm; and assesses and addresses the patient's knowledge of puberty, menstruation, sexuality, safety, and consent. PMID:27454728

  2. Ovarian hemangioma with stromal luteinization and HCG-producing mononucleate and multinucleate cells of uncertain histogenesis: A rare co-existence with therapeutic dilemma

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    Murthy S Anand

    2012-01-01

    Full Text Available A 21 year old female presented with amenorrhea, hirsutism and change in voice along with an elevated serum β-HCG (human chorionic gonadotrophin level and normal CA-125 level. Laparotomy revealed an enlarged right ovary measuring 6 × 5 × 1 cms with presence of an ovarian hemangioma along with stromal luteinization and HCG producing mononucleate as well as multinucleate cells of uncertain histogenesis on histopathological examination. Immunohistochemistry for inhibin and calretinin were positive in the luteinized component whereas β-HCG and Ki-67 were positive in the multinucleate cell component. The diagnostic rarity and therapeutic dilemma of such a rare mixed tumor within a single ovary has proven to be an exceptional case and an excellent investigative opportunity.

  3. Pharmacological Review on Centella asiatica: A Potential Herbal Cure-all.

    Science.gov (United States)

    Gohil, Kashmira J; Patel, Jagruti A; Gajjar, Anuradha K

    2010-09-01

    In recent times, focus on plant research has increased all over the world. Centella asiatica is an important medicinal herb that is widely used in the orient and is becoming popular in the West. Triterpenoid, saponins, the primary constituents of Centella asiatica are manly believed to be responsible for its wide therapeutic actions. Apart from wound healing, the herb is recommended for the treatment of various skin conditions such as leprosy, lupus, varicose ulcers, eczema, psoriasis, diarrhoea, fever, amenorrhea, diseases of the female genitourinary tract and also for relieving anxiety and improving cognition. The present review attempts to provide comprehensive information on pharmacology, mechanisms of action, various preclinical and clinical studies, safety precautions and current research prospects of the herb. At the same time, studies to evaluate the likelihood of interactions with drugs and herbs on simultaneous use, which is imperative for optimal and safe utilization of the herb, are discussed. PMID:21694984

  4. Pharmacological review on Centella asiatica: A potential herbal cure-all

    Directory of Open Access Journals (Sweden)

    Gohil Kashmira

    2010-01-01

    Full Text Available In recent times, focus on plant research has increased all over the world. Centella asiatica is an important medicinal herb that is widely used in the orient and is becoming popular in the West. Triterpenoid, saponins, the primary constituents of Centella asiatica are manly believed to be responsible for its wide therapeutic actions. Apart from wound healing, the herb is recommended for the treatment of various skin conditions such as leprosy, lupus, varicose ulcers, eczema, psoriasis, diarrhoea, fever, amenorrhea, diseases of the female genitourinary tract and also for relieving anxiety and improving cognition. The present review attempts to provide comprehensive information on pharmacology, mechanisms of action, various preclinical and clinical studies, safety precautions and current research prospects of the herb. At the same time, studies to evaluate the likelihood of interactions with drugs and herbs on simultaneous use, which is imperative for optimal and safe utilization of the herb, are discussed.

  5. Modern Approach in Premature Ovarian Failure

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    Pacu Irina

    2014-09-01

    Full Text Available Premature ovarian failure (POF is a condition affecting 1-2% of women younger than 40 years of age, characterized by amenorrhea, hypoestrogenism and elevated gonadotropin levels. In the last years it became a problem of social health interest as the frequency increased due to environmental factors and new, efficient methods for cancer treatment in young women. Few genes have beed identified to explain cases of POF but there are also autoimmune associated conditions and an increasing number of iatrogenic cases (chemotherapy, surgery, radiotherapy. Modern approach in POF means not only a precise etiological diagnosis, but also a correct counseling for these patients who often want to become parents, and a chance for a healthy life without the long term consequences of estrogen deprivation from an early age. In vitro fertilization (IVF techniques can be useful for certain cases but research is needed on strategies to improve fertility for women who have follicles remaining in the ovaries.

  6. Preservation of neuroendocrine control of reproductive function despite severe undernutrition.

    Science.gov (United States)

    Miller, K K; Grinspoon, S; Gleysteen, S; Grieco, K A; Ciampa, J; Breu, J; Herzog, D B; Klibanski, A

    2004-09-01

    Anorexia nervosa (AN) is characterized by low weight and self-imposed caloric restriction and leads to severe bone loss. Although amenorrhea due to acquired GnRH deficiency is nearly universal in AN, a subset of patients maintains menses despite low weight. The mechanisms underlying continued GnRH secretion despite low weight in these patients and the impact of gonadal hormone secretion on bone mineral density (BMD) in such eumenorrheic, low-weight patients remain unknown. We hypothesized that 1) eumenorrheic women with AN would have higher body fat and levels of nutritionally dependent hormones, including leptin and IGF-I, than amenorrheic women with AN and comparable body mass index; and 2) BMD would be higher in these women. We also investigated whether the severity of eating disorder symptomatology differed between the groups. We studied 116 women: 1) 42 low-weight women who fulfilled all Diagnostic and Statistical Manual of Mental Disorders (fourth edition) diagnostic criteria for AN, except for amenorrhea; and 2) 74 women with AN and amenorrhea for at least 3 months. The two groups were similar in body mass index (17.1 +/- 0.2 vs. 16.8 +/- 0.2 kg/m(2)), percent ideal body weight (78.2 +/- 0.8% vs. 76.7 +/- 0.8%), duration of eating disorder (70 +/- 13 vs. 59 +/- 9 months), age of menarche (13.2 +/- 0.3 vs. 13.5 +/- 0.2 yr), and exercise (4.5 +/- 1.0 vs. 4.2 +/- 0.5 h/wk). As expected, eumenorrheic patients had a higher mean estradiol level (186.6 +/- 19.0 vs. 59.4 +/- 2.5 nmol/liter; P eating disorder symptomatology, as measured by the Eating Disorders Inventory, and where differences were observed, eumenorrheic subjects manifested more severe symptomatology than amenorrheic subjects. Mean BMD at the posterior-anterior and lateral spine were low in both groups, but were higher in patients with eumenorrhea than in those with amenorrhea [posterior-anterior spine T-score, -0.9 +/- 0.1 vs. -1.9 +/- 0.1 (P < 0.0001); lateral spine T-score, -1.2 +/- 0.1 vs. -2

  7. Female Athlete Triad: Past, Present, and Future.

    Science.gov (United States)

    Matzkin, Elizabeth; Curry, Emily J; Whitlock, Kaitlyn

    2015-07-01

    After the passage of Title IX in 1972, female sports participation skyrocketed. In 1992, the female athlete triad was first defined; diagnosis required the presence of an eating disorder, amenorrhea, and osteoporosis. However, many athletes remained undiagnosed because they did not meet all three of these criteria. In 2007, the definition was modified to a spectrum disorder involving low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density. With the new definition, all three components need not be present for a diagnosis of female athlete triad. Studies using the 1992 definition of the disorder demonstrated a prevalence of 1% to 4% in athletes. However, in certain sports, many female athletes may meet at least one of these criteria. The actual prevalence of athletes who fall under the "umbrella" diagnosis of the female athlete triad remains unknown. PMID:26111876

  8. Common injuries and ailments of the female athlete; pathophysiology, treatment and prevention.

    Science.gov (United States)

    Hilibrand, Miryl J; Hammoud, Sommer; Bishop, Meghan; Woods, Daniel; Fredrick, Robert W; Dodson, Christopher C

    2015-11-01

    With increasing numbers of women competing in high school and collegiate athletics, it is important that physicians become familiar with injury patterns and medical conditions unique to the female athlete. Observations and clinical data have elucidated unique biomechanical, anatomic and hormonal factors that predispose skeletally mature female athletes to anterior cruciate ligament (ACL) injuries, patellofemoral disorders and lower extremity stress fractures. Additionally, younger female athletes are particularly at risk of developing components of the "Female Athlete Triad" (more recently included under the syndrome of "Relative Energy Deficiency in Sport" [RED-S]): disordered eating, amenorrhea and osteoporosis. An understanding of the pathophysiology of these conditions has led to the development of programs that can treat their underlying causes, decrease susceptibility to injury, and improve the long-term health of the female athlete. This paper is intended to provide physicians with a review of the sex-specific etiology, prevention and treatment of injuries common to the female athlete. PMID:26458108

  9. Clinical evaluation of 413 Thalassemic patients

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    Korosdari Gh.H

    2000-08-01

    Full Text Available Thalassemia is the most prevalent genetic disorder in Iran and around the world and these patients need regular careful care. The present study reports results of routine examination of patients visited Thalassemia clinic of Tehran. Data about clinical and laboratory examinations of 413 Thalassemic were extracted and analyzed. The prevalence of heart complications, diabetes, growth retardation, delayed puberty and primary and secondary amenorrhea was 9%, 8%, 21.3%, 3.1% and 6.3%, respectively. 44% didn't have secondary sex characteristics. Splenectomy had been done for 67.2% of cases. HBsAg, HBsAb and HBcAb were positive in 1.9%, 57.4% and 43%, respectively. We concluded that blood transfusion standards in this clinic was acceptable, whereas because of poor knowledge, iron chelating is unfavorable.

  10. "Mixed germ cell testicular tumor" in an adult female

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    Udasimath Shivakumarswamy

    2012-01-01

    Full Text Available The androgen insensitivity (testicular feminization syndrome was described by Morris in phenotypic females with 46XY karyotype, presenting with primary amenorrhea, adequate breast development, and absent or scanty pubic or axillary hair. Gonads consist usually of seminiferous tubules without spermatogenesis. These patients have a 5-10% risk of developing germ cell tumors, usually after the complete development of secondary female sexual characteristics. We hereby report a case considered as a female with married life of 15 years, who was operated for severe abdominal pain. Phenotype characters were that of female. Microscopic examination of the tumor from the abdomen revealed germinoma and yolk sac tumor with adjacent seminiferous tubules. Karyotyping showed 46XY. Final diagnosis of malignant mixed germ cell tumor in androgen insensitivity syndrome was made. Surveillance may be the most appropriate option when these conditions are initially diagnosed in adulthood to prevent development of germ cell tumors.

  11. Spontaneous Unruptured Bilateral Tubal Pregnancy: A Case Report

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    Nayereh Ghomian

    2015-11-01

    Full Text Available Bilateral spontaneous tubal ectopic pregnancy is the rarest form of extra uterine pregnancy. The diagnosis is usually made intraoperatively and levels of serum BHCG and ultrasound has not been useful in the diagnosis of bilateral tubal ectopic pregnancy. A 33-year-old woman with 8 weeks amenorrhea and sever lower abdominal pain was admitted. A transvaginal pelvic ultrasound revealed left adnexal mass and massive fluid collection in the pelvis and abdomen. The serum BHCG was 5,700 mIU/ml and in laparotomy bilateral unruptured tubal pregnancy was noted. Left salpingectomy and right salpingostomy were performed. The diagnosis of bilateral spontaneous tubal ectopic pregnancy is usually made intraoperatively. Both tubes at the time of surgery should be closely examined in order to prevent maternal morbidity and mortality.

  12. Pure gonadal dysgenesis (46 XX type) with a familial pattern.

    Science.gov (United States)

    Kohmanaee, Shahin; Dalili, Setila; Rad, Afagh Hassanzadeh

    2015-01-01

    46, XX gonadal dysgenesis without the phenotype of Turner's syndrome is described as "pure". Although, previous investigations obtained that commonly gonadal dysgenesis did not cause breast development as a result of low levels of circulating estradiol. However, in this study, we aimed to report a familial pure gonadal dysgenesis with and without normal secondary sexual characteristics. In this study, we reported three siblings with pure gonadal dysgenesis with and without normal secondary sexual characteristics. The elder two sisters had a normal female phenotype and the youngest had amenorrhea with no breast development (B1) and pubic hair. In addition, it seems that the absence of pubic hair occurred due to delayed constitutional puberty. According to results, it seems that clinicians should consider different presentations for pure gonadal dysgenesis with familial pattern. PMID:26430655

  13. Smooth muscle relaxant activity of Crocus sativus (saffron and its constituents: possible mechanisms

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    Amin Mokhtari-Zaer

    2015-08-01

    Full Text Available Saffron, Crocus sativus L. (C. sativus is rich in carotenoids and used in traditional medicine for treatment of various conditions such as coughs, stomach disorders, amenorrhea, asthma and cardiovascular disorders. These therapeutic effects of the plant are suggested to be due to its relaxant effect on smooth muscles. The effect of C. sativus and its constituents on different smooth muscles and the underlying mechanisms have been studied. Several studies have shown the relaxant effects of C. sativus and its constituents including safranal, crocin, crocetin and kaempferol on blood vessels. In addition, it was reported that saffron stigma lowers systolic blood pressure. The present review highlights the relaxant effects of C. sativus and its constituents on various smooth muscles. The possible mechanisms of this relaxing effect including activation of ß2-adrenoceptors, inhibition of histamine H1 and muscarinic receptors and calcium channels and modulation of nitric oxide (NO are also reviewed.

  14. Importance of early diagnosis and gonadectomy in 46, XY females.

    Science.gov (United States)

    MacMahon, R A; Cussen, L J; Walters, W A

    1980-10-01

    Gonadal neoplasms developed in three 46, XY females aged 3 yr and 10 mo, 15 yr, and 19 yr. One patient died from metastatic neoplasia. Early diagnosis of 46, XY gonadal dysgenesis is essential, and should be considered in female infants and children with any features of Turner's syndrome, ambiguous genitalia, phallic hypertrophy, excessive height, large hands and feet, failure of development of secondary sexual characteristics, primary amenorrhea, abdominal mass, or unexplained hypertension. Any female with gonadal dysgenesis and a Y chromosome in her karyotype should have prophylactic gonadectomy as soon as possible. The absence of Sertoli cells in these patients, causing lack of androgen binding protein with deficient local concentration of androgens and consequent failure of maturation of spermatogonia, may lead to unregulated proliferation of germ cells, and hence explain the frequency of gonadal neoplasia in the 46, XY female. PMID:7441456

  15. Recent progress in the utility of anti-Müllerian hormone in female infertility

    DEFF Research Database (Denmark)

    Grynnerup, Anna G-A; Lindhard, Anette; Sørensen, Steen

    2014-01-01

    PURPOSE OF REVIEW: To discuss the recent developments in the utility of anti-Müllerian hormone (AMH) in the context of female infertility. RECENT FINDINGS: AMH measurements have entered the clinical practice in counseling of women before in-vitro fertilization (IVF) treatment. AMH measurements can...... predict both poor and hyperresponse, and can enable clinicians to individualize the treatment strategies. In natural conception, AMH is a good predictor of age at menopause, but it is unclear whether AMH correlates with the fecund ability in the normal population. AMH has also proven its utility...... in the assessment of ovarian damage due to gonadotoxic treatment or ovarian surgery. Lastly, AMH might assist in the initial diagnosis of oligomenorrhea or amenorrhea, as high levels of AMH are suggestive of polycystic ovarian syndrome and seem to correlate with the severity of the syndrome. SUMMARY: AMH...

  16. Rupture of non-communicating rudimentary horn ectopic pregnancy of a unicornuate uterus in first trimester

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    Tsering Wangdi

    2015-08-01

    Full Text Available Pregnancy in rudimentary horn of a unicornuate uterus is a very rare type of ectopic pregnancy. Ninety percent of cases eventually rupture in the second trimester. Only few cases of rupture of the pregnant rudimentary horn occur during first trimester. A 23 year old primigravida presented with 8 weeks of amenorrhea with acute pain abdomen and vomiting. On examination, the patient was in shock. On ultrasound, unicornuate uterus with ruptured rudimentary horn ectopic pregnancy was suspected. On laparotomy, the diagnosis was confirmed. The rudimentary horn was excised and ipsilateral salpingectomy was done. This case is presented because of rarity of rupture of rudimentary horn ectopic in first trimester and also to emphasize on the importance of recognizing subtle clinical findings which are suggestive of this rare condition. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1211-1213

  17. Antipsychotic-induced Hyperprolactinemia

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    Suheyla Dogan Bulut

    2015-06-01

    Full Text Available Prolactin provides the growth of the mammary gland during pregnancy and synthesis and preparation of breast milk for lactation. Antipsychotics and antidepressants that are frequently used in psychiatry, cause hyperprolactinemia. The prevalent opinion is that especially typical antipsychotics increase prolactin levels primarily by blocking D2 receptors in the anterior pituitary. The effects of atypical antipsychotics on hyperprolactinemia vary. Hyperprolactinemia causes galactorrhea, gynecomastia, sexual dysfunction, infertility, acne, hirsutism in women, weight gain, obesity and mood changes in addition to menstrual irregularities such as oligomenorrhea, polymenorrhea and amenorrhea. In the long term, hyperprolactinemia may cause reduction in bone density and osteoporosis. Hyperprolactinemia as a side effect of antipsychotics drugs and its treatment will be reviewed in this article. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(2: 109-124

  18. Hyperprolactinemia with Antipsychotic Drugs in Children and Adolescents

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    Rosenbloom ArlanL

    2010-08-01

    Full Text Available There is increasing use of antipsychotic drugs in pediatric and psychiatry practice for a wide range of behavioral and affective disorders. These drugs have prominent side effects of interest to pediatric endocrinologists, including weight gain and associated metabolic risk factors and hyperprolactinemia. The drugs block dopamine action, thus disinhibiting prolactin secretion. Hyperprolactinemia is especially prominent with first-generation antipsychotics such as haloperidol and the second-generation drugs, most commonly risperidone, with some patients developing gynecomastia or galactorrhea or, as a result of prolactin inhibition of gonadotropin releasing hormone from the hypothalamus, amenorrhea. With concern about the long-term effects of antipsychotics on bone mass and pituitary tumor formation, it is prudent to monitor serum prolactin levels in antipsychotic drug-treated pediatric patients and consider treatment with an agent less likely to induce hyperprolactinemia.

  19. Hyperprolactinemia with Antipsychotic Drugs in Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Arlan L. Rosenbloom

    2010-01-01

    Full Text Available There is increasing use of antipsychotic drugs in pediatric and psychiatry practice for a wide range of behavioral and affective disorders. These drugs have prominent side effects of interest to pediatric endocrinologists, including weight gain and associated metabolic risk factors and hyperprolactinemia. The drugs block dopamine action, thus disinhibiting prolactin secretion. Hyperprolactinemia is especially prominent with first-generation antipsychotics such as haloperidol and the second-generation drugs, most commonly risperidone, with some patients developing gynecomastia or galactorrhea or, as a result of prolactin inhibition of gonadotropin releasing hormone from the hypothalamus, amenorrhea. With concern about the long-term effects of antipsychotics on bone mass and pituitary tumor formation, it is prudent to monitor serum prolactin levels in antipsychotic drug-treated pediatric patients and consider treatment with an agent less likely to induce hyperprolactinemia.

  20. Celiac disease and its effect on human reproduction: a review.

    Science.gov (United States)

    Soni, Shelly; Badawy, Shawky Z A

    2010-01-01

    Celiac disease is an intestinal inflammatory disease that is triggered by gluten in the diet. Patients present with a wide array of symptoms due to malabsorption that include diarrhea, abdominal pain, bloating and weight loss. In women, this disease may have implications on menstrual and reproductive health. The symptom complex includes delayed menarche, early menopause, secondary amenorrhea, infertility, recurrent miscarriages and intrauterine growth restriction. These women benefit from early diagnosis and treatment. Therefore, celiac disease should be considered and screening tests performed on women presenting with menstrual and reproductive problems and treated accordingly. The objective of this article is to review the current literature on celiac disease and its association with the above-mentioned disorders. PMID:20337200

  1. Reproductive Function in Women with Graves’ Disease

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    T V Kashirova

    2009-06-01

    Full Text Available Reproductive function was evaluated in 308 with Graves’ disease (GD: in 250 retrospectively (group 1 and in 58 – prospectively (group 2; the control group included 34 healthy women in reproductive age. The manifestation of Graves’ disease was associated with menstrual abnormalities in 118 women (47.2% in group 1 and in 37 women (63.8% in group 2; the most common abnormalities were oligomenorrhea (26 and 21% and hypomenorrhea (22 and 32%; premature and early menopause were found in 18 and 19%; polymenorrhea in 16% and 11% cases; hypermenorrhea in 11% and 6% cases; amenorrhea in 7% and 11% cases. The prevalence of spontaneous abortion in undertreated hyperthyroidism was 67%, but only 11.8% in case of stable disease (euthyroidism. GD was associated with lower ovarian reserve (high FSH, low Inhibin-B, Antimullerian hormone and ovarian volume. The most favorable results in the view of reproductive outcomes were achieved after radioiodine treatment of GD.

  2. Analysis of cortical bone porosity using synchrotron radiation microtomography to evaluate the effects of chemotherapy

    Science.gov (United States)

    Alessio, R.; Nogueira, L. P.; Salata, C.; Mantuano, A.; Almeida, A. P.; Braz, D.; de Almeida, C. E.; Tromba, G.; Barroso, R. C.

    2015-11-01

    Microporosities play important biologic and mechanical roles on health. One of the side effects caused by some chemotherapy drugs is the induction of amenorrhea, temporary or not, in premenopausal women, with a consequent decrease in estrogen production, which can lead to cortical bone changes. In the present work, the femur diaphysis of rats treated with chemotherapy drugs were evaluated by 3D morphometric parameters using synchrotron radiation microtomography. Control animals were also evaluated for comparison. The 3D tomographic images were obtained at the SYRMEP (SYnchrotron Radiation for MEdical Physics) beamline at the ELETTRA Synchrotron Laboratory in Trieste, Italy. Results showed significant differences in morphometric parameters measured from the 3D images of femur diaphysis of rats.

  3. PHYTOCHEMICAL AND PHARMACOGNOSTICAL STUDIES ON PEDALLIUM MUREX LINN

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    A.R. Mulaicharam

    2011-02-01

    Full Text Available Pedallium Murex Linn (entire plant (Pedaliaceae, a plant of immense medicinal values was taken for the present study. It is essential to ensure the quality and purity of the popular fragrance plant. The entire plant of Pedallium Murex Linn was subjected to various Pharmacognostical evaluations like Morphological, Microscopical and Powder analysis. Results have revealed clearly that the entire plant is genuine. The Phytochemical constituents of Leaves of Pedallium Murex Linn have been worked out. The dry powder of the entire plant was successfully extracted with Total Petroleum ether extract, Alcohol Extract, Chloroform extract, and Aqueous Extract. All the extracts were subjected to Preliminary Phytochemical screening. It showed the presence of Carbohydrates, Glycosides, Alkaloids, Steroids and Flavonoids. As per Materia medica (Krithikar and Basu, studies are required for the screening of various Pharmacological activities like plant pacifies vitiated vata, pitta, urinary retention, kidney stone, seminal weakness, amenorrhea, inflammation, flatulence and fever.

  4. A rare case of Turner's syndrome presenting with Mullerian agenesis.

    Science.gov (United States)

    Vaddadi, Suresh; Murthy, Ramana S V; Rahul, C H; Kumar, Vinod L

    2013-10-01

    Turner's syndrome also called as Ullrich Turner's syndrome, is a disease of unclear pathogenesis characterized by complete or partial absence of one sex chromosome, with or without cell line mosaicism in a phenotypic female with short stature. Various anomalies result in a constellation of features, of which the most disturbing is primary amenorrhea due to gonadal dysgenesis. Hormone therapy in these patients can often result in successful menstruation, and scope for subsequent pregnancy because of anatomically normal uterus and vagina. Coexisting Mullerian agenesis in these patients can jeopardize the chances of future pregnancy as they have associated structural abnormalities of the uterus and vagina. We report a rare case of middle-aged female with Turner's syndrome and Mullerian agenesis having absent secondary sexual characters and missing uterus with incompletely formed vagina. PMID:24672170

  5. Finding of Polydactyly and Syndactyly in an Eight-week Human Embryo. A Case Report

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    Maria Nelia Martínez Lima

    2014-02-01

    Full Text Available The case of a human embryo at Carnegie stage 23 (eighth weeks, which belongs to the collection of embryos of the Faculty of Medicine in Villa Clara is presented. It was the result of the elective termination of pregnancy using misoprostol in a 41-year-old woman with 9.6 weeks of amenorrhea and a history of good health. The aim of this paper is to inform the diagnostic finding of polydactyly and syndactyly in a stage as early as the eighth week of development. Basic and clinical aspects of both malformations are described and the finding is shown through digital images. The importance of the morphological study of these products is emphasized, which would provide value judgments to genetic counselling in future pregnancies.

  6. An incidental coexistence of Mayer-Rokitansky-Kuster-Hauser syndrome with pelvic ectopic kidney and perirenal endometrioma

    International Nuclear Information System (INIS)

    In this case report, Mayer-Rokitansky-Kuster-Hauser syndrome with pelvic ectopic kidney and a perirenal cyst with endometrial tissue inside is demonstrated. A 17 year old patient admitted with primary amenorrhea. Pubertal stages were completed. In pelvic ultrasonography; uterus could not be detected, a 6x11 cm sized cystic lesion was seen on the right adnexal area. A centrally located 5.5x9 cm sized ectopic pelvic kidney was detected. Hormones and tumor markers were normal. Laparoscopy was planned. In the laparoscopic observation, uterus and both tubes could not be detected, ovaries were normal. There was a 6x7 cm sized cyst located in the retroperitoneal area, the origin of cyst could not be identified. Laparatomy was considered, retroperitoneal space was entered, an 8x11 sized smooth contoured perirenal cyst adjacent to the pelvic kidney was detected. Cyst was extirpated. The pathology result was reported to include endometrial tissue and hemorrhage inside. (author)

  7. Reversible thyrotroph hyperplasia with hyperprolactinemia: A rare presenting manifestation of primary hypothyroidism

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    Rajesh Rajput

    2012-01-01

    Full Text Available Pituitary thyrotroph hyperplasia with hyperprolactinemia has been described as a rare presentation of primary hypothyroidism. Premenopausal females with this disorder can present with features of hypothyroidism, menstrual disturbances, galactorrhea, and visual field defects because of enlarged pituitary. Here we describe a 32-year-old female presenting to her gynecologist primarily with galactorrhea and secondary amenorrhea. She was found to have raised serum prolactin, and MRI brain showed enlarged pituitary. She was referred for pituitary surgery when she came to us. Clinical examination and biochemistry were suggestive of primary hypothyroidism. She was prescribed levothyroxine replacement. At 6 weeks follow-up, serum prolactin came down to normal, galactorrhea subsided, and spontaneous menstrual cycles resumed. In 12 weeks, pituitary enlargement completely regressed and in another month after that, she conceived. Hence, primary hypothyroidism can present with thyrotroph hyperplasia, where correct diagnosis and levothyroxine therapy can prevent unnecessary pituitary surgery. Hyperprolactinemia in this setting is of no clinical significance.

  8. Papillary tumor of the pineal region-report of three cases with literature review

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    Debajyoti Chatterjee

    2015-01-01

    Full Text Available Papillary tumor of the pineal region (PTPR is a rare tumor of the pineal region. Not much is known about the pathogenesis, prognosis, and treatment protocol of this uncommon entity. We present three cases of PTPR with follow-up from 8 months to 98 months. All patients presented with headache and visual disturbance. One patient also had amenorrhea. Radiology revealed an heterogeneously enhancing mass arising from the pineal region with associated hydrocephalus. Histopathologically, all cases showed the papillary architecture, strong pan cytokeratin and cytokeratin 18 positivity, and faint positivity for synaptophysin and neuron-specific enolase. All cases received postoperative radiotherapy. One case showed tumor recurrence after 7 years. Other two cases did not show any recurrence till the last follow-up.

  9. Reproductive Function in Patients with Non-functioning Pituitary Adenoma According to the Register of the Republic of Uzbekistan

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    Dinara A. Alieva

    2016-06-01

    Full Text Available The main aim of our study was to evaluate the reproductive system status and gonadotropic pituitary function in patients with non-functioning pituitary adenoma (NFPA according to the register data. Depending on the state of the reproductive system at the time of NFPA diagnosis, men and women can be classified into three groups: secondary hypogonadism (40.7%; normal state of the sexual system (22.0%; and PCOS in women (36.5% and reduced testicular size in men (11.2%. Menstrual irregularities took place in 77.8% NFPA women of reproductive age (41.3% of them had galactorea-oligo/amenorrhea combined with moderate hyperprolactinemia, and sexual dysfunction occurred in 42.0% of male patients with NFPA.

  10. Menstrual Management for Adolescents With Disabilities.

    Science.gov (United States)

    Quint, Elisabeth H; O'Brien, Rebecca F

    2016-07-01

    The onset of menses for adolescents with physical or intellectual disabilities can affect their independence and add additional concerns for families at home, in schools, and in other settings. The pediatrician is the primary health care provider to explore and assist with the pubertal transition and menstrual management. Menstrual management of both normal and abnormal cycles may be requested to minimize hygiene issues, premenstrual symptoms, dysmenorrhea, heavy or irregular bleeding, contraception, and conditions exacerbated by the menstrual cycle. Several options are available for menstrual management, depending on the outcome that is desired, ranging from cycle regulation to complete amenorrhea. The use of medications or the request for surgeries to help with the menstrual cycles in teenagers with disabilities has medical, social, legal, and ethical implications. This clinical report is designed to help guide pediatricians in assisting adolescent females with intellectual and/or physical disabilities and their families in making decisions related to successfully navigating menarche and subsequent menstrual cycles. PMID:27325636

  11. Osteoporosis in anorexia nervosa.

    Science.gov (United States)

    Mehler, Philip S; Cleary, Barbara S; Gaudiani, Jennifer L

    2011-01-01

    Osteoporosis is common in anorexia nervosa. It places these patients at increased lifetime risk for fractures. Bone loss may never recover completely even once weight is restored. The strongest predictors of osteoporosis include low body weight and amenorrhea. Loss of bone density can occur rapidly and very early in the course of anorexia nervosa. The etiology of bone loss in the patient with anorexia nervosa is multifactorial. In addition to reduced estrogen and progesterone, excess cortisol levels and low levels of insulin growth factor (IGF-1), a correlate for bone formation, are observed. Dual energy x-ray absorptiometry screening is important to assess bone density. However, successful treatments to reverse bone loss, in those with anorexia nervosa, are lacking. Early diagnosis and treatment of anorexia nervosa are paramount to prevent initial weight loss and subsequent loss of bone. PMID:21360368

  12. Uterine arterial chemoembolization combined with curettage for the treatment of cesarean scar pregnancy

    International Nuclear Information System (INIS)

    Objective: To evaluate uterine arterial chemoembolization combined with curettage in treating cesarean scar pregnancy. Methods: Super-selective bilateral uterine arterial catheterization and angiography was performed in 64 patients with cesarean scar pregnancy (duration of amenorrhea 43-84 days), which was followed by arterial infusion of MTX and embolization with Gelfoam particles. Then curettage was carried out. The technical success rate and the therapeutic results were observed and analyzed. Results: Technical success in catheterization and in performing chemoembolization was achieved in all 64 patients. The pregnant tissues were successfully cleared away in 62 patients. The average blood loss during curettage procedure was 21.4 ml. For the remaining two patients lesion resection together with repair of lower segment was employed. No severe complications occurred after the treatment. Conclusion: Uterine arterial chemoembolization combined with curettage is a safe,minimally-invasive and effective treatment for cesarean scar pregnancy. It is worth popularizing this technique in clinical practice. (authors)

  13. Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

    International Nuclear Information System (INIS)

    Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.

  14. Intra-Abdominal Testicular Seminoma in a Woman with Testicular Feminization Syndrome

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    Darshana D. Rasalkar

    2011-01-01

    Full Text Available We report a case of intra-abdominal testicular tumor in a 36-year-old married lady presenting with chief complaints of primary amenorrhea. The patient was later diagnosed with testicular feminization syndrome, a form of male pseudohermaphroditism. This testicular tumor was histologically proven as seminoma. Due to rarity, imaging findings in patients with testicular feminization syndrome and intraabdominal testicular tumor have been poorly documented. So far, only one case report had described the combined role of CT and MR imaging in intraabdominal testicular sex-cord stromal tumor. To our knowledge, this case is first to document USG and MR imaging in addition to MR spectroscopy features in intraabdominal testicular seminoma.

  15. Magnetic resonance imaging diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome

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    M J Govindarajan

    2008-01-01

    Full Text Available Magnetic resonance imaging (MRI is the mainstay in the imaging evaluation of Mullerian agenesis, but is not routinely being utilized, particularly in India. Though sagittal MRI clearly demonstrates the absence or hypoplasia of the uterus and the axial images demonstrate the normal ovaries, it is the ability to identify and objectively evaluate other associated anomalies that makes MRI a unique diagnostic modality. It is also noninvasive and has multiplanar capabilities at the same time having a very high soft tissue resolution. We presume it can be used as a comprehensive imaging package for evaluating these patients at one sitting. We report a case of Mullarian agenesis presenting as primary amenorrhea stressing the role and benefits of MRI.

  16. A NEGLECTED CASE OF PRIMARY INFERTILITY – A CASE REPORT OF DISSEMINATED TUBERCULOSIS

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    Nidhi

    2013-05-01

    Full Text Available ABSTRACT: Tuberculosis (TB is a major health problem in devel oping countries including India and genital tuberculosis (GTB is responsible for infertility in a significant proportion of these women. Inspite of recent advances in medicine and availability of sophisticated investigative modalities, definitive diagnosis of G TB is elusive in absence of high clinical suspicion. Majority of women with genital tuberculos is present with infertility. Oligomenorrhea or amenorrhea is more common with other vague sympto ms. Laparoscopy is now a well recognized procedure in the diagnostic work up of pat ients with infertility. In a clinically suspicious case, endometrial biopsy (EB should be fo llowed by laparoscopy. The treatment of GTB should begin with anti tuberculous therapy. Preg nancy rates can now be significantly improved with In vitro fertilization (IVF. The fact remains that fertility rates are not optimistic in genital TB patients even after treatment.

  17. Anorexia nervosa and bone metabolism

    Science.gov (United States)

    Fazeli, Pouneh K.; Klibanski, Anne

    2014-01-01

    Anorexia nervosa (AN) is a psychiatric disorder characterized by self-induced starvation with a lifetime prevalence of 2.2% in women. The most common medical co-morbidity in women with AN is bone loss, with over 85% of women having bone mineral density values more than one standard deviation below an age comparable mean. The low bone mass in AN is due to multiple hormonal adaptations to under nutrition, including hypothalamic amenorrhea and growth hormone resistance. Importantly, this low bone mass is also associated with a seven-fold increased risk of fracture. Therefore, strategies to effectively prevent bone loss and increase low bone mass are critical. We will review hormonal adaptations that contribute to bone loss in this population as well as promising new therapies that may increase bone mass and reduce fracture risk in AN. PMID:24882734

  18. Anorexia nervosa and estrogen receptors.

    Science.gov (United States)

    Ramoz, Nicolas; Versini, Audrey; Gorwood, Philip

    2013-01-01

    Anorexia nervosa (AN) is a chronic psychiatric disorder with a high prevalence of 0.6% and the highest mortality rates among psychiatric diseases, around 10%, mostly due to undernutrition and suicide. AN is characterized by physiological features with a body mass index less than 17.5 kg/m(2), low bone mineral density and amenorrhea, psychological symptoms with a distortion of image body, and behavioral abnormalities. Estrogen molecules and estrogen biological pathway are clearly involved in food intake and body weight in animals and humans. Further, hypoestrogenism has been demonstrated in AN patients and convergent evidence involves the estrogen pathway in the development of AN. AN presents a high heritability and polymorphisms in genes coding the estrogen receptors alpha and beta have been found significantly associated with the disorder. This chapter shows the implication of estrogens in AN and suggests investigation to develop future pharmacological treatments for anorexia. PMID:23601424

  19. Ovarian failure and cancer treatment: Incidence and interventions for premenopausal women

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, J.E.

    1989-09-01

    Ovarian failure may be a long-term consequence of cancer treatment for premenopausal women. Caused by several treatments, including radiation therapy and the alkylating agents, it produces signs and symptoms associated with menopause: hot flashes, amenorrhea, dyspareunia, loss of libido, and irritability. Critical factors that determine ovarian functioning after treatment for cancer are the patient's age at the time of therapy, the amount of radiation that the ovaries received, and the dose of the antineoplastic agent(s). Medical interventions, such as hormonal therapy and surgical repositioning of the ovaries, may maintain ovarian function for some women. Nursing intervention includes assessment, education, and counseling. Counseling focuses on how the prematurely menopausal patient feels about herself as indicated by self-esteem, body image, and sexuality.

  20. CERVICAL ECTOPIC PREGNANCY : A DIAGNOSTIC DILEMMA

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    Bhakti

    2015-09-01

    Full Text Available C ervical pregnancy is defined as implantation and development of the fertilized ovum within the cervical structure without involving the corpus uteri . This rare ectopic gestation has been reported in the literature infrequently . We report here a case presenting late with life threatening vaginal bleeding . G3 P2L2 with Previous two Caesarean sections with history of amenorrhea of 3 months presented to our emergency obstetr ic unit with heavy bleeding per - vaginum since one day . Patient gave history of having taken abortive pills from a private practitioner, details of which were not available . Differential diagnosis of cervical abortion and scar site pregnancy were considered . Ultrasound features can help diagnose this condition with fair accuracy . Ultimately an emergency salvage Hysterectomy was needed to save the life of the patient . KEYWORDS: Cervical Ectopic Pregnancy .

  1. Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Kyung Bum; Namkung, Sook; Hong, Myung Sun; Kim, Heung Cheol; Cho, Young; Choi, Young Hee [Chuncheon Sacred Heart Hospital, Chyncheon (Korea, Republic of)

    2012-06-15

    Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.

  2. A successful laparoscopic neovaginoplasty using peritoneum in Müllerian agenesis with inguinal ovaries accompanied by primary ovarian insufficiency

    Science.gov (United States)

    Gweon, Seonghye; Lee, Jisun; Hwang, Suna; Hwang, Kyoung Joo

    2016-01-01

    The combination of Müllerian agenesis with inguinal ovaries accompanied by primary ovarian insufficiency is extremely rare. A 21-year-old Korean woman was referred to our center with primary amenorrhea. The patient was diagnosed with Müllerian agenesis with inguinal ovaries. Her hormonal profile showed hypergonadotrophic hypogonadism suggesting primary ovarian insufficiency. We performed laparoscopic neovaginoplasty using modified Davydov's procedure and reposition inguinal ovaries in the pelvic cavity. Oral estrogen replacement was applied for the treatment of primary ovarian insufficiency. This is a rare case report on Mayer-Rokitansky-Kuster-Hauser syndrome accompanied not only by inguinal ovaries but also with primary ovarian insufficiency. We present our first experience on the laparoscopic neovaginoplasty performed on the patient with müllerian agenesis accompanied by inguinal ovaries and primary ovarian insufficiency. PMID:27462606

  3. High fetal irradiation: about one pregnant woman receiving infra diaphragmatic radiotherapy for Hodgkin lymphoma

    International Nuclear Information System (INIS)

    We report the case of a 19-year-old young woman for whom was discovered a pregnancy at the end of the irradiation for a Hodgkin lymphoma (stage IV bone Bb), initially treated by chemotherapy. The radiotherapy delivered 36 Gy in infra-diaphragmatic volumes (lumbo-aortic, spleen, L5), beginning in a pregnant patient for less than 4 amenorrhea weeks. The calculated received fetal dose (literature data, measurement with software T.P.S., measurement on phantom) is high: it's between 2.8 and 5 Gy. With a current follow-up of 4 years since the radiotherapy's end, the patient is in complete remission and her child presents with a normal development for the age, in spite of the infra diaphragmatic irradiation. (authors)

  4. Pituitary hyperplasia: an uncommon presentation of a common disease

    Science.gov (United States)

    Massolt, E T; Peeters, R P; Neggers, S J; de Herder, W W

    2015-01-01

    Summary A 21-year-old woman presented with amenorrhea, bilateral galactorrhea and fatigue. Visual acuity and visual fields were normal. Laboratory examination demonstrated hyperprolactinemia. Magnetic resonance imaging (MRI) of the pituitary showed a 19×17×12-mm sellar mass with supra- and parasellar extension, causing compression of the pituitary stalk and optic chiasm. Further examinations confirmed mild hyperprolactinemia, strongly elevated TSH (>500 mU/l), low free thyroxine (FT4), hypogonadotropic hypogonadism and secondary adrenal insufficiency. Hydrocortisone and l-T4 replacement therapy was started. Three months later, the galactorrhea had disappeared, thyroid function was normalized and MRI revealed regression of the pituitary enlargement, confirming the diagnosis of pituitary hyperplasia (PH) due to primary hypothyroidism. Subsequently, the menstrual cycle returned and the hypocortisolism normalized. This case demonstrates that severe primary hypothyroidism may have an unusual presentation and should be considered in the differential diagnosis of pituitary enlargement associated with moderate hyperprolactinemia. Learning points One should always try to find one etiology as the common cause of all the clinical findings in a pathologic process.Amenorrhea, galactorrhea and fatigue may be the only presenting clinical manifestations of primary hypothyroidism.Not every patient with galactorrhea, hyperprolactinemia and a pituitary mass has a prolactinoma.Primary hypothyroidism should always be considered in the differential diagnosis of hyperprolactinemia associated with pituitary enlargement and pituitary hormone(s) deficiency(ies).When PH due to primary hypothyroidism is suspected, thyroid hormone replacement should be started and only regression of pituitary enlargement on MRI follow-up can confirm the diagnosis.Examination of thyroid function in patients with a pituitary mass may avoid unnecessary surgery. PMID:26279852

  5. A Multicentre Study of CLa Implant and Sino-implant Expanded Application (two-year follow-up)

    Institute of Scientific and Technical Information of China (English)

    方可娟; 关艳敏; 范慧民; 高尔生; 杨丹; 薜丽; 韩耀玲; 刘宝

    1997-01-01

    A multicentre comparative clinical study of CLa implant and Sino-implant was carried out at 100 subcentres in 11 provinces, and a total of 19673 subjects were recruited. Two year follow up has been finished. The follow-up rate at the end of two years was 94,29%. Two-year cumulative continuation rate per 100 women for Sino-implant(89.93) was significantly higher than that for CLa implant (88.89). Two-year cumulative pregnancy rates per 100 women were 0.0462(CLa implant) and 0.281(Sino-implant) respectively; there was statistically significant difference between them. No ectopic pregnancy was recorded among CLa implant users and three ectopic pregnancies were reported among Sino implant users,resulting in an ectopic pregnancy rate of 0.163 per 1000 women years. The incidence of side-effects appeared to diminish with time. The major side effects were the menstrual disturbances, which accounted for more than 90% of the total sideeffects, and the incidence of frequent menstruation, irregular bleeding and spotring was higher than that of infrequentjscanty menstruation and amenorrhea. Use of CLa implant had higher incidence of amenorrhea and infrequentjscanty menstruation than that of Sin-imptant. During two-year follow-up, the number of discontinuation due to menstrual problems contributed 78% of the total number of discontinuation; two year menstrual-related cumulative discontinuation rates were 8.96 per 100 women for CLa implant and 7.84 for Sino-implant; there was statistically significant difference(P< 0.01). Two-year study shows that the two types of implant are similar to Norplant in the incidence of side-effects and contraceptive efficacy as well as two year continuation rates.

  6. Rate and Time of Ovarian Function Restoration in Menopausal Breast Cancer Patients Who Received Letrozole Following Chemotherapy

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    Shapour Omidvari

    2015-01-01

    Full Text Available Background: The present study aimed to investigate the rate and time of ovarian function restoration in breast cancer patients between 40 and 60 years of age who were in menopause (biochemically documented and received letrozole after chemotherapy. We intended to further clarify the management strategy for breast cancer patients with different menopausal status. Methods: We prospectively measured the effects of replacing tamoxifen with letrozole on ovarian function recovery in 90 women from two age groups (40-50 and 51-60 years. All had breast cancer and were treated by chemotherapy. Patients had laboratory documentation of menopause (FSH >40 mIU/ml and estradiol <20 pg/mL. Patients did not have menstruation for at least one year. Study patients received letrozole. At three month intervals, we checked their FSH and estradiol levels. Results:At three months after beginning letrozole, 12 patients in the younger age group had laboratory ovarian function restoration, among which three had vaginal bleeding. In the older group, 8 patients had increased estradiol levels; however, there was no evidence of vaginal bleeding in this group. At 6, 9 and 12 months, no ovarian function restoration was seen in the older group. However in younger patients, 4 had laboratory evidence of ovarian function restoration at 6 months, 2 at 9 months and 1 patient showed laboratory ovarian function restoration at 12 months of follow-up. Totally, there was a significant difference in the occurrence of ovarian function restoration between the two groups (P=0.03. Conclusion: A remarkable portion of women with chemotherapy-induced amenorrhea may develop ovarian function restoration. Therefore, endocrine therapy using aromatase inhibitors in patients with chemotherapy-induced amenorrhea should be followed by a regular hormonal study.

  7. Turner Syndrome Genotype and phenotype and their effect on presenting features and timing of Diagnosis

    Science.gov (United States)

    Al Alwan, I; M, Khadora; Amir; G, Nasrat; A, Omair; L, Brown; M, Al Dubayee; M, Badri

    2014-01-01

    Background Turner syndrome (TS) is a common genetic disorder caused by abnormalities of the X chromosome. We aimed to describe the phenotypic characteristics of TS patients and evaluate their association with presenting clinical characteristics and time at diagnosis. Methods We studied females diagnosed with TS at King Abdul Aziz Medical City (KAMC), Riyadh between 1983 and 2010. Patients were classified based upon karyotype into females with classical monosomy 45,X (group A) and females with other X chromosome abnormalities (mosaic 45,X/46,XX, Xqisochromosomes, Xp or Xq deletion) (group B). Clinical features of the two groups were analyzed. Results Of the 52 patients included in the study, 16(30.8%) were diagnosed with classical monosomy 45,X and the rest with other X chromosome abnormalities. Only 19(36.5%) patients were diagnosed in infancy and the remaining during childhood or later (odds ratio (OR) = 4.5,95%CI 1.27–15.90, p=0.02). Short stature was universal in group A versus 77.8% in group B. All patients in group A had primary amenorrhea compared with 63.2% of those in group B (P = 0.04); the rest of group B had secondary amenorrhea. Cardiovascular abnormalities were higher in group A (OR=3.50, 95%CI 0.99–12.29, p-value =0.05). Renal defects and recurrent otitis media were similar in both groups. Conclusion This study suggests that karyotype variations might affect the phenotype of TS; however, it may not reliably predict the clinical presentation. Chromosomal analysis for all suspected cases of TS should be promptly done at childhood in order to design an appropriate management plan early in life. PMID:25246887

  8. Pituitary gonadotropic hormones in women with oligo/amenorrhoea

    International Nuclear Information System (INIS)

    Any abnormality of menstrual cycle makes women worried and requires proper evaluation. Oligomenorhea is one of the indicators of Polycystic Disease of the Ovary (PCO) which is associated not only with reproductive failure but it also has metabolic and cardiovascular complications. The recent study was conducted to find out the role of Pituitary Gonadotropins in the diagnosis. After diagnosing and finding out the cause for menstrual irregularities and chronic anovulation one can explain the prognosis and management of these disorders. Fifty patients were studied in the year 2005-06 in the outpatient department of Khyber Teaching Hospital Peshawar. A history Performa was duly completed in all subjects. Blood sample was collected for hormonal essay during first ten days of the cycle. Hormonal essay was performed by Microparticle enzyme immunoassay (MEIA) on AXSYM system of Abbott. Age ranged from 13-45 years, 82% of the women were infertile, 60% had infrequent periods and 22% of the women had amenorrhea, 30% patients were overweight while 48% were obese. Physical examination revealed hersuitism in 24%, acne in 8% and galactorrhea in 6% of the patients. Ultrasound examination showed classical picture of PCO in 28% patients while 32% women had multiple small follicles and 16 % women were devoid of follicles. Elevated LH levels were found in 36% women. FSH level were found normal in 64% patients while in 16% women the levels were in menopausal range. LH/FSH ratio of more than two was observed in 52% women. Prolactin level was raised in 22% women. TSH level was below normal in 16% and higher in 22% women. Hormonal essays are mandatory in the evaluation of women presenting with Oligomenorhea/amenorrhea and chronic anovulatory infertility for finding out the cause and explaining the prognosis of the disease to the patient. (author)

  9. Menstrual irregularities and energy deficiency in physically active women: the role of ghrelin, PYY and adipocytokines.

    Science.gov (United States)

    Scheid, Jennifer L; De Souza, Mary Jane

    2010-01-01

    Menstrual cycle irregularities are often observed among physically active women and athletes who participate in physical activity ranging from recreational to competitive exercise training. Further, such irregularities have been casually linked to an energy deficiency where caloric intake is inadequate for exercise energy expenditure resulting in a suppressive effect on growth and reproduction. Adaptations consistent with chronic energy deficiency, including reductions in resting energy expenditure and total triiodothyronine, have been observed in exercising women with functional hypothalamic amenorrhea (FHA). Gut peptides and adipocytokines also appear to be altered in exercising women with FHA and have been hypothesized to be involved in the etiology of FHA. Ghrelin concentrations are elevated in exercising women with FHA. Interestingly, while fasting ghrelin, an orexigenic peptide, is elevated in women with FHA, PYY, an orexigenic peptide, is paradoxically also elevated in women with anorexia nervosa and exercising women with FHA. Leptin, an adipocytokine, is also suppressed in FHA associated with exercise and anorexia. A critical leptin concentration threshold is suggested to be necessary for regular menses to occur. Ghrelin, PYY, and leptin all have the ability to cross the blood brain barrier and, in the hypothalamus, can modulate appetite and food intake, and are hypothesized to affect the hypothalamic-pituitary-ovarian axis. Future studies are needed to determine if ghrelin, PYY, or leptin play a direct role in the regulation of the hypothalamic-pituitary-ovarian axis, and if these signals can be altered by improving energy status secondary to increasing caloric intake and initiate the reversal of amenorrhea. PMID:20956862

  10. Female athlete triad and its components: toward improved screening and management.

    Science.gov (United States)

    Javed, Asma; Tebben, Peter J; Fischer, Philip R; Lteif, Aida N

    2013-09-01

    As female athletic participation has increased, the positive effects of exercise on health have become evident. However, with this growth in sports activity, a set of health problems unique to the female athlete has emerged. The female athlete triad as first described in 1992 by the American College of Sports Medicine consisted of disordered eating, amenorrhea, and osteoporosis; the definition was updated in 2007 to include a spectrum of dysfunction related to energy availability, menstrual function, and bone mineral density. For this review, a comprehensive search of databases-MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Scopus, from earliest inclusive dates to January 2013-was conducted by an experienced librarian with input from the authors. Controlled vocabulary supplemented with keywords such as female athlete triad, amenorrhea, oligomenorrhea, fracture, osteopenia, osteoporosis, bone disease, anorexia, bulimia, disordered eating, low energy availability was used to search for articles on female athlete triad. Articles addressing the prevalence, screening, and management of the female athlete triad were selected for inclusion in the review. This article reviews the current definitions of the triad components, epidemiology, pathophysiology, and recommended screening and management guidelines. The lack of efficacy of current screening of athletes is highlighted. Low energy availablity, from either dietary restriction or increased expenditure, plays a pivotal role in development of the triad. Athletes involved in "lean sports" (those that emphasize weight categories or aesthetics, such as ballet, gymnastics, or endurance running) are at highest risk. Treatment is centered on restoring energy availability to reverse adverse changes in the metabolic milieu. Prevention and early recognition of triad disorders are crucial to ensure timely intervention

  11. BIRTH INTERVAL AMONG NOMAD WOMEN

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    E.Keyvan

    1976-06-01

    Full Text Available To have an, idea about the relation between the length of birth interval and lactation, and birth control program this study have been done. The material for such analysis was nomad women's fertility history that was in their reproductive period (15-44. The material itself was gathered through a health survey. The main sample was composed of 2,165 qualified women, of whom 49 due to previous or presently using contraceptive methods and 10 for the lack of enough data were excluded from 'this study. Purpose of analysis was to find a relation between No. of live births and pregnancies with total duration of married life (in other word, total months which the women were at risk of pregnancy. 2,106 women which their fertility history was analyzed had a totally of272, 502 months married life. During this time 8,520 live births did occurred which gave a birth interval of 32 months. As pregnancy termination could be through either live birth, still birth or abortion (induced or spontaneous, bringing all together will give No. of pregnancies which have occurred during this period (8,520 + 124 + 328 = 8,972 with an average of interpregnancy interval of 30.3 months. Considering the length of components of birth interval: Post partum amenorrhea which depends upon lactation. - Anovulatory cycles (2 month - Ooulatory exposure, in the absence of contraceptive methods (5 months - Pregnancy (9 months.Difference between the length, of birth interval from the sum of the mentioned period (except the first component, (2 + 5+ 9 = 16 will be duration of post partum amenorrhea (32 - 16 = 16, or in other word duration of breast feeding among nomad women. In this study it was found that, in order to reduce birth by 50% a contraceptive method with 87% effectiveness is needed.

  12. Cancer of endometrium and prolonged estrogen therapy.

    Science.gov (United States)

    Fremont-smith, M; Meigs, J V; Graham, R M; Gilbert, H H

    1946-07-01

    A causal link between prolonged estrogen (E) therapy and endometrial cancer is argued for in this report of a case who was treated with large amounts of estrogenic substances almost continuously for an 8-year period. In 1919 a 25-year-old woman was admitted with asthma of 1-year duration. Asthma onset had been very severe, requiring administration of epinephrine hydrochloride every few hours and frequent hospital observation. In 1928, the patient was amenorrheic for 8 months; in 1936, she experienced amenorrhea for 4 months. In 1937 (patient now 45 years old), the relationship between amenorrhea and increased severity of asthma was suspected. At this time, the patient also complained of hot flashes and sweats. Treatment with estrogenic substances was begun in 1937 and continued through 1945. 3 unusual features were noted during therapy: 1) persistence of hot flashes; 2) persistence of high urine titers of follicle stimulating hormone (FSH) despite adequate E doses; and 3) absence of bleeding when E was temporarily withdrawn. By 1945, endometrial cancer had been identified by vaginal smear and verified by biopsy. Because of the previous absence of respose of FSH to prolonged E therapy, Es were omitted for 4 weeks, and after this period the vaginal smear showed complete absence of intrinsic estrogenic stimulation, and the urine titer of FSH was high. E given for 10 days caused moderate pituitary inhibition. Determination of 17-keto-steroids made before and after therapy was abnormally low. Except for the state of chronic illness and the continuous administration of asthma medication (chronic alarm reaction?), there is no explanation of carcinoma grade 2. PMID:12334535

  13. New research on breast-feeding as a method of fertility regulation.

    Science.gov (United States)

    1995-01-01

    The World Health Organization (WHO) Special Programme of Research, Development and Research Training in Human Reproduction's Task Force on Methods for the Natural Regulation of Fertility promotes research on lactation to develop a better understanding of how breast feeding inhibits fertility. The knowledge gained will allow health workers and pregnant women to receive reliable advice on breast feeding as a birth spacing method. A multicenter study, begun in 1989, examined how different breast feeding practices influence the length of time lactating women go without menstruation. The 4100 mothers maintained detailed records of all feeding episodes and of supplementary foods as well as of vaginal bleeding. The not-yet-published findings should further development of guidelines on lactational amenorrhea. They should show how lactating mothers can use certain breast feedings to influence the length of infertility. Some findings already revealed are feeding patterns vary greatly worldwide. For example, the breast feeding episodes of Australian and Swedish infants are, on average, 3 times longer than those of Chinese infants (24 vs. 6 minutes/episode). The study's findings will contribute greatly to the second Bellagio Conference in December 1995 entitled The Lactational Amenorrhoea Method (LAM) of Family Planning: Efficacy and Modification of the Bellagio Guidelines. A study in Sri Lanka shows that a 50 g powdered skimmed milk supplement given to lactating mothers did not affect the duration of lactational amenorrhea, but these mothers did breast feed longer than those who did not receive the supplement. Demographic and Health Survey data from Indonesia and Peru suggest that postpartum abstinence is not associated with breast feeding status and that lactating women were more likely to use contraception than non-lactating women. Another multicenter study is examining the efficacy, feasibility, and acceptability of LAM as an interim method of birth spacing and as a way to

  14. Treatment of hyperprolactinemia: a systematic review and meta-analysis

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    Wang Amy T

    2012-07-01

    Full Text Available Abstract Background Hyperprolactinemia is a common endocrine disorder that can be associated with significant morbidity. We conducted a systematic review and meta-analyses of outcomes of hyperprolactinemic patients, including microadenomas and macroadenomas, to provide evidence-based recommendations for practitioners. Through this review, we aimed to compare efficacy and adverse effects of medications, surgery and radiotherapy in the treatment of hyperprolactinemia. Methods We searched electronic databases, reviewed bibliographies of included articles, and contacted experts in the field. Eligible studies provided longitudinal follow-up of patients with hyperprolactinemia and evaluated outcomes of interest. We collected descriptive, quality and outcome data (tumor growth, visual field defects, infertility, sexual dysfunction, amenorrhea/oligomenorrhea and prolactin levels. Results After review, 8 randomized and 178 nonrandomized studies (over 3,000 patients met inclusion criteria. Compared to no treatment, dopamine agonists significantly reduced prolactin level (weighted mean difference, -45; 95% confidence interval, -77 to −11 and the likelihood of persistent hyperprolactinemia (relative risk, 0.90; 95% confidence interval, 0.81 to 0.99. Cabergoline was more effective than bromocriptine in reducing persistent hyperprolactinemia, amenorrhea/oligomenorrhea, and galactorrhea. A large body of noncomparative literature showed dopamine agonists improved other patient-important outcomes. Low-to-moderate quality evidence supports improved outcomes with surgery and radiotherapy compared to no treatment in patients who were resistant to or intolerant of dopamine agonists. Conclusion Our results provide evidence to support the use of dopamine agonists in reducing prolactin levels and persistent hyperprolactinemia, with cabergoline proving more efficacious than bromocriptine. Radiotherapy and surgery are useful in patients with resistance or intolerance

  15. Genetic and environmental determinants of menstrual characteristics

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    Shayesteh Jahanfar

    2012-01-01

    Full Text Available Background: The impact of women′s menstrual cycle on her quality of life, health, work, and community is substantial. Menstrual disturbance is linked with general ill conditions such as migraine, asthma, and endocrinopathies. The clinical significance of medical interventions to prevent these conditions becomes clear if the role of genetic or environment is clarified. Aims: To identify the genetic and environmental contribution on menstrual characteristics. Setting and Design: This was a cross-sectional study in 2 Asian countries. Materials and Methods: 2 cohorts of monozygotic and dizygotic twins born between (1945-1988, n = 122 and (1951-1993, n = 71 were taken. A standard questionnaire was designed inclusive of socio- demographic characteristics of subjects as well as menstrual history (duration, interval, amount, irregularity. Subjects were interviewed by phone. Statistical Analysis: Quantitative variables were analyzed using Falconars′ formula as well as maximum likelihood analysis. Structural modeling was then applied to twin correlations to provide estimates of the relative genetic and/or environmental factors contribution in determining the measured trait. Results: Menstrual characteristics were found to be under environmental influence where the best fitting model for menstrual interval and duration was common environment. CDF plotting confirmed the results for both variables. Proband-wise concordance analysis for amount of menstruation, amenorrhea, and irregular menstruation revealed no genetic influence. The best fitting model for menstrual irregularity was CE (C73%, E27%. The same model was defined for amenorrhea (C48%, E52%. Conclusions: Environmental factors are most likely responsible to determine the menstrual flow, its integrity, and regularity. These factors need to be studied further.

  16. Bleeding patterns of women using Lunelle monthly contraceptive injections (medroxyprogesterone acetate and estradiol cypionate injectable suspension) compared with those of women using Ortho-Novum 7/7/7 (norethindrone/ethinyl estradiol triphasic) or other oral contraceptives.

    Science.gov (United States)

    Garceau, R J; Wajszczuk, C J; Kaunitz, A M

    2000-12-01

    Persistent and/or unpredictable bleeding is a common reason for discontinuation of hormonal contraceptive methods. An open-label, nonrandomized, parallel, controlled study compared the efficacy, safety, and cycle control of the new, highly efficacious monthly injectable contraceptive containing 25 mg medroxyprogesterone acetate (MPA) and 5 mg estradiol cypionate (E(2)C) (MPA/E(2)C) (Lunelle Monthly Contraceptive Injection) with that of the frequently used norethindrone 0.5, 0.75, 1.0 mg/0.035 mg ethinyl estradiol (NET/EE) triphasic oral contraceptive (Ortho-Novum 7/7/7). This report directly compares the bleeding patterns of women on MPA/E(2)C to those of women on NET/EE and untreated women. Overall, breakthrough bleeding occurred less frequently in women using MPA/E(2)C than in women using NET/EE (p < or =0.01). However, more women using MPA/E(2)C experienced amenorrhea/missed periods than those on NET/EE (p < or =0.01). In addition, the percentage of women experiencing breakthrough bleeding or amenorrhea while using other oral contraceptives is compared to that of women using MPA/E(2)C. A rapidly reversible method, MPA/E(2)C, combines the high contraceptive efficacy of surgical sterilization with the convenience of monthly administration. These data suggest that, for a large proportion of women, MPA/E(2)C offers predictability in bleeding patterns comparable to or greater than that experienced by ovulatory untreated women or those using combination oral contraceptives. PMID:11239615

  17. Prevalence of depressive symptoms among perimenopausal female teachers for both Primary and High School levels

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    Isabel Eugenia Jáuregui-Durán,

    2005-08-01

    Full Text Available Depression is the main cause of disability-adjustedlost years around the world; hormonal changes which happen duringmenopause seem to increase susceptibility to develop depression.Aim: To establish depressive symptoms prevalence among femaleteachers aged 45 to 55 living at the Metropolitan Area of the Cityof Bucaramanga. Method: Cross-sectional survey with CES-D.Multivariated analysis was made to adjust confounding caused bydemographic and sexual/reproductive history variables with clinicallysignificant depressive symptoms (CSDS. Results: 581 womenparticipated (age average 50.3 years, 19.2% took hormonal therapy(HT; 50.2% (95%CI 45.3-55.2 were at their menopause. CES-Dscore oscillated between 0 and 39 points (average 13.6, beingsuperior among women with more time of amenorrhea, but not accordingto age, marital status, HT or sexual life. CSDS prevalencewas 32.4% (95%CI 28.6-36.3, but adjusted by predictive valuesallows to estimate a depression prevalence in 11.5%. The associatedfactors with CSDS were age (prevalence rate –PR– 0.948,95%CI 0.912-0.986, to have active sexual life (PR 0.492, 95%CI0.384-0.632, amenorrhea time (PR 1.57, 95%IC 1.057, IC 95%1.035-1.080, being divorced (PR 0.604, 95%CI 0.371-0.983, beingsingle (PR 0.590, 95%CI 0.381-0.914 and living out of wedlock.(PR 1.707, 95%CI 1.352-2.155. Conclusions: The depressionprevalence among perimenopauseal female teachers is similar to thegeneral population, being their risk factors similar to ones alreadyinformed in the medical literature.

  18. Endocrine identification of menopausal status of Sudanese women

    International Nuclear Information System (INIS)

    This study was conducted in order to identify the menopausal statues of Sudanese women which is critically important in determining the treatment strategy for infertile patients. In this study samples were collected from two hundred Sudanese women, aged between 35 and 62. They were from different social classes and are not suffering any systemic or endocrine disease. They were not exposed to any surgical intervention by complete hysterectomy or partial removal of ovaries or thyroidectomy. Reproductive hormones were determined for these women. Immunoradiometric Assay (IRMA) was adopted for the measurement of serum prolactin, follicle stimulating hormone, and luteinizing hormone. Enzyme linked immunosorbent assay (ELISA) was used for the determination of estradiol and esterone, whereas, enzyme immunoassay (tube format) was used for the determination of serum testosterone. Average menopausal age for Sudanese women was determined in this study and found to be 43.0±4.2 which is lower than that of the neighboring countries. A new classification system was developed during this study which uses a combination of symptoms together with hormonal profile in order to identify the menopausal status of women. The three key tools of this system are FSH and LH level together with the absence of menstrual cycle during the last three months. The new classification scheme had successfully differentiated the early peri-menopausal women from pre-menopausal ones. The early peri-menopausal women according to the new classification scheme are suffering cycle irregularities and amenorrhea but with normal hormonal levels. The new classification scheme is now, clearly indicating that amenorrhea with normal hormonal levels may be an indication to the beginning of the peri-menopausal life. The big challenge faced during this study had been the sub-classification of the peri-menopausal stage as it is not a single homogeneous stage but a wide heterogenous and transitional stage extending from

  19. THALASSAEMIA AND ABERRATIONS OF GROWTH AND PUBERTY

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    Andreas Kyriakou

    2009-07-01

    Full Text Available Endocrine dysfunction in Thalassaemia major (TM is a common and disturbing complication, which requires prompt recognition and treatment. The contribution of the underlying molecular defect in TM to the development of endocrinopathies is significant because the patients with the more severe genetic defects have a greater rate of iron loading through higher red cell consumption. TM patients frequently present delay of growth and puberty with reduction of final height. The pathogenesis of growth failure is multifactorial and is mainly due to chronic anemia and hypoxia, chronic liver disease, zinc and folic acid deficiency, iron overload, intensive use of chelating agents, emotional factors, and endocrinopathies (hypogonadism, delayed puberty, hypothyroidism and GH-IGF-1 axis dysregulation. Although appropriate iron chelation therapy can improve growth and development, TM children and adolescents treated intensively with desferrioxamine remain short as well, showing body disproportion between the upper and lower body segment. Body disproportion is independent of prepubertal or pubertal period of greater height gain. Treatment with recombinant GH (rhGH is recommended when GH deficiency is established, and even so, the therapeutic response is often non satisfactory. Growth acceleration is mostly promoted with sex steroids in children with associated pubertal delay. Sexual complications in TM, which include Delayed Puberty, Arrested Puberty and Hypogonadism, present the commonest endocrine complication. Iron deposition on gonadotroph cells of the pituitary leads to disruption of gonadotrophin production which is proven by the poor response of FSH and LH to GnRH stimulation. In the majority of patients gonadal function is normal as most women with Amenorrhea are capable of achieving pregnancy with hormonal treatment and similarly men with azoospermia become fathers. Secondary Hypogonadism appears later in life,    and is manifested in women as

  20. [CONSERVATIVE TREATMENT OF MAYER-ROKITANSKY-KÜSTER-HAUSER SYNDROME. REVIEW OF LITERATURE AND OUR EXPERIENCE].

    Science.gov (United States)

    Sirakov, M; Tomova, E

    2016-01-01

    Mayer-Rokitansky-Küster-Hauser syndrome is a part of the group of abnormalities known as "Anomalies of the fusion of the Müllerian ducts". It is characterized by normal development of breasts and hairs, normal appearance of external genitalia, normal feminine genotype (46XX), normal FSH, LH, E₂ and Test. levels, normal ovaries and congenital absence of uterus and the whole or the upper two thirds of the vagina. It is observed in about 15% of the cases with primary amenorrhea and the incidence is about 1:4500-6000. Etiologycal factors such as lack of estrogen/gestagen receptors, deletions or mutations of genes that stop the fusion, as well as the activation of anti-Müllerian hormone (AMH), are considered. The etiology is being explored but there is no consensus yet. The diagnosis is confirmed during a clinical examination, which takes place because of a primary amenorrhea (often happening at the age of 16), and the absence of a uterus and vagina is proved. The therapy should be handled by a multidisciplinary team including obstetrician, trained midwife, psychologist, specialist in imaging and psycho-sexual counseling. The idea for surgical creation of vagina (neovagina) dates many years ago. The first known documents date back to 1817 and over the years a variety of methods are offered usage of amnion, dura mater, peritoneum, skin grafts, different parts of the intestine, cellulose, etc. The first method of non-surgical treatment is offered by the Czech gynecologist Frank. His ambition was to build a vagina by gradual dilatation of the tissue while applying dilatators with successively increasing length and thickness. The method was further developed by Ingram (1981) and nowadays by Edmonds (2012). He reported about 245 patients treated during the last 12 years by his team. 232 of them had a success in anatomic aspect (95%), 13 did not complete the treatment due to psychological or cultural problems. The experts from American College of Obstetricians and

  1. Radiotherapy for pituitary adenomas: long-term outcome and complications

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    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung AE; Kim, Chul Yong [Korea University Medical Center, Seoul (Korea, Republic of)

    2011-09-15

    To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-fi ve patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing

  2. The changing role of breastfeeding in economic development: a theoretical exposition.

    Science.gov (United States)

    Butz, W P

    1981-01-01

    This paper develops a model of breastfeeding, contraception, and birth spacing that includes physiological and behavioral aspects and yields a number of testable predictions concerning influences of particular factors on breastfeeding. The model is built on the assumption that breastfeeding is a costly activity for most women, requiring time and nutrients, neither of which is freely available. Given these costs, the fact that many women do breastfeed suggests that it also produces benefits that people value such as the survival and development of the child and birth spacing. The model also assumes that mothers respond to changes in the cost of the activity and that of other means of contraception and feeding babies. It implies that mothers will breastfeed less when their time spent in other ways is more valuable and when substitutes for breastfeeding are more readily available. The author begins with a model of birth spacing and child survival that includes the roles of breastfeeding, and its substitutes. The number of live births is influenced by economic returns that raise family income, and utility returns to the parents. Given a desired number of surviving children and a particular probability of child survival, the couple can achieve its resulting desired number of births and the implied average births interval by adjusting either the length of postpartum amenorrhea or the length of the interval. A shift in the demand (supply) curve causes a larger shift in the amount of breastfeeding when the supply (demand) curve is more elastic. When there is an active wetnursing market, variations in factors that underlie a woman's breastfeeding supply curve may affect her period of postpartum amenorrhea but not the survival or development of her children. Also, shifts in factors that influence woman's demand for breastfeeding may affect her infant's development and survival but not a woman's fecundity. Some implications of this model are: 1) an increase in the market

  3. Effect of Chronic Athletic Activity on Brown Fat in Young Women

    Science.gov (United States)

    Singhal, Vibha; Maffazioli, Giovana D.; Ackerman, Kate E.; Lee, Hang; Elia, Elisa F.; Woolley, Ryan; Kolodny, Gerald; Cypess, Aaron M.; Misra, Madhusmita

    2016-01-01

    Background The effect of chronic exercise activity on brown adipose tissue (BAT) is not clear, with some studies showing positive and others showing negative associations. Chronic exercise is associated with increased resting energy expenditure (REE) secondary to increased lean mass and a probable increase in BAT. Many athletes are in a state of relative energy deficit suggested by lower fat mass and hypothalamic amenorrhea. States of severe energy deficit such as anorexia nervosa are associated with reduced BAT. There are no data regarding the impact of chronic exercise activity on BAT volume or activity in young women and it is unclear whether relative energy deficiency modifies the effects of exercise on BAT. Purpose We assessed cold induced BAT volume and activity in young female athletes compared with non-athletes, and further evaluated associations of BAT with measures of REE, body composition and menstrual status. Methods The protocol was approved by our Institutional Review Board. Written informed consent was obtained from all participants prior to study initiation. This was a cross-sectional study of 24 women (16 athletes and8 non-athletes) between 18–25 years of age. Athletes were either oligo-amenorrheic (n = 8) or eumenorrheic (n = 8).We used PET/CT scans to determine cold induced BAT activity, VMAX Encore 29 metabolic cart to obtain measures of REE, and DXA for body composition. Results Athletes and non-athletes did not differ for age or BMI. Compared with non-athletes, athletes had lower percent body fat (p = 0.002), higher percent lean mass (p = 0.01) and trended higher in REE (p = 0.09). BAT volume and activity in athletes trended lower than in non-athletes (p = 0.06; p = 0.07, respectively). We found negative associations of BAT activity with duration of amenorrhea (r = -0.46, p = 0.02).BAT volume correlated inversely with lean mass (r = -0.46, p = 0.02), and positively with percent body fat, irisin and thyroid hormones. Conclusions Our study

  4. Effect of Chronic Athletic Activity on Brown Fat in Young Women.

    Directory of Open Access Journals (Sweden)

    Vibha Singhal

    Full Text Available The effect of chronic exercise activity on brown adipose tissue (BAT is not clear, with some studies showing positive and others showing negative associations. Chronic exercise is associated with increased resting energy expenditure (REE secondary to increased lean mass and a probable increase in BAT. Many athletes are in a state of relative energy deficit suggested by lower fat mass and hypothalamic amenorrhea. States of severe energy deficit such as anorexia nervosa are associated with reduced BAT. There are no data regarding the impact of chronic exercise activity on BAT volume or activity in young women and it is unclear whether relative energy deficiency modifies the effects of exercise on BAT.We assessed cold induced BAT volume and activity in young female athletes compared with non-athletes, and further evaluated associations of BAT with measures of REE, body composition and menstrual status.The protocol was approved by our Institutional Review Board. Written informed consent was obtained from all participants prior to study initiation. This was a cross-sectional study of 24 women (16 athletes and8 non-athletes between 18-25 years of age. Athletes were either oligo-amenorrheic (n = 8 or eumenorrheic (n = 8.We used PET/CT scans to determine cold induced BAT activity, VMAX Encore 29 metabolic cart to obtain measures of REE, and DXA for body composition.Athletes and non-athletes did not differ for age or BMI. Compared with non-athletes, athletes had lower percent body fat (p = 0.002, higher percent lean mass (p = 0.01 and trended higher in REE (p = 0.09. BAT volume and activity in athletes trended lower than in non-athletes (p = 0.06; p = 0.07, respectively. We found negative associations of BAT activity with duration of amenorrhea (r = -0.46, p = 0.02.BAT volume correlated inversely with lean mass (r = -0.46, p = 0.02, and positively with percent body fat, irisin and thyroid hormones.Our study shows a trend for lower BAT in young female

  5. Radiotherapy for pituitary adenomas: long-term outcome and complications

    International Nuclear Information System (INIS)

    To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-fi ve patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing's disease

  6. A comparison of levonorgestrel implants with depo-medroxyprogesterone acetate injections for contraception.

    Science.gov (United States)

    London, R S

    1993-10-01

    The Norplant System of levonorgestrel implants and the Depo Provera contraceptive Injection of sterile medroxy progesterone acetate suspension (DMPA) are longterm, progestagen-based contraceptive delivery systems designed to overcome noncompliance which are under review for use in Canada. 150 mg of DMPA, a pregnane compound derived from progesterone, is injected every 3 months. Peak plasma concentrations are reached in 24 hours and plateau for 3-4 months before gradually declining. After termination, ovulation returns on average in 4.5 months, and conception occurs at a median time of 10 months. 90% conceive by 24 months. In the Norplant system, a steady daily supply of 50-80 mcg of levonorgestrel, a gonane progestin derived from the testosterone nucleus which has both progestogenic and androgenic receptor affinity, diffuses from 5 Silastic implants, which must be replaced every 5 years. Ovulation and fertility return rapidly after rod removal. The actual and lowest expected failure rates are equal for both systems. The failure rate for DMPA is .3 pregnancies per 100 women years, while that for levonorgestrel is .4% in 1 year. Although neither method affects blood pressure, DMPA appears to affect carbohydrate metabolism by impairing glucose tolerance and increasing insulin production. Lipid metabolism is also affected. 5% of those who use levonorgestrel discontinue it because of side effects, including headache, mastodynia, and acne; 19.1% of DMPA users did so, especially for weight gain and menstrual cycle abnormalities. Both methods have a higher frequency of menstrual abnormalities than normal. 27.7% of levonorgestrel users experienced prolonged bleeding, while 17% experienced spotting during the first 6 months. However, normal menses usually returned within a year, and only 7.9% discontinued use because of cycle abnormalities. In 1 study, less than 10% of DMPA users experienced normal cycles, and in another study 35% experienced amenorrhea (500/700 discontinued

  7. Management of resistant prolactinoma in infertile lady with successful maternal and perinatal outcome

    Directory of Open Access Journals (Sweden)

    Niroopama Pushpagiri

    2015-10-01

    Full Text Available Mrs. X of 28 years presented to the gynaecology department with primary infertility for 4 years, secondary amenorrhea for 6 months and galactorrhea for 3 months. She was investigated and diagnosed to have macroprolactinoma. Medical treatment with cabergoline was started. Patient became symptomatically free in 6 months with gradual reduction in serum prolactin levels as well as tumour size. After 2 years of therapy, failure of normalisation of prolactin levels and failure of significant tumour reduction observed and diagnosed it as resistant prolactinoma. Considering her infertility and future complications associated with resistant macroadenoma, she was treated with stereotactic radiosurgery using cyber knife radiation. Tumour regression in MRI with significant decrease in serum prolactin levels were observed in the post radiation period and monthly follow up done. She conceived spontaneously after 2 months of radiotherapy. She has been followed up with visual field testing during antenatal period. Her antenatal, intranatal period was uneventful with successful maternal and perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1659-1662

  8. [Current diagnosis and treatment of hyperprolactinemia].

    Science.gov (United States)

    Melgar, Virgilio; Espinosa, Etual; Sosa, Ernesto; Rangel, María José; Cuenca, Dalia; Ramírez, Claudia; Mercado, Moisés

    2016-01-01

    Hyperprolactinemia is a frequent neuroendocrinological condition that should be approached in an orderly and integral fashion, starting with a complete clinical history. Once physiological causes such as pregnancy, systemic disorders such as primary hypothyroidism and the use of drugs with dopamine antagonistic actions such as metochlopramide have been ruled out, the most common cause of hyperprolactinemia is a PRL-secreting pituitary adenoma or prolactinoma. Prolactinomas are usually classified as microprolactinomas (less than 1 cm) or macroprolactinomas (larger than 1 cm), which can either be confined or invasive. The hormonal consequence of hypeprolactinemia is hypogonadism; in women, this is manifested as amenorrhea/oligomenorreha, anovulation and galactorrhea, whereas in men the main complaints are a diminished libido and erectile dysfunction. Macroprolactinomas can also present with symptoms and signs resulting form mass effect of the tumor, such as headaches and visual field defects. Other structural causes of hyperprolactinemia include non-functioning pituitary adenomas and infiltrative disorders, which can interrupt the inhibitory, descending dopaminergic tone. The primary treatment of prolactinomas is pharmacological with dopamine agonists such as cabergoline. PMID:26820213

  9. Identification of a novel large CYP17A1 deletion by MLPA analysis in a family with classic 17α-hydroxylase deficiency.

    Science.gov (United States)

    Turkkahraman, Doga; Guran, Tulay; Ivison, Hannah; Griffin, Aliesha; Vijzelaar, Raymon; Krone, Nils

    2015-01-01

    Steroid 17α-hydroxylase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia caused by mutations in the 17α-hydroxylase ( CYP17A1) gene. CYP17A1 is a key enzyme in the biosynthesis of adrenal and gonadal steroid hormones facilitating both 17α-hydroxylase and 17,20-lyase activities. We characterized a partial CYP17A1 deletion in a Kurdish family with 17OHD by multiplex ligation-dependent probe amplification (MLPA). The index patient presented with amenorrhea and lack of pubertal development. Investigations established the diagnosis of 46,XY disorder of sex development (DSD). She is the daughter of consanguineous parents and has 2 sisters with similar clinical presentation. All patients showed biochemical signs of primary adrenal and gonadal insufficiency. The molecular genetic analysis by PCR suggested a deletion spanning exons 1–6 of the CYP17A1 gene. MLPA analysis confirmed the large partial CYP17A1 deletion in patients and parents in homozygous and heterozygous state, respectively. This is the first report employing MLPA for mutation analysis to detect a deletion of CYP17A1 spanning multiple exons in 3 patients with classic 17OHD. Therefore, it is important to consider large partial CYP17A1 deletions in 17OHD in addition to point mutations in cases where no segregation analysis is possible to determine the correct genotype. PMID:25765894

  10. IGSF10 mutations dysregulate gonadotropin-releasing hormone neuronal migration resulting in delayed puberty.

    Science.gov (United States)

    Howard, Sasha R; Guasti, Leonardo; Ruiz-Babot, Gerard; Mancini, Alessandra; David, Alessia; Storr, Helen L; Metherell, Lousie A; Sternberg, Michael Je; Cabrera, Claudia P; Warren, Helen R; Barnes, Michael R; Quinton, Richard; de Roux, Nicolas; Young, Jacques; Guiochon-Mantel, Anne; Wehkalampi, Karoliina; André, Valentina; Gothilf, Yoav; Cariboni, Anna; Dunkel, Leo

    2016-01-01

    Early or late pubertal onset affects up to 5% of adolescents and is associated with adverse health and psychosocial outcomes. Self-limited delayed puberty (DP) segregates predominantly in an autosomal dominant pattern, but the underlying genetic background is unknown. Using exome and candidate gene sequencing, we have identified rare mutations in IGSF10 in 6 unrelated families, which resulted in intracellular retention with failure in the secretion of mutant proteins. IGSF10 mRNA was strongly expressed in embryonic nasal mesenchyme, during gonadotropin-releasing hormone (GnRH) neuronal migration to the hypothalamus. IGSF10 knockdown caused a reduced migration of immature GnRH neurons in vitro, and perturbed migration and extension of GnRH neurons in a gnrh3:EGFP zebrafish model. Additionally, loss-of-function mutations in IGSF10 were identified in hypothalamic amenorrhea patients. Our evidence strongly suggests that mutations in IGSF10 cause DP in humans, and points to a common genetic basis for conditions of functional hypogonadotropic hypogonadism (HH). While dysregulation of GnRH neuronal migration is known to cause permanent HH, this is the first time that this has been demonstrated as a causal mechanism in DP‡. PMID:27137492

  11. Middle calyx ureterocalicostomy in ectopic pelvic kidney with ureteropelvic junction obstruction: Only alternative for renal salvage

    Directory of Open Access Journals (Sweden)

    Jaisukh Kalathia

    2016-01-01

    Full Text Available Anomalous kidneys are mostly asymptomatic and are often found incidentally during physical or radiological investigations for urological or other medical complaints. The associated genital anomalies ranges from 15% to 45%. Females are associated with bicornuate or unicornuate uterus, rudimentary or absent uterus while males have undescended testes, duplication of the urethra, and hypospadias. A 21 year old married female presented with on and off lower abdomen pain for the past one year with history of primary amenorrhea. On examination an ill defined tender lump palpated in the lower abdomen. USG showed left ectopic pelvic kidney with gross hydronephrosis. The computed tomography confirmed hydronephrotic left ectopic pelvic kidney in front of the sacrum with anteriorly directed renal pelvis with ureter located posteriorly. There was delayed excretion from the ectopic kidney but right kidney was in normal position and function. The diethylene triamine pentaacetic acid (DTPA scan showed 33% function of the ectopic kidney. On diagnostic laparoscopy, the uterus was small hypoplastic with bilateral ovaries appearing normal. The patient was taken for open pyeloplasty where the ureter was transected below PUJ but for a dependent drainage, the middle calyx as was the most dependent calyx as seen on the CT-scan. So a middle calyx ureterocalicostomy was performed calyx with excellent outcome. The ectopic kidney always remains a challenge because of complex neurovascular anatomy, presence of viscera and associated UPJO, but for a dependent drainage, middle calyx ureterocalicostomy is a feasible option with excellent outcome as was in our case.

  12. Influence of pregnancy stage and fetus position on the whole-body and local exposure of the fetus to RF-EMF

    International Nuclear Information System (INIS)

    This paper analyzes the influence of pregnancy stage and fetus position on the whole-body and brain exposure of the fetus to radiofrequency electromagnetic fields. Our analysis is performed using semi-homogeneous pregnant woman models between 8 and 32 weeks of amenorrhea. By analyzing the influence of the pregnancy stage on the environmental whole-body and local exposure of a fetus in vertical position, head down or head up, in the 2100 MHz frequency band, we concluded that both whole-body and average brain exposures of the fetus decrease during the first pregnancy trimester, while they advance during the pregnancy due to the rapid weight gain of the fetus in these first stages. From the beginning of the second trimester, the whole-body and the average brain exposures are quite stable because the weight gains are quasi proportional to the absorbed power increases. The behavior of the fetus whole-body and local exposures during pregnancy for a fetus in the vertical position with the head up were found to be of a similar level, when compared to the position with the head down they were slightly higher, especially in the brain. (paper)

  13. Testosterone-secreting adrenal adenoma in a peripubertal girl

    International Nuclear Information System (INIS)

    A 15-year-old girl who presented with primary amenorrhea and virilization had an adrenocortical adenoma that secreted predominantly testosterone. To the authors' knowledge, she is the first peripubertal and second youngest patient with a testosterone-secreting adrenal tumor described. Serum dehydroepiandrosterone sulfate and urinary 17-ketosteroid an 17-hydroxycorticosteroid levels were normal. A tumor was located by a computed tomographic (CT) scan and by uptake of 6-β-[75Se] selenomethylnorcholesterol. Microscopic examination of the tumor showed typical features of an adrenocortical adenoma with no histologic features characteristic of Leydig cells. Postoperatively, her hirsutism regressed, she rapidly went through puberty, and regular monthly menstruation started four months later. Finding the source of testosterone in a virilized patient can be difficult. Eleven of the 14 previously described patients with testosterone-secreting adrenal tumors initially underwent misdirected surgery on the ovaries. Review of these cases revealed that results of hormone stimulation and suppression tests are unreliable and that these tumors are usually large. Therefore, CT scanning of the adrenal glands is recommended in all patients suspected of having a testosterone-secreting tumor

  14. An unexpected reason for elevated human chorionic gonadotropin in a young woman. Cervical squamous carcinoma.

    Science.gov (United States)

    Mustafa, Aynur; Bozdag, Zehra; Tepe, Neslihan B; Ozcan, Husiyen C

    2016-08-01

    Human chorionic gonadotropin has been used for decades, in addition to specific investigations, to detect pregnancy, trophoblastic tumors, as well as congenital defects. Rarely, it can be elevated in  non-trophoblastic tumors such as squamous cell cancers and germ cell tumors. A 33-year-old Asian Syrian female had irregular menses accompanied with feelings of heaviness in the vagina. In addition to routine investigations, we measured the serum beta human chorionic gonadotropin (ß-HCG) level (based on the patient's complaint of amenorrhea), which was 50.05 ml UI/ml. Cervical biopsy revealed a non-keratinized large cell squamous carcinoma. After excluding other causes, ß-hCG elevation was explained by the ectopic secretion of cancer cells line. Cervical biopsy was suggestive of large cell non-keratinizing squamous cell carcinoma and positive for human chorionic gonadotropin on immunohistochemistry. As a result, we manage the possibility of ectopic secretion of ß-HCG from non- trophoblastic disease. PMID:27464870

  15. Vaginoplastia: modificación de la técnica de McIndoe usando esponja de gel hemostático Vaginoplasty: modification to McIndoe techique using hemostatic gel sponge

    Directory of Open Access Journals (Sweden)

    N. Antoniadis

    2011-03-01

    Full Text Available Presentamos el caso de una paciente de 23 años de edad, que consulta por amenorrea primaria. En el examen físico encontramos: fenotipo femenino, genitales externos normales y genitales internos con ausencia de vagina. Los exámenes complementarios, ultrasonido y tomografía abdomino-pélvica, demostraron útero aplásico. El perfil hormonal (FSH, LH, estradiol, progesterona, testosterona y prolactina fue normal y el cariotipo, 46 XX. Se diagnosticó clínicamente como Síndrome de Mayer-Rokitansky-Küster-Hauser. Realizamos vaginoplastia utilizando técnica descrita por McIndoe modificada, empleando esponja de gel hemostático para la fijación de los injertos.We report a case of a 23 years old female patient with primary amenorrhea. Physical exam: phenotipically female, normal external genitalia, show internal genitalia without evidence of vagina. Complimentary exams, abdominopelvic ultrasound and tomography: aplasic uterus. FSH, LH, estradiol, progesterone, testosterone, prolactin, all normal. Cariotype: 46XX. She is clinically diagnosed as a Mayer-Rokitansky-Küster-Hauser syndrome. Vaginoplasty was performed by modifications of McIndoe´s technique, using hemostatic gel sponges for grafts integration.

  16. A Case of Swyer Syndrome Associated with Advanced Gonadal Dysgerminoma Involving Long Survival

    Directory of Open Access Journals (Sweden)

    Salete Da Silva Rios

    2015-03-01

    Full Text Available Swyer syndrome is caused by abnormal sex differentiation during the embryonic period, resulting in incomplete intrauterine masculinization and undifferentiated gonads. The current case report describes a patient with Swyer syndrome associated with stage 3 gonadal dysgerminoma who has survived for 23 years. At age 18, this patient sought assistance for primary amenorrhea from the Gynecological Services Department of the University of Brasília Hospital. A physical examination revealed that the patient was at Tanner stage 4 with respect to axillary hair, breasts, and pubic hair; she presented with a eutrophic vagina and a small cervix. She was treated with a combination of estrogens and progestogens to induce cycling. Approximately 4 years later, a complex tumor was found and resected; a histopathological analysis revealed that this tumor was a right adnexal dysgerminoma with peritoneal affection. The patient was also subjected to chemotherapy. Her follow-up has continued to the present time, with no signs of tumor recurrence. In conclusion, this report describes an extremely rare case in which Swyer syndrome was associated with ovarian dysgerminoma; relative to similar patients, the described patient has survived for an unusually prolonged time.

  17. Magnetic Resonance Evaluation of Müllerian Remnants in Mayer-Rokitansky-Küster-Hauser Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Roh-Eul; Cho, Jeong Yeon; Kim, Sang Youn; Kim, Seung Hyup [Department of Radiology, Seoul National University Hospital, Seoul 110-744 (Korea, Republic of)

    2013-07-01

    To analyze magnetic resonance imaging (MRI) findings of Müllerian remnants in young females clinically suspected of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome in a primary amenorrhea workup. Fifteen young females underwent multiplanar T2- and transverse T1-weighted MRI at either a 1.5T or 3.0T MR imager. Two gynecologic radiologists reached consensus decisions for the evaluation of Müllerian remnants, vagina, ovaries, and associated findings. All cases had bilateral uterine buds in the pelvic cavity, with unilateral cavitation in two cases. The buds had an average long-axis diameter of 2.64 ± 0.65 cm. In all cases, bilateral buds were connected with fibrous band-like structures. In 13 cases, the band-like structures converged at the midline or a paramedian triangular soft tissue lying above the bladder dome. The lower one-third of the vagina was identified in 14 cases. Fourteen cases showed bilateral normal ovaries near the uterine buds. One unilateral pelvic kidney, one unilateral renal agenesis, one mild scoliosis, and three lumbar sacralization cases were found as associated findings. Typical Müllerian remnants in MRKH syndrome consist of bilateral uterine buds connected by the fibrous band-like structures, which converge at the midline triangular soft tissue lying above the bladder dome.

  18. Does myo-inositol effect on PCOS follicles involve cytoskeleton regulation?

    Science.gov (United States)

    Bizzarri, Mariano; Cucina, Alessandra; Dinicola, Simona; Harrath, Abdel Halim; Alwasel, Saleh H; Unfer, Vittorio; Bevilacqua, Arturo

    2016-06-01

    Inositol metabolism is severely impaired in follicles obtained from cystic ovaries, leading to deregulated insulin transduction and steroid synthesis. On the contrary, inositol administration to women suffering from polycystic ovary syndrome (PCOS) has been proven to efficiently counteract most of the clinical hallmarks displayed by PCOS patients, including insulin resistance, hyperandrogenism and oligo-amenorrhea. We have recently observed that myo-inositol induces significant changes in cytoskeletal architecture of breast cancer cells, by modulating different biochemical pathways, eventually modulating the epithelial-mesenchymal transition. We hypothesize that inositol and its monophosphate derivatives, besides their effects on insulin transduction, may efficiently revert histological and functional features of cystic ovary by inducing cytoskeleton rearrangements. We propose an experimental model that could address not only whether inositol modulates cytoskeleton dynamics in both normal and cystic ovary cells, but also whether this effect may interfere with ovarian steroidogenesis. A more compelling understanding of the mechanisms of action of inositol (and its derivatives) would greatly improve its therapeutic utilization, by conferring to current treatments a well-grounded scientific rationale. PMID:27142131

  19. Polycystic ovary syndrome: symptomatology, pathophysiology, and epidemiology.

    Science.gov (United States)

    Guzick, D

    1998-12-01

    Women with polycystic ovary syndrome seek health care for 3 major reasons: infertility, menstrual irregularity, and androgen excess. The infertility is associated with anovulation. The menstrual irregularity is typically chronic, beginning with menarche. Although amenorrhea may sometimes occur, the more common presentation is irregular bleeding characteristic of anovulation. Androgen excess may be manifested by varying degrees of hirsutism. Patients may also report acne. The rapid development of virilizing signs, such as deepening of the voice, increased muscle mass, and temporal balding, should prompt a search for a tumor and lead one away from a diagnosis of polycystic ovary syndrome. Typically treatment is directed at alleviating the symptoms: ovulation induction for infertility, oral contraceptives or a progestin for menstrual irregularity, and oral contraceptives or spironolactone for hirsutism. On the basis of recent epidemiologic data suggestive of increased cardiovascular risk among women with polycystic ovary syndrome, such treatment might be complemented by a long-term approach that addresses the underlying pathophysiology of insulin resistance. PMID:9855614

  20. Arabin cerclage pessary as a treatment of an acute urinary retention in a pregnant woman with uterine prolapse.

    Science.gov (United States)

    Martínez-Varea, Alicia; Nohales-Alfonso, Francisco; Diago Almela, Vicente José; Perales-Marín, Alfredo

    2013-01-01

    A 35-year-old gravida 7, para 1, and abortus 5 female with hypogastric pain and inability to void urine after 14 + 3 weeks of amenorrhea was examined in the emergency department. One year before, a uterine prolapse had been diagnosed in another hospital. Examination showed a uterine prolapse grade 2 with palpable bladder. The patient was unable to void urine. After a manual reduction of the uterine prolapse, the patient underwent an emergency catheterization for bladder drainage. A Hodge pessary (size 70) was placed, which led to spontaneous micturitions. Due to the persistence of the symptoms the following day, Hodge pessary was replaced by an Arabin cerclage pessary. Although the pessary could be removed from the beginning of the second trimester, due to the uterine prolapse as a predisposing factor in the patient and the uncomplicated progression of pregnancy, it was decided to maintain it in our patient. Therefore, Arabin cerclage pessary allowed a successful pregnancy outcome and was not associated with threatened preterm delivery or vaginal infection. PMID:23936698

  1. Evaluation of toxicity due to commercial pesticides in female workers

    International Nuclear Information System (INIS)

    Objective: To see the agricultural sprays hazards in female workers at Multan. Main outcomes measure: Age, work experience, physical health, marital status, fertility, menstrual status, number of offspring, number of abortion, blood choline esterase level, reproductive hormonal assay. Results: The overall age of the 38 participants included in the study was in the range of 12-50 years. Most of the participants enjoyed good physical health. The overall toxicity determined through the reproductive hormonal assay was 18.42%; with 22.22% in the married group and 9.09% in the unmarried group. Eleven participants were in follicular phase of menstrual cycle, two were in luteal state, five were in mid cycle, six were pregnant, six participants had menopause, one had lactational amenorrhea while seven were poisoning cases with no infertility case. The blood plasma level of AChE of 7.8% participants were on safe side, 42.86% were in alarming situation while 52.63% participants were in dangerous condition. Conclusion: Agricultural pesticides are the endocrine disrupting chemicals which poses a health threat, particularly to the sensitive gender, frequent farm workers and onward into their children. (author)

  2. Huge bilateral ovarian cysts in adulthood as the presenting feature of Van Wyk Grumbach syndrome due to chronic uncontrolled juvenile hypothyroidism.

    Science.gov (United States)

    Shivaprasad, K S; Dutta, Deep; Jain, Rajesh; Kumar, Manoj; Maisnam, Indira; Biswas, Dibakar; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar

    2013-10-01

    Juvenile primary hypothyroidism causing cystic ovaries and pseudoprecocious puberty (Van-Wyk Grumbach syndrome (VWGS)) is well documented in literature. There are only a few reports of primary hypothyroidism presenting as ovarian cysts in adults. Here we present a case of huge bilateral ovarian cysts in adulthood as the presenting feature of VWGS due to chronic uncontrolled juvenile hypothyroidism. Large uniloculor right ovarian cyst (119 × 81 × 90 mm) and a multicystic left ovary (55 × 45 × 49 mm) were detected in a 24 year lady with secondary amenorrhea, galactorrhea, and palpable abdominal mass with history of neonatal jaundice, delayed milestones, short stature, and precocious menarche at age of 7.5 years age. She had elevated levels of cancer antigen (CA)-125 which normalized post levothyroxine supplementation. Elevated CA-125 may lead to misdiagnosis of ovarian carcinoma and inadvertent treatment. Bilateral ovarian cysts in adults are a rare presentation of juvenile hypothyroidism. It is necessary to screen for primary hypothyroidism in patients presenting with bilateral ovarian cysts to prevent unnecessary evaluation and treatment. PMID:24251145

  3. FEMIC (Fibromes Embolises aux MICrospheres calibrees): Uterine Fibroid Embolization using Tris-acryl Microspheres. A French Multicenter Study

    International Nuclear Information System (INIS)

    Purpose: A French multicenter registry was set up to confirm the safety and efficacy of large calibrated tris-acryl gelatin microspheres for embolization of symptomatic fibroids. Methods: Technical recommendations included embolization using large microspheres (>500 μm) with no secondary embolization agent. Postprocedural pain, clinical improvement and adverse events were prospectively evaluated during a follow-up period of at least 6 months.Results: Eighty-five women complaining of fibroid-related symptoms entered the study. In seven women, a secondary embolization agent was used in addition to microspheres. Complete resolution of menorrhagia was achieved in 84% of women at 24 months and significant uterine and fibroid volume reductions were noted after 6 months (37% and 73%, respectively). Three women experienced definitive amenorrhea (4%) and two women required hysteroscopic resection of a fibroid. Eight women were treated by hysterectomy because of treatment failure. In seven of these women, treatment failure was explained by an additional cause of symptoms including diffuse adenomyosis, endometrial hyperplasia or ovarian artery supply to the fibroids.Conclusion: Limited uterine artery embolization using large microspheres has good clinical success rate with low postprocedural pain and complications. Women can expect excellent midterm results with a high level of symptom control and significant fibroid volume reduction. Confidence in the end-point recommended here may require the experience of several cases

  4. Pituitary Stone or Calcified Pituitary Tumor? Three Cases and Literature Review

    Science.gov (United States)

    Chentli, Farida; Safer-Tabi, Amel

    2015-01-01

    Introduction: Pituitary stone or pituitary calculus is a scientific enigma characterized by a large calcification in the pituitary sella. It can be discovered incidentally or in a patient with endocrine and/or neurological problems. Its mechanism is not understood. In this article, we described three patients harboring a large pituitary calcification. Case Presentation: The first case was observed in a 27-year-old woman who consulted for secondary amenorrhea. The second case concerned a woman who consulted for infertility, and the third one was observed in an 11-year and nine-month-old girl who was sent to our department for short stature. Clinical examination was normal in both adults. The pediatric case had dwarfism with lack of pubertal development. Hormonal assessment showed hyperprolactinemia in both women and thyrotroph and somatotroph deficits in the child. Radiologic exploration discovered pituitary calcifications measuring 10, 11, and 45 mm without any cystic or solid mass. Conclusions: Radiological findings pleaded for a pituitary stone, but calcified adenomas in women, and calcified craniopharyngioma in the pediatric case could not be excluded, as our three patients were not operated on. PMID:26401144

  5. Functional Evaluation of TSH Secretory Reserve Capacity in Hypothalamo pituitary Disorders

    International Nuclear Information System (INIS)

    The TRH stimulation test was known as a highly diagnostic method in hypothalamo pituitary disorders. To evaluate the location and the extension of the lesion, we estimated TSH response to TRH test in 27 patients. Correlation between volume of sella and TSH response was also studied. The results obtained were 25 follows: 1) In Sheehan's syndrome, TSH response after TRH test were not observed in all of 12 patients. 2) All 2 acromegaly patients showed normal TSH response. 3) In 4 cases of chromophobe adenoma, 2 cases showed no TSH response. In 2 responded cases, one patient whose tumor mass extended to suprasella region was hypothyroid state. 4) In craniopharyingioma 3 cases, the tumor which extended to intrasella showed hypothyroid and no TSH response. 5) Correlation between volume of sella and TSH response were valuable in 2 cases, but no diagnostic significance. 6) In diabetes inspidus, TSH response were all absent. 7) In primary amenorrhea, TSH response observed in 1 case, which conformed with isolated FSH deficiency.

  6. High-Dose Hook Effect in 17-Hydroxyprogesterone Assay in a Patient with 21-Hydroxylase Deficiency

    Science.gov (United States)

    Parlak, Mesut; Ellidağ, Hamit Yaşar; Türkkahraman, Doğa

    2015-01-01

    Congenital adrenal hyperplasia (CAH) describes a group of disorders characterized by enzyme defects in adrenal steroidogenesis. 21-hydroxylase deficiency (21-OHD) is the most commonly encountered form. The analysis of steroids in pediatric cases requires high-sensitivity assays. A 14-year-old Syrian girl was referred for evaluation of short stature, amenorrhea, and hirsutism. On physical examination, breast development was Tanner stage 1. She had a phallic clitoris with a single urogenital orifice. Laboratory findings revealed primary adrenal deficiency with high androgen levels and low levels of 17-hydroxyprogesterone (17-OHP), (<0.05 ng/mL) and estrogen. This unexpected result led to suspicion of a high-dose hook effect. The measurement was repeated after 1/10 dilution of serum, and a high level of 17-OHP (115.4 ng/mL) was detected with the same test-enzyme-linked immunosorbent assay (ELISA). Simple virilizing form of CAH (21-OHD) was suspected and confirmed with genetic analysis. After initiation of glucocorticoid therapy, breast development was noted along with a decrease in testosterone level and an increase in estrogen level. To our knowledge, this is the first case report of hook effect for 17-OHP immunoassay in a patient with 21-OHD. High-dose hook effect should be suspected in patients with CAH when the test results are incompatible with one another. Additionally, this case demonstrates that a high testosterone level can block aromatase activity and consequently also estrogen production and breast development. PMID:26777045

  7. Pituitary disease in childhood: utility of magnetic resonance; Patologia hipofisaria en la edad pediatrica: unidad de la resonance magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Vela, A. C.; Oleaga, L.; Ibanez, A. M.; Campo, M.; Grande, D. [Hospital de Basurto. Bilbao (Spain)

    2000-07-01

    To assess the utility of magnetic resonance (MR) imaging in the study of pediatric patients with clinical suspicion of pituitary disease. We studied 18 patients aged 7 to 18 years.Fifteen had hormonal disturbances, two presented amenorrhea and 1 complained of headache, fever and symptoms of polyuria and polydipsia. All the patients were examined using a Siemens SP 42 1-Tesla MRI scanner. Sagittal and coronal T1-weighted spin-echo images were obtained; in addition T2-weighted spin-echo or fast spin-echo imaging was performed in ten cases and intravenous gadolinium was administered in nine. We found 9 patients with hypothalamic-pituitary dysgenesis, 2 with germinoma, 2 cases of pituitary hemosiderosis in patients with thalassemia, 2 cases of microadenoma, one abscess, one case of idiopathic central diabetes insipidus and one of Langerhans cell histiocytosis. MR enabled us to assess pituitary structural alterations in children with hypothalamic-pituitary hormone deficiencies. In our series of patients, hypothalamic-pituitary dysgenesiss was the most frequent cause of adenohypophyseal deficiencies, and most cases of central diabetes insipidus were secondary to masses in the sellar and suprasellar region. In patients with thalassemia, T2-weighted MR images showed the amount of iron deposited in adenophypophysis. Gadolinium-enhanced studies were useful in the study of masses and when the presence of microadenoma was suspected. (Author) 26 refs.

  8. Osteoporosis: prevention and treatment in anorexia nervosa.

    Science.gov (United States)

    Wolfert, A; Mehler, P S

    2002-06-01

    One of the most serious and potentially permanently disabling medical complications of anorexia nervosa is osteoporosis, which greatly increases the long-term risk of bone fractures. The decreased bone density in patients with anorexia nervosa (AN) is due to the many effects on bone metabolism of amenorrhea, reduced levels of insulin growth factor-1 (IGF-1), high cortisol levels and weight loss. Although estrogen replacement therapy is clearly efficacious in preventing postmenopausal osteoporosis, its efficacy in AN is uncertain. Clinicians caring for patients with AN need to be aware of this because, despite such therapy, there may be an inexorable decline in bone mineral density in what is a relatively young group of patients. AN frequently has its onset during adolescence, when peak bone mass is normally reached, and an anorectic episode in youth may permanently impair skeletal integrity and lead to debilitating fractures and pain. It is important to recognise this formidable risk, counsel AN patients about the longterm and possibly permanent sequelae of low body weight, use densitometry to screen for bone loss and treat it accordingly. The most effective treatment is still early weight restoration and the resumption of menses. PMID:17644861

  9. Magnetic Resonance Evaluation of Müllerian Remnants in Mayer-Rokitansky-Küster-Hauser Syndrome

    International Nuclear Information System (INIS)

    To analyze magnetic resonance imaging (MRI) findings of Müllerian remnants in young females clinically suspected of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome in a primary amenorrhea workup. Fifteen young females underwent multiplanar T2- and transverse T1-weighted MRI at either a 1.5T or 3.0T MR imager. Two gynecologic radiologists reached consensus decisions for the evaluation of Müllerian remnants, vagina, ovaries, and associated findings. All cases had bilateral uterine buds in the pelvic cavity, with unilateral cavitation in two cases. The buds had an average long-axis diameter of 2.64 ± 0.65 cm. In all cases, bilateral buds were connected with fibrous band-like structures. In 13 cases, the band-like structures converged at the midline or a paramedian triangular soft tissue lying above the bladder dome. The lower one-third of the vagina was identified in 14 cases. Fourteen cases showed bilateral normal ovaries near the uterine buds. One unilateral pelvic kidney, one unilateral renal agenesis, one mild scoliosis, and three lumbar sacralization cases were found as associated findings. Typical Müllerian remnants in MRKH syndrome consist of bilateral uterine buds connected by the fibrous band-like structures, which converge at the midline triangular soft tissue lying above the bladder dome

  10. Variant Turner Syndrome With 46, X, i(Xq Karyotype: A Case Report

    Directory of Open Access Journals (Sweden)

    Mahmut Balkan

    2005-01-01

    Full Text Available Case was 14 years-old girl having complaints of growth retardations and primary amenorrhea. In the physical and gynecological examinations; her height and weight were 130 cm and 45 kg, respectively and secondary sex characteristics were infantile and hymen annular was intact and the depth of vagina was 7 cm and, palpitate of pelvis was empty. The case did not show broad chest, neck webbing and low posterior hairline. Uterus dimensions were 11x7x4 mm and ovaries were not seen in ultrasonographyic examination. Karyotypes in the peripheral blood cells were variant Turner Syndrome with isochromosome Xq constitution; 46,X, i(Xq, so made detailed laboratory analysis. She had high plasma gonadotropin and low estradiol and progesterone and slightly high plasma TSH and slightly low free T3 and T4 hormone levels. Ultrasonography showed that thyroid was diffuse. Insulin and growth hormone levels were normal. The bone age was 10-11 year and compatible with her age. IQ test in the patient was found the normal. In the variant turner syndrome, clinic table was slighter than Classic Turner Syndrome as in our case.

  11. Nonclassic congenital adrenal hyperplasia misdiagnosed as Turner syndrome

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    Vineet V Mishra

    2015-01-01

    Full Text Available We present a patient with nonclassic congenital adrenal hyperplasia (NCAH misdiagnosed as mosaic Turner syndrome. She presented with complaints of primary infertility. Short stature, the presence of facial hair and hoarse voice was also noted. She had primary amenorrhea and was advised for karyotype at 16 years of age, which was reported as 45, X[20]/46, XX[80], stating her as a case of mosaic Turner syndrome. Clitoroplasty was done at 21 years of age for clitoromegaly, which was noticed during puberty. The diagnosis of mosaic Turner could not explain the virilization. Therefore, we repeated the karyotype, which revealed 46, XX in more than 100 metaphases and was sufficient to exclude mosaicism. Furthermore, the endocrinological evaluation revealed high testosterone level with a normal 17 alpha-hydroxyprogesterone (17-OHP. The presence of pubertal onset virilization with a karyotype of 46, XX and raised testosterone level with normal 17-OHP level, raised the suspicion of NCAH for which adrenocorticotropic hormone stimulation test was done which confirmed the diagnosis of NCAH.

  12. Placental site trophoblastic tumor in the pelvic wall: A case report and review of the literature

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    Xiao Tang

    2013-01-01

    Full Text Available Extra-uterine placental site trophoblastic tumor (PSTT is extremely rare. To our knowledge, PSTT that occurs in the pelvic wall has not yet been reported. A 29-year-old woman presented with amenorrhea and irregular vaginal bleeding of 1 month. A solid tumor mass was detected by ultrasonography in the right pelvic wall. The tumor was comprised of large, polygonal tumor cells, with brisk mitosis and obvious vascular invasion. Immunohistochemical staining demonstrated that tumor cells were positive for human placental lactogen, CD146, cytokeratin, placental alkaline phosphatase, human chorionic gonadotropin were positive, the Ki-67 proliferative index was about 80%. The pathological diagnosis was PSTT. After the operation, the patient was treated with six cycles of etoposide, methotrexate, actinomycin, cyclophosphamide, and vincristine. The patient was followed for 18 months without recurrence. The report shows that extra-uterine PSTT is extremely rare and may have a good prognosis; surgical resection and adjuvant chemotherapy are good options. However, further experience to diagnose and cure this rare tumor is warranted.

  13. [Medication of the month. A new combined oral contraceptive containing estradiol valerate and dienogest (Qlaira)].

    Science.gov (United States)

    Gaspard, U; Pintiaux, A; Kridelka, F

    2010-12-01

    In combined oral contraception (OC), a drastic reduction of both ethinylestradiol and androgenic progestins mostly derived from 19 NOR testosterone, allowed to moderately reduce the adverse impact of classical combined pills on metabolism and circulation (both arterial and venous). However, the marked hepatic action of ethinylestradiol, even in small dosages, lessens the expected risk reduction. For the first time, an OC has been developed, which contains estradiol valerate (with reduced hepatic action because of lack of a 17alpha ethinyl group) with dienogest, a 19 NOR testosterone-derived nonandrogenic progestin, which powerfully inhibits endometrial proliferation. Thanks to a dynamic modulation of estrogen and progestin doses (26 active days + 2 placebo days), an adequate contraceptive effectiveness, a good cycle control and drug tolerance are achieved, similar to those obtained with a classical low-dose OC. Recent data indicate that this new combination reduces the usually observed metabolic impact. An adequate cycle control (with 20% amenorrhea) is achieved for the first time with estradiol valerate + progestin,, in opposition with prior catastrophic results with other formulations containing 17beta-estradiol. A second combination containing estradiol + nomegestrol acetate (monophasic, 24 active days + 4 placebo days) is under study and seems also to yield promising results. Of course, in-depth study of metabolic and vascular effects of these new combinations is mandatory - and ongoing. PMID:21287768

  14. [Pharmacological, metabolic and clinical aspects of new oral contraceptive associations containing natural estrogens].

    Science.gov (United States)

    Ferrari, S; Piacenti, I; Napolitano, A; Cagnacci, A

    2014-02-01

    Introduction of new compounds containing natural estrogens represented a major development in the field of hormonal contraception. Micronized estradiol (E2) and its estere valerate (EV), is more easily metabolized by the liver than ethynylestradiol (EE). This causes minimal metabolic impact, but the weak estrogenic activity needs not be antagonized by androgenic progestin and requires progestin capable to stabilize the endometrium. Dienogest (DNG), an antiandrogenic progestin with a short half-life, is associated with estradiol valerate (EV) in a quadriphasic fashion. In comparison to EE/levonorgestrel (LNG), EV/DNG is more neutral on metabolism and coagulation. Furthermore, it does not seem to negatively affect the cardiovascular system and breast. Cycle control is optimal with a higher prevalence of amenorrhea and reduction of menstrual flow. For this reason EV/DNG can be tehrapeutic for heavy menstrual bleedings. Nomegestrol acetate (NOMAc), an anti-andogen progestin with a long half-life is combined in monophasic regimen with micronized E2. E2/NOMAc is more neutral than EE/LNG on metabolism and more neutral than EE/DRSP on coagulation. NOMAc reduces peripheral tissue estrogen formation, and this may be beneficial for the breast. The two formulations exert a high contraceptive efficacy similar to the ones containing EE, but with less estrogen-related side-effects. The additional benefits due to DNG and NOMAc need to be further explored. PMID:24569408

  15. Huge bilateral ovarian cysts in adulthood as the presenting feature of Van Wyk Grumbach syndrome due to chronic uncontrolled juvenile hypothyroidism

    Directory of Open Access Journals (Sweden)

    K S Shivaprasad

    2013-01-01

    Full Text Available Juvenile primary hypothyroidism causing cystic ovaries and pseudoprecocious puberty (Van-Wyk Grumbach syndrome (VWGS is well documented in literature. There are only a few reports of primary hypothyroidism presenting as ovarian cysts in adults. Here we present a case of huge bilateral ovarian cysts in adulthood as the presenting feature of VWGS due to chronic uncontrolled juvenile hypothyroidism. Large uniloculor right ovarian cyst (119 × 81 × 90 mm and a multicystic left ovary (55 × 45 × 49 mm were detected in a 24 year lady with secondary amenorrhea, galactorrhea, and palpable abdominal mass with history of neonatal jaundice, delayed milestones, short stature, and precocious menarche at age of 7.5 years age. She had elevated levels of cancer antigen (CA-125 which normalized post levothyroxine supplementation. Elevated CA-125 may lead to misdiagnosis of ovarian carcinoma and inadvertent treatment. Bilateral ovarian cysts in adults are a rare presentation of juvenile hypothyroidism. It is necessary to screen for primary hypothyroidism in patients presenting with bilateral ovarian cysts to prevent unnecessary evaluation and treatment.

  16. Parto tras la transferencia de embriones generados por fecundación de ovocitos vitrificados: Comunicación de un caso Live birth after the transfer of embryos obtained by fertilization of vitrified oocytes: Report of one case

    Directory of Open Access Journals (Sweden)

    Ricardo Pommer

    2011-07-01

    Full Text Available We report the first successful live birth after the transfer of embryos obtained by fertilization of vitrified oocytes. A couple with primary infertility due to teratozoospermy and chronic an ovulation decided to undergo assisted reproductive technology after 4 failed cycles of super ovulation and intrauterine insemination. The woman underwent a standard luteal phase agonist protocol, with controlled ovarian hyper stimulation with daily 150IU recombinant gonadotropin and 75IU urinary gonadotropin for 12 days. Due to the high risk of ovarian hyper stimulation syndrome the couple was advised to delay embryo transfer. Eighteen mature oocytes were recovered, eight were vitrified and 10 fertilized and cryopreserved as pro-nuclei. Two months later, four vitrified oocytes were thawed, and three morphologically-normal embryos were transferred to an estrogen-progesterone-primed uterus, obtaining triple clinical pregnancy. The pregnancy was uneventful until 32 weeks of amenorrhea, when pre-term delivery started. After inducing lung maturity, a cesarean section was performed and three healthy fetuses were delivered. Nowadays, the babies are two and a half years old, and have had a normal psycho-motor development.

  17. Profile of follitropin alpha/lutropin alpha combination for the stimulation of follicular development in women with severe luteinizing hormone and follicle-stimulating hormone deficiency

    Science.gov (United States)

    Rinaldi, Leonardo; Selman, Helmy

    2016-01-01

    A severe gonadotropin deficiency together with chronic estradiol deficiency leading to amenorrhea characterizes patients suffering from hypogonadotropic hypogonadism. Administration of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to these patients has been shown to be essential in achieving successful stimulation of follicular development, ovulation, and rescue of fertility. In recent years, the availability of both recombinant FSH (rFSH) and recombinant LH (rLH) has provided a new therapeutic option for the stimulation of follicular growth in hypopituitary–hypogonadotropic women (World Health Organization Group I). In this article, we review the data reported in the literature to highlight the role and the efficacy of using recombinant gonadotropins, rFSH and rLH, in the treatment of women with severe LH/FSH deficiency. Although the studies on this issue are limited and the experiences available in the literature are few due to the small number of such patients, it is clearly evident that the recombinant gonadotropins rFSH and rLH are efficient in treating patients affected by hypogonadotropic hypogonadism. The results observed in the studies reported in this review suggest that recombinant gonadotropins are able to induce proper follicular growth, oocyte maturation, and eventually pregnancy in this group of women. Moreover, the clinical use of recombinant gonadotropins in this type of patients has given more insight into some endocrinological aspects of ovarian function that have not yet been fully understood. PMID:27307766

  18. A rare case of Swyer’s syndrome

    Directory of Open Access Journals (Sweden)

    Vijaya M. Babre

    2013-06-01

    Full Text Available Swyer syndrome was first described by Jim Swyer in 1955. It is a form of “Pure Gonadal Dysgenesis”. The affected female has 46XY karyotype. A 17 year old unmarried girl came with complaints of primary amenorrhea, non development of breast. On examination she has normal built. Examination of secondary sexual characters revealed no breast development, pubic and axillary hairs were sparse. Female type of genitalia with vaginal opening. Serum FSH was 117.5 mIU/ml. Thyroid and Prolactin was in normal range. Karyotype showed genotype of 46XY. Diagnostic laparoscopy showed streak gonads, small uterus, and normal fallopian tubes. Diagnosis of Swyer syndrome was made. Patient was started on hormonal replacement therapy (HRT. In Swyer syndrome there is a mutation of SRY gene leads failure of development of testis. Mullerian duct development takes place by default. These patients can have normal sexual intercourse and can become pregnant by donor oocyte. They need to be on HRT. The risk of gonadoblastoma and dysgerminoma are very high in streak gonads so bilateral gonadectomy is advised. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000: 485-487

  19. [Masculine anorexia nervosa: realities and perspectives].

    Science.gov (United States)

    Chambry, Jean; Corcos, Maurice; Guilbaud, Olivier; Jeammet, Phillipe

    2002-05-01

    Since its description by Morton in 1694, masculine anorexia nervosa has been the subject of much debate. For many, two questions remain unanswered: does anorexia nervosa, as described in girls, exist in boys? - if so, is it the same disease? We analyzed the data in the literature which demonstrate a lower incidence than in the female population, although estimates are probable low due to underdiagnosis. The behavioral aspects suggest a similarity between masculine and feminine anorexia nervosa although the pure restrictive forms of anorexia are more rare in boys. There are however a few differences. Affected boys, according to Crips and Burns (1990), are heavier than girls at onset of the disorder but present a lower body weight during certain periods of the disease. Excessive physical activity is more frequent as is excessive intellectual involvement (Margo, 1987). The problem of amenorrhea, on/off periods, is not present in the male form. Testosterone and sexual function decline gradually, in parallel with the state of malnutrition (Anersen, 1990). The patient does not have particular difficulty discussing sexual relations but does exhibit a poor level of experience and mental representations. Contact with the opposite sex is rare and the fantastic life is generally very limited. The frequency of homosexual behavior would lie between 25% (Herzog, 1984) and 58% (Schneider and Agras, 1987), which is higher than in the female anorexia population (Herzog, 1984). This observation raises the question concerning the relationship between masculine mental anorexia nervosa and fragile sexual identity. PMID:12218886

  20. Eating disorders in the obstetric and gynecologic patient population.

    Science.gov (United States)

    Andersen, Arnold E; Ryan, Ginny L

    2009-12-01

    The eating disorders anorexia nervosa and bulimia nervosa and eating disorders not otherwise specified disproportionately affect women, have profound effects on the overall well-being of women and their children, and can have mortality rates as high as those found with major depression. These disorders may present to obstetrician-gynecologists (ob-gyns) clinically as menstrual dysfunction, low bone density, sexual dysfunction, miscarriage, preterm delivery, or low birth weight in offspring. Ninety percent of eating disorders develop before the age of 25 in otherwise healthy young women, a group that characteristically seeks the majority of their health care from ob-gyns. For all of these reasons, ob-gyns must have a greater awareness of these disorders and a lower index of suspicion for screening their patients than they currently do. Otherwise, they may miss life-threatening illness, treat characteristic amenorrhea inappropriately, or inadvertently intervene to help these women conceive, contributing to maternal and fetal risks. As providers of both primary and specialty care for women, ob-gyns have the opportunity to play a vital role in prevention and diagnosis of eating disorders and in the multidisciplinary management required to effectively manage these disorders. PMID:19935043

  1. The Clinical Effect of Mifepristone in the Treatment of Perimenopausal Dysfunctional Uterine Bleeding%米非司酮治疗围绝经期功血的临床效果

    Institute of Scientific and Technical Information of China (English)

    刘芳

    2016-01-01

    Objective To investigate the clinical effect of mifepristone in perimenopausal uterine bleeding applications. Methods From January 2013 to December 2014 in our hospital, 36 cases of patients with dysfunctional uterine bleeding treated with mifepristone were treated as the research object, and 2 months after treatment, the changes of the volume of the uterus, serum hormone levels and adverse reactions were compared. Results All patients appeared after mifepristone treatment of amenorrhea, found no significant adverse reactions, and basic liver and kidney function was normal. After treatment, endometrial thickness was significantly smaller than the thickness of the endometrium before treatment, the difference was statistically significant ( P 0. 05 ); Indicators improved FSH, LH, E2, P and other significant before and after treatment ( P 0.05);患者治疗前后FSH、 LH、 E2、 P等指标改善显著(P<0.05)。结论应用米非司酮治疗围绝经期功血,使用方便,疗效肯定,副反应少,在临床值得推广应用。

  2. A systematic approach to the magnetic resonance imaging-based differential diagnosis of congenital Müllerian duct anomalies and their mimics.

    Science.gov (United States)

    Yoo, Roh-Eul; Cho, Jeong Yeon; Kim, Sang Youn; Kim, Seung Hyup

    2015-01-01

    Müllerian duct anomalies (MDAs) represent a wide spectrum of developmental abnormalities related to various gynecologic and obstetric complications, including primary amenorrhea, infertility, and endometriosis. The use of diverse imaging modalities, in conjunction with clinical information, provide important clues to the diagnosis of MDAs. Diagnostic imaging work-up for MDAs often begins with hysterosalpingography (HSG) and/or ultrasonography (US). Although HSG and/or US may suffice to detect the presence of a uterine abnormality, magnetic resonance (MR) imaging is generally needed to classify the abnormality into a specific MDA category. MR imaging has been gaining in popularity for use in evaluating MDAs, by virtue of its noninvasiveness, lack of ionizing radiation, and capability for multiplanar imaging and soft tissue characterization. Abnormalities in the external uterine fundal contour are readily recognized with MR imaging, allowing for clear differentiation between a fusion anomaly, such as a uterus didelphys or a bicornuate uterus, and a resorption anomaly, such as a septate uterus. Furthermore, MR imaging enables clear depiction of a rudimentary uterine horn in a unicornuate uterus. Accurate differential diagnosis of MDAs on the basis of their characteristic MR imaging findings is crucial, because the rates of gynecologic and obstetric complications vary considerably among MDAs. The diagnostic accuracy may be enhanced by adopting a systematic approach to MR imaging-based differential diagnosis. PMID:25070770

  3. Imaging of müllerian duct anomalies.

    Science.gov (United States)

    Behr, Spencer C; Courtier, Jesse L; Qayyum, Aliya

    2012-10-01

    The müllerian ducts are paired embryologic structures that undergo fusion and resorption in utero to give rise to the uterus, fallopian tubes, cervix, and upper two-thirds of the vagina. Interruption of normal development of the müllerian ducts can result in formation of müllerian duct anomalies (MDAs). MDAs are a broad and complex spectrum of abnormalities that are often associated with primary amenorrhea, infertility, obstetric complications, and endometriosis. MDAs are commonly associated with renal and other anomalies; thus, identification of both kidneys is important. However, MDAs are not associated with ovarian anomalies. Hysterosalpingography (HSG) is routinely used in evaluation of infertility. Because a key component of MDA characterization is the external uterine fundal contour, HSG is limited for this purpose. Patients suspected of having an MDA are often initially referred for pelvic ultrasonography (US). Magnetic resonance (MR) imaging is typically reserved for complex or indeterminate cases. MR imaging is the imaging standard of reference because it is noninvasive, does not involve ionizing radiation, has multiplanar capability, allows excellent soft-tissue characterization, and permits a greater field of interrogation than does US. Use of MR imaging for evaluation of MDAs reduces the number of invasive procedures and related costs by guiding management decisions. PMID:23065173

  4. Triplet heterotopic pregnancy following ovulation induction with clomiphene citrate: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Maheswari S

    2013-08-01

    Full Text Available Heterotopic pregnancy, though rare is a combined pregnancy in which synchronous intrauterine and extra uterine pregnancy occur. An estimated incidence of between 1/8000 to 1/30,000 has been reported following spontaneous conception. After artificial reproductive techniques, the incidence is as high as 1/100 and after ovulation induction with clomiphene citrate, it is around 1/900. We are reporting a case of 26 year old gravida 2 who conceived after ovulation induction with clomiphene citrate and presented to the emergency department with acute abdominal pain. Ultrasound pelvis showed viable twin intrauterine gestation of 8 weeks along with ruptured ectopic pregnancy on the right tube. After stabilizing the patient, emergency laparotomy and right salpingectomy was performed. Fortunately, the intrauterine twin fetuses grew satisfactorily and patient was delivered by caesarean section at 36 weeks in view of previous lower segment caesarean section with preterm labour. Heterotopic pregnancy must be considered in a patient with amenorrhea, abdominal pain, adnexal mass and enlarged uterus particularly, conception following artificial reproductive techniques or fertility drugs, even though the intrauterine pregnancy has been documented. A high index of suspicion is important to avoid maternal morbidity, sometimes mortality and loss of intrauterine pregnancy. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 743-745

  5. Progesterone and Bone: Actions Promoting Bone Health in Women

    Directory of Open Access Journals (Sweden)

    Vanadin Seifert-Klauss

    2010-01-01

    Full Text Available Estradiol (E2 and progesterone (P4 collaborate within bone remodelling on resorption (E2 and formation (P4. We integrate evidence that P4 may prevent and, with antiresorptives, treat women's osteoporosis. P4 stimulates osteoblast differentiation in vitro. Menarche (E2 and onset of ovulation (P4 both contribute to peak BMD. Meta-analysis of 5 studies confirms that regularly cycling premenopausal women lose bone mineral density (BMD related to subclinical ovulatory disturbances (SODs. Cyclic progestin prevents bone loss in healthy premenopausal women with amenorrhea or SOD. BMD loss is more rapid in perimenopause than postmenopause—decreased bone formation due to P4 deficiency contributes. In 4 placebo-controlled RCTs, BMD loss is not prevented by P4 in postmenopausal women with increased bone turnover. However, 5 studies of E2-MPA co-therapy show greater BMD increases versus E2 alone. P4 fracture data are lacking. P4 prevents bone loss in pre- and possibly perimenopausal women; progesterone co-therapy with antiresorptives may increase bone formation and BMD.

  6. A Review of the Pharmacological Effects of the Dried Root of Polygonum cuspidatum (Hu Zhang and Its Constituents

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    Huan Zhang

    2013-01-01

    Full Text Available Traditional Chinese medicine (TCM has been widely used in China for thousands of years to treat and prevent diseases. TCM has been proven safe and effective, and it is being considered as one of the important types of complementary and alternative medicine and receives increasing attention worldwide. The dried root of Polygonum cuspidatum Sieb. et Zucc. (also known as “Hu Zhang” in Chinese is one of the medicinal herbs listed in the Pharmacopoeia of the People's Republic of China. Hu Zhang is widely distributed in the world. It can be found in Asia and North America and is used as folk medicine in countries such as Japan and Korea. In China, Hu Zhang is usually used in combination with other TCM herbs. The therapeutic uses of those Hu Zhang-containing TCM prescriptions or formulations are for treating cough, hepatitis, jaundice, amenorrhea, leucorrhea, arthralgia, burns and snake bites. Recent pharmacological and clinical studies have indicated that Hu Zhang has antiviral, antimicrobial, anti-inflammatory, neuroprotective, and cardioprotective functions. This review gives a summary of the reported therapeutic effects of the active compounds and the different extracts of Hu Zhang.

  7. The Tissue Selective Estrogen Complex: A Promising New Menopausal Therapy

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    Sebastian Mirkin

    2012-09-01

    Full Text Available Menopause is associated with health concerns including vasomotor symptoms, vulvar/vaginal atrophy (VVA, and osteoporosis. Estrogen therapy or combined estrogen-progestin therapy (EPT are primary treatment options for menopausal symptom relief and osteoporosis prevention. Because EPT has been associated with some safety/tolerability concerns relating to undesirable effects of estrogen and progestin, alternative options are needed. The tissue selective estrogen complex (TSEC is a novel class of agents pairing a selective estrogen receptor modulator (SERM with 1 or more estrogens. The TSEC combines the established efficacy of estrogens on menopausal symptoms and bone with the protective effects of a SERM on the reproductive tract. The pairing of bazedoxifene (BZA with conjugated estrogens (CE has been evaluated in a series of phase 3 clinical trials. BZA 20 mg/CE 0.45 mg and BZA 20 mg/CE 0.625 mg have shown efficacy in reducing the frequency and severity of hot flushes, relieving VVA symptoms, and maintaining bone mass while protecting the endometrium and breast. These BZA/CE doses have been associated with a favorable safety/tolerability profile, with higher rates of cumulative amenorrhea and lower incidences of breast pain than those reported for EPT. Thus, BZA/CE may be a promising alternative to conventional EPT for treating non-hysterectomized, postmenopausal women.

  8. Cytogenetic Analysis of 65 Women with Premature Ovarian Insufficiency

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    Seda Ates

    2014-12-01

    Full Text Available Aim: Premature ovarian insufficiency (POI is characterized as amenorrhea for more than 6 months, occurring before the age of 40, with an increased follicle-stimulating hormone and low estrogen concentrations. The aim of our study is to determine the types and distribution of cytogenetic abnormalities among women with POI. Material and Method: The study is based on the retrospective karyotype analysis of 65 women with idiopathic POI referred to the Medical Genetics Department at the Bezmialem Vakif University Hospital. Results: Chromosomal abnormalities were present in 12 of 65 cases (18.4%. All of them had numerical abnormalities of the X chromosome. The most frequently detected abnormalities were X chromosome mosaicisms. Two cases had fragile X premutation carriers. Eight (12.3% women were considered as familial POI. Discussion: Our results underline the essential role of the X chromosome in the etiology of POI. Therefore, regardless of clinical features and woman%u2019s age, cytogenetic investigations should be routinely performed in cases with POI.

  9. Dietary intakes in infertile women a pilot study

    Directory of Open Access Journals (Sweden)

    Nappi Rossella E

    2009-11-01

    Full Text Available Abstract Background The reproductive axis is closely linked to nutritional status. The purpose of this study was to compare the nutritional status in two groups of young infertile women, without clinically overt eating disorders: hypothalamic amenorrhea (HA and polycystic ovary syndrome (PCOS. Methods Eighteen young infertile women (10 HA, 8 PCOS attending an outpatient gynecological endocrinology unit, underwent evaluation of anthropometry, body composition, dietary intakes by means of a food frequency questionnaire (FFQ and a seven-day food diary (7DD, and psychological characteristics by means of EDI2 and SCL90 tests. Results HA women had lower BMI and body fat compared to PCOS women. Habitual intake derived from FFQs showed a similar macronutrient distribution between groups (about 16% protein, 33% fat, 52% carbohydrates. The psychometric profiles of the two groups did not differ significantly. The underreporting of dietary intakes (measured as habitual energy intake by FFQs/basal metabolic rate was found to be negatively correlated with the interpersonal sensitivity SCL-90 subscale scores (r = -0.54, p = 0.02. Conclusion Our study identified differences in body composition but not in dietary habits between HA and PCOS infertile women. We documented, for the first time, a relationship between the accuracy of dietary surveys and the psychological characteristics of subjects with anovulation. This finding suggests that it may be important to be aware of the psychological terrain when planning a dietary survey in infertile women.

  10. CYTO PATHOLOGICAL STUDY OF GESTA TIONAL TROPHOBLASTIC DISEASE

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    Hemalatha

    2015-10-01

    Full Text Available AIM: The main aim of this study is to evaluate cytological features of trophoblastic disease and to correlate with histopathological findings. BACKGROUND: Gestational trophoblastic lesions include pregnancy related disorders ranging from benign hydatidiform mole, clinically malignant conditions like invasive mole and metastatic mole, to anaplastic conditions including choriocarcinoma, Placental site trophoblastic tumor and Epithelioid Trophoblastic mole with varying proportion for local invasion and metastasis. Gestational trophoblastic lesions mimic growth pattern encountered in early normal placental development, non - molar abortions and variety of non - trophoblastic lesions. Therefore an appreciation of different types of Gestational trophoblastic disease with its cytopathological manifestations and serum markers (serum β hCG are important for the confirmation of diagn osis. Thus the study is under taken. MATERIAL AND METHODS : The material for the present study was obtained from patients presented with complaints of amenorrhea and bleeding per vagina. After obtaining detailed clinical history the patients under went thor ough physical examination and relevant investigations were carried out. Then the patients were subjected uterine aspiration curettage, prior to aspiration hCG was performed in all cases . RESULTS : Aspiration smear was adequate for cytological interpretation . It well correlated with histopathological findings. Morphological features were well preserved, cytological features of individual cells could be appreciated. Correlation with histology found to be accurate. Specificity and sensitivity found to be 100%. CONCLUSION: Thus this study suggests that aspiration cytology can be utilized in follow up of patients particularly in trophoblastic disease under treatment

  11. Umbilical KeyPort bilateral laparoscopic orchiectomy in patient with complete androgen insensitivity syndrome

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    Felipe P. Andrade

    2012-10-01

    Full Text Available MAIN FINDINGS: A 22-year-old woman with complete androgen insensitivity syndrome (CAIS presenting with primary amenorrhea and normal female external genitalia was referred for laparoscopic gonadectomy. She had been diagnosed several years earlier but was reluctant to undergo surgery. CASE HYPOTHESIS: Diagnosis of this X-linked recessive inherited syndrome characterizes by disturbance of virilization in males with an AR mutation, XY karyotipe, female genitalia and severely undescended testis with risk of malignization. The optimal time to orchidectomy is not settled; neither the real risk of malignancy in these patients. Early surgery impacts development of a complete female phenotype, with enlargement of the breasts. Based on modern diagnostic imaging using DCE-MRI and surgical technology with single port laparoscopic access we hypothesize that the optimum time for gonadectomy is not at the time of diagnosis, but once feminization has completed. PROMISING FUTURE IMPLICATIONS: An umbilical laparoendoscopic single-site access for bilateral gonadectomy appears to be the first choice approach as leaves no visible incision and diminishes the psychological impact of surgery in a patient with CAIS absolutely reassured as female. KeyPort, a single port access with duo-rotate instruments developed by Richard Wolf facilitates this surgery and allows excellent cosmetic results.

  12. Ectopic molar pregnancy: a case report.

    Science.gov (United States)

    Bousfiha, Najoua; Erarhay, Sanaa; Louba, Adnane; Saadi, Hanan; Bouchikhi, Chahrazad; Banani, Abdelaziz; El Fatemi, Hind; Sekkal, Med; Laamarti, Afaf

    2012-01-01

    The incidence of hydatidiform moles is 1 per 1,000 pregnancies. Ectopic pregnancy occurs in 20 per 1,000 pregnancies. Thus, the incidence of the ectopic molar gestation is very rare. We report a case of tubal molar pregnancy diagnosed at the systematic histology exam of an ectopic pregnancy. We report the case of 32 years old nulliparus women who presented a vaginal bleeding, lower abdominal pain and 6 weeks amenorrhea corresponding to the last menstrual period. At the clinical examination, the arterial pressure was 100/60 mmHG. The gynecological examination was difficult because of lower abdominal pain. Serum gonadotropin activity was 3454 ui/l. Pelvic ultrasound revealed an irregular echogenic mass in the left adnexa. Diagnostic laparoscopy revealed a left-sided unruptured ampullary ectopic pregnancy. A left laparoscopic salpingectomy was performed. The systematic histologic test identified an ectopic partial molar pregnancy, which was confirmed by DNA ploidy image analysis. The patient was followed with weekly quantitative B-hCG titers until three successive B-hCG levels were negative. It is pertinent that clinicians take routine histological examination of tubal specimens in ectopic pregnancy very seriously in order to diagnose cases of ectopic molar gestations early and mount appropriate post treatment surveillance. PMID:22655097

  13. Epidemiology, diagnosis, and management of polycystic ovary syndrome.

    Science.gov (United States)

    Sirmans, Susan M; Pate, Kristen A

    2013-01-01

    Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder characterized by irregular menses, hyperandrogenism, and polycystic ovaries. The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but is as high as 15%-20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria are used. Clinical manifestations include oligomenorrhea or amenorrhea, hirsutism, and frequently infertility. Risk factors for PCOS in adults includes type 1 diabetes, type 2 diabetes, and gestational diabetes. Insulin resistance affects 50%-70% of women with PCOS leading to a number of comorbidities including metabolic syndrome, hypertension, dyslipidemia, glucose intolerance, and diabetes. Studies show that women with PCOS are more likely to have increased coronary artery calcium scores and increased carotid intima-media thickness. Mental health disorders including depression, anxiety, bipolar disorder and binge eating disorder also occur more frequently in women with PCOS. Weight loss improves menstrual irregularities, symptoms of androgen excess, and infertility. Management of clinical manifestations of PCOS includes oral contraceptives for menstrual irregularities and hirsutism. Spironolactone and finasteride are used to treat symptoms of androgen excess. Treatment options for infertility include clomiphene, laparoscopic ovarian drilling, gonadotropins, and assisted reproductive technology. Recent data suggest that letrozole and metformin may play an important role in ovulation induction. Proper diagnosis and management of PCOS is essential to address patient concerns but also to prevent future metabolic, endocrine, psychiatric, and cardiovascular complications. PMID:24379699

  14. Eating disorders in the twenty-first century.

    Science.gov (United States)

    Weiselberg, E C; Gonzalez, M; Fisher, M

    2011-12-01

    The first description of anorexia nervosa appeared in the literature over three hundred years ago. Since then, much has been learned about eating disorders, including the different presentations, medical complications, prognosis, and treatment strategies. In spite of this knowledge, the prevalence of eating disorders continues to grow. As well, eating disorders are seen in increasing frequency among males, children, and adults, and from all cultures and ethnicities. Of particular concern, is that patients with eating disorders often first present because of a complication such as amenorrhea, syncope, or abdominal pain, without disclosing the eating disorder. Therefore, all physicians should be aware of the various presentations of eating disorders, including the medical complications and risks, and be able to screen for a possible eating disorder. The major medical complications are due to the decreased caloric intake which leads to a hypometabolic state. While most complications are reversible with recovery, some, such as bone loss, may not be. Of particular concern during recovery is the possible development of a refeeding syndrome which occurs as the body goes from a catabolic to an anabolic state, causing hypophosphatemia, hypocalcemia and hypomagnesemia, which can lead to delirium, coma and death. Of further concern is that eating disorders have the highest mortality rate of all psychiatric disorders at 5.6% per decade. This article will review the changing demographics, medical complications, treatment options, and prognosis of eating disorders. PMID:22036757

  15. The path of least resistance: A case of cervical stenosis and uterocutaneous fistula

    Directory of Open Access Journals (Sweden)

    Steven Neil Shephard

    2015-10-01

    Full Text Available Uterocutaneous fistula is exceedingly rare, and uniformly follows some type of operative procedure. In this case, a young woman underwent a cesarean delivery at an outlying clinic in rural Nigeria, following which she developed amenorrhea and cyclic pelvic pain. In attempts to resolve her condition, a second laparotomy was performed at the same medical center. She presented to us 2 weeks later, at which time an opening was present at the healing laparotomy scar, severe vaginal scarring and cervical stenosis were present, and marked hematometra was seen on ultrasound. Following a procedure to open her cervix, she began menstruating through a fistulous tract in her abdomen, which we subsequently excised and closed with no further problems for the patient. This case highlights the challenge in developing countries of surgical complications resulting from a lack of appropriately trained physicians in rural medical centers. We suggest that focus on excellent training of our young physicians and the creation of incentives to place and keep fully qualified physicians in such hospitals will improve this situation.

  16. Editorial

    Directory of Open Access Journals (Sweden)

    Akula Annapurna

    2013-09-01

    Full Text Available It’s our great pleasure to introduce the second issue of the “Journal ofPharmaceutical Research and Health Care” (JPRHC. We received positive responsefrom the pharmacy community from all over the world with the launch of JPRHC. It isour tradition to start every issue with a topic which is necessary for the community.Indiscriminate usage of drugs is a worldwide problem which needs immediate attention.We come across reports on misuse of progesterone.Norethisterone is progesterone and is generally prescribed to treat conditions likedysfunctional uterine bleeding, amenorrhea, and endometriosis. Progesterone’s can alsobe used to postpone menstruation. It is sold with brand name Primolut–N. In a countrylike India, where most of the prescription drugs are available without prescription,Primolut- N is often used by women for the postponement of menstrual cycle withouteven consulting a qualified medical professional.There was a recent report on misuse of primolut N. A woman has taken the abovedrug for postponement of menstrual cycle, but the fact was unknown that, by that timeshe consumed the pill she was already pregnant. She gave birth to mentally retarded babyboy and boy survived only for 2 years.Most of the women have no awareness of the nature of the drug, its adverseeffects and contraindications which include known or suspected pregnancy, lactation,diabetes mellitus, thromboembolism, hepatic disorders and hormone dependentmalignancies. Hence indiscriminate use of these pills is not advisable. Let us all bringmore awareness on proper usage of drugs.

  17. The association of a high drive for thinness with energy deficiency and severe menstrual disturbances: confirmation in a large population of exercising women.

    Science.gov (United States)

    Gibbs, Jenna C; Williams, Nancy I; Scheid, Jennifer L; Toombs, Rebecca J; De Souza, Mary Jane

    2011-08-01

    A high drive-for-thinness (DT) score obtained from the Eating Disorder Inventory-2 is associated with surrogate markers of energy deficiency in exercising women. The purposes of this study were to confirm the association between DT and energy deficiency in a larger population of exercising women that was previously published and to compare the distribution of menstrual status in exercising women when categorized as high vs. normal DT. A high DT was defined as a score ≥7, corresponding to the 75th percentile for college-age women. Exercising women age 22.9 ± 4.3 yr with a BMI of 21.2 ± 2.2 kg/m2 were retrospectively grouped as high DT (n = 27) or normal DT (n = 90) to compare psychometric, energetic, and reproductive characteristics. Chi-square analyses were performed to compare the distribution of menstrual disturbances between groups. Measures of resting energy expenditure (REE) (4,949 ± 494 kJ/day vs. 5,406 ± 560 kJ/day, p amenorrhea and oligomenorrhea was observed in the high-DT group (χ2 = 9.3, p = .003) than in the normal-DT group. The current study confirms the association between a high DT score and energy deficiency in exercising women and demonstrates a greater prevalence of severe menstrual disturbances in exercising women with high DT. PMID:21813911

  18. Update on the female athlete triad.

    Science.gov (United States)

    Barrack, Michelle T; Ackerman, Kathryn E; Gibbs, Jenna C

    2013-06-01

    Updated prevalence estimates of all 3 components of the Female Athlete Triad, a syndrome characterized by low energy availability, functional hypothalamic amenorrhea, and osteoporosis, is low (0 %-16 %), however, estimates of 1 or 2 concurrent components approach 50 %-60 % among certain athlete groups. Recent research identifies components of the Triad among female adolescent athletes, particularly those participating in leanness sports, such as endurance running. This is alarming, as adolescents require adequate nutrition and normal hormone function to optimize bone mineral gains during this critical developmental period. Current literature highlights new assessments, such as measurements of bone microarchitecture and hormone levels to better evaluate bone strength and the hormonal and metabolic profile of athletes with and at risk for the Triad. Recent data also provides support for additional potential consequences of the Triad, such as endothelial dysfunction and related cardiovascular effects, stress fractures, and musculoskeletal injuries. Additional prospective research is needed to evaluate long-term indicators and consequences of the Triad and identify effective behavioral treatment strategies. PMID:23613226

  19. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013.

    Science.gov (United States)

    De Souza, Mary Jane; Nattiv, Aurelia; Joy, Elizabeth; Misra, Madhusmita; Williams, Nancy I; Mallinson, Rebecca J; Gibbs, Jenna C; Olmsted, Marion; Goolsby, Marci; Matheson, Gordon

    2014-03-01

    The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves 3 components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with 1 or more of the 3 Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement represents a set of recommendations developed following the first (San Francisco, California) and second (Indianapolis, Indianna) International Symposia on the Female Athlete Triad. It is intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the Female Athlete Triad and to provide clear recommendations for return to play. The 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad Expert Panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision-making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts. This consensus paper has been endorsed by The Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians, and other health care professionals, the American College of Sports Medicine, and the American Medical Society for Sports Medicine. PMID:24569429

  20. Effects of physical exercise on the female reproductive system.

    Science.gov (United States)

    Orio, F; Muscogiuri, G; Ascione, A; Marciano, F; Volpe, A; La Sala, G; Savastano, S; Colao, A; Palomba, S

    2013-09-01

    The excess in physical activity could be closely linked to considerable negative consequences on the whole body. These dysfunctions called as "female athlete triad"' by the American College of Sports Medicine (ACSM) include amenorrhea, osteoporosis and disorder eating. The female athlete triad poses serious health risks, both on the short and on the long term, to the overall well-being of affected individuals. Sustained low energy availability can impair health, causing many medical complications within skeletal, endocrine, cardiovascular, reproductive and central nervous system. On the contrary, several studies have shown, that physical activity improves cardiovascular risk factors, hormonal profile and reproductive function. These improvements include a decrease in abdominal fat, blood glucose, blood lipids and insulin resistance, as well as improvements in menstrual cyclicity, ovulation and fertility, decreases in testosterone levels and Free Androgen Index (FAI) and increases in sex hormone binding globulin (SHBG). Other studies reported that physical activity improved self-esteem, depression and anxiety. Thus, the aim of this review is to elucidate the effect of physical exercise on female reproductive system and viceversa the impact of hormonal status on physical activity and metabolism. In addition this review supports the idea that physical exercise is a helpful tool for the management of obesity, prevention of cardiovascular, metabolic diseases and female reproductive organs related diseases (e.g. breast cancer). When the excess in physical activity leads up to the female athlete triad, it is imperative to treat each component of the triad by employing both pharmacological and non pharmacological treatments. PMID:24126551

  1. [Energy balance, body composition and the female athlete triad syndrome].

    Science.gov (United States)

    Weinstein, Yitzhak; Weinstein, Ayelet

    2012-02-01

    With the rising participation of women in sports events, the prevalence of eating disorders and the female athlete triad (FTS), a syndrome of disordered eating, amenorrhea, and osteoporosis, have also increased in recent years. FTS is often seen in sports that emphasize thinness (e.g. gymnastics, figure skating and dancing) and also in endurance events. Elements of the FTS are pathophysiologically linked, leading to several disease risks and even to mortality. In spite of the considerable knowledge about sports nutrition, there is no consensus as to the correct nutrition regime for the female athlete. There is consensus that minimizing fluctuations in 'target-body-weight' is an indication of a long-term energy balance. Female athletes (e.g. in endurance events and gymnastics) are less likely to achieve the recommended carbohydrates (CHO) and fat consumption due to chronic or episodic constraints of total energy intake while struggling to achieve or maintain low levels of body fat. It is recommended that dietary CHO and fat content be increased to preserve fat-free mass thus enhancing health and performance. Energy balance should also be maintained during recesses. Furthermore, within-day episodes of energy deficits/surplus (measured by the frequency and/or magnitude of the episodes) should be monitored and treated closest to the time of the incidents. PMID:22741211

  2. Neuroendocrine mechanisms in athletes.

    Science.gov (United States)

    Misra, Madhusmita

    2014-01-01

    Athletic activity may be associated with alterations in various neuroendocrine axes depending on the state of energy availability. In addition, genetic factors and an underlying predilection for polycystic ovarian syndrome (PCOS) may predispose some athletes to develop functional hypothalamic amenorrhea earlier than other athletes. In conditions of low energy availability associated with athletic activity, changes that occur in various neuroendocrine axes are primarily adaptive, and aim to either conserve energy for the most essential functions, or allow the body to draw on its reserves to meet energy needs. These hormonal changes, however, then lead to changes in body composition and bone metabolism. Impaired bone accrual in younger athletes and low bone density in older athletes constitutes the major pathologic consequence of neuroendocrine changes associated with low energy availability. The female athlete triad of low energy availability, menstrual dysfunction, and low bone density is prevalent in certain kinds of sports and activities, particularly endurance sports, gymnastics, and ballet. It is essential to screen for this condition in athletes at every preparticipation physical and during office visits, and to put in place an effective treatment team to manage the triad early, in order to optimize outcomes. PMID:25248600

  3. Basketball injuries in children

    Energy Technology Data Exchange (ETDEWEB)

    Gaca, Ana Maria [Duke University Health Systems, Division of Pediatric Radiology, Department of Radiology, Durham, NC (United States); McGovern-Davison Children' s Health Center, Division of Pediatric Radiology, Department of Radiology, Durham, NC (United States)

    2009-12-15

    Basketball is a popular, worldwide sport played outdoors and indoors year-round. Patterns of injury are related to abrupt changes in the athlete's direction, jumping, contact between athletes, the hard playing surface and paucity of protective equipment. Intensity of play and training in the quest of scholarships and professional careers is believed to contribute to an increasing occurrence of injury. Radiologists' appreciation of the breadth of injury and its relation to imaging and clinical findings should enhance the care of these children. Some of the patterns of injury are well known to radiologists but vary due to age- and size-related changes; the growing skeleton is affected by differing susceptibilities from biomechanical stresses at different sizes. Beyond screening radiographs, the accuracy of MRI and CT has improved diagnosis and treatment plans in this realm. Investigations to detect symptoms and signs in an attempt to prevent the tragedy of sudden cardiac death in basketball players may lead to MRI and CTA studies that compel radiologists to evaluate cardiac function along with myocardial and coronary artery anatomy. Worthy of mention also is the female athlete triad of disordered eating, amenorrhea, and osteoporosis that is observed in some young women participating in this and other sports. (orig.)

  4. 2014 female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad.

    Science.gov (United States)

    Joy, Elizabeth; De Souza, Mary Jane; Nattiv, Aurelia; Misra, Madhusmita; Williams, Nancy I; Mallinson, Rebecca J; Gibbs, Jenna C; Olmsted, Marion; Goolsby, Marci; Matheson, Gordon; Barrack, Michelle; Burke, Louise; Drinkwater, Barbara; Lebrun, Connie; Loucks, Anne B; Mountjoy, Margo; Nichols, Jeanne; Borgen, Jorunn Sundgot

    2014-01-01

    The female athlete triad is a medical condition often observed in physically active girls and women and involves three components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with one or more of the three triad components, and early intervention is essential to prevent its progression to serious end points that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement presents a set of recommendations developed following the first (San Francisco, CA) and second (Indianapolis, IN) International Symposia on the Female Athlete Triad. This consensus statement was intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the female athlete triad and to provide clear recommendations for return to play. The expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts. PMID:25014387

  5. Psiloxylon mauritianum (Bouton ex Hook.f.) Baillon (Myrtaceae): A promising traditional medicinal plant from the Mascarene Islands.

    Science.gov (United States)

    Mahomoodally, Mohamad Fawzi; Korumtollee, Housna Nazifah; Chady, Zaynab Zaina Banu Khan

    2014-01-01

    Psiloxylon mauritianum (PM) (Bouton ex Hook.f.) Baillon (Myrtaceae) is an evergreen endemic medicinal plant which has shown promising uses in traditional medicine from the Mascarene Islands (Mauritius and Réunion Islands). Folk use of this endemic plant in Mauritius and Réunion Islands has been geared toward the treatment and management of amenorrhea, dysentery and Type II diabetes mellitus. Recent findings from in vitro studies have led to the discovery of two potent acids namely corosolic acid and asiatic acid which have been shown to bear most inhibitory activities against Staphylococcus aureus. Such findings tend to appraise the therapeutic potential of this medicinal plant against infectious diseases. The present monograph has tried to establish the botanical description, traditional uses and the main constituents identified from PM (Bouton ex Hook.f.) Baillon. The limited documentation of in vitro assays of this plant demonstrates an urgent need for extensive research in order to validate other traditional uses and hence open new avenues for drug development. PMID:26401372

  6. Current status, questions and challenges of transcatheter uterine artery embolization for the treatment of uterine fibroids

    International Nuclear Information System (INIS)

    Current status, questions and challenges of transcatheter uterine artery embolization (UAE) in the treatment of uterine fibroids were summarized and analysed. It has been proved that UAE presents a good effectiveness in controlling the symptoms and shrinkage of fibroid and uterine volumes during follow-up of 4 to 6.9 years domestically and abroad, but relapse of the fibroid may however occur in 2 years or longer after UAE. Generally speaking, UAE is safe in the treatment of uterine fibroids but has a possibility of serious complications. UAE has no damage on normal uterine tissues but may affect pregnancy and delivery of patients significantly later on the cause of hypoxia and inertia of uterus. UAE may cause amenorrhea in the minority of women with ovarian failure and endometrium atrophy. The current questions are how to improve long-term efficiency to reduce relapse of tumor and to insure the safety of UAE. It is our further task to exploit more new effective and safe embolic agents by using animal and clinical study on the basic knowledge of pathology, pharmacology, biochemistry, endocrinology and molecular biology. (authors)

  7. Expectant management of cesarean scar pregnancy: a case report and a review of literature

    Institute of Scientific and Technical Information of China (English)

    Liu Hai-Yuan; Shi Hong-hui; Liu Zhu-Feng; Leng Jin-hua; Lang Jing-he

    2012-01-01

    Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy.Little is known about its natural history and optimal management.All literatures except one reported that the expectant treatments for such patients were unsuccessful or led to complication.This paper presents one case of cesarean scar pregnancy (CSP)with expectant management,and discusses the value of this expectant management.The paper also appears a glimpse of the natural courses of certain cesarean scar pregnancies.A 32-year-old woman with a history of cesarean section presented to our outpatient clinic with amenorrhea and bleeding.Sonography and magnetic resonance imaging (MRI) revealed the diagnosis of CSP without viable gestation sac.The patient opted for expectant treatment.We closely monitored the patient with a detailed plan.The patient had mild bleeding during monitoring and her serum β-hCG levels dropped quickly to normal range after seven weeks.She was fully recovered with total absorption of the mixed mass in the scar of the anterior wall of uterus.If patient with CSP has no viable gestation sac and serum β-hCG levels are rapidly decreased,she can be expectantly treated.Such cesarean scar pregnancies may be naturally demised.Patient with CSP should be followed up strictly.Medical or surgical therapy should be considered prior to rupture to remove the gestational sac and retain the patient future fertility.

  8. Study of 50 cases of modern management of ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Rajita S. Jani

    2014-04-01

    Results: Lower abdominal pain was most common presenting symptom of ectopic pregnancy in 96% cases. The classical triad of symptoms (amenorrhea, abdominal pain and vaginal bleeding was present in only 28% cases. PID contributed 24% cases and previous abortion contributed 28% cases indicating these two as the common risk factors. Ampulla was the commonest site for ectopic pregnancy, in 52% cases. Salpingostomy performed mainly at this site. In 6% cases ectopic pregnancy in infundibulum were treated with fimbrial expression and fimbriectomy. 22% patients were managed medically (methotraxte. These were the cases having unruptured ectopic pregnancy and ectopic mass <4 cm. Laparoscopy was done in 34% cases, in 2 cases it was converted to laparotomy. While open laparotomy was done in 40% cases. Conclusions: Ectopic pregnancy is a treatable problem. Ultrasonography plays central role in the diagnosis and management. Mode of therapy is determined by a combination of clinical symptoms, sonography findings and serum b-HCG values. Surgical management is still a cornerstone of management of ectopic pregnancy. But now scope of medical and laparoscopic management is also there. In recent years laparotomy has been replaced by laparoscopic surgery which is more conservative, minimally invasive and less time consuming which leads to quick recovery. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 374-379

  9. Clinical Observation on Termination of Early Pregnancy of 213 Cases after Caesarian Section with Repeated Use of Mifepristone and Misoprostol

    Institute of Scientific and Technical Information of China (English)

    高佩佩; 汪平

    1999-01-01

    Objective To investigate the efficacy and safety in women after caesarian section for termination of early pregnancies by treatment, or repeated treatment with mifepristone and misoprostot.Subjects and Methods A total of 213 pregnant women with amenorrhea of 34-69d after caesarian section who asked for medical abortion were recruited,including 63 cases undergoing their second medical abortion.A total amount of mi feprisstone of 150 mg given in separate doses(25 mg×4 and 50 mg at the first time)was administered orally within 3d, followed by misoprostot of 0.6 mg orally in the morning of d 3.Results The complete abortion rate was 92.5%,incomplete abortion was 4.7% and failure was 2.8%.Conclusion The sequential use of mifepristone and misoprostol could be successfully and repeatedly used for induced abortion in those women with a caesarian section histo-ry.Its efficacy was similar to that for ordinary population.Its safety and effec-tiveness were satisfactory.

  10. A case of swyer syndrome associated with advanced gonadal dysgerminoma involving long survival.

    Science.gov (United States)

    Da Silva Rios, Salete; Monteiro, Isabella Christina Mazzaro; Braz Dos Santos, Larissa Gonçalves; Caldas, Natasha Garcia; Chen, Ana Carolina Rios; Chen, Juliana Rios; Silva, Helena Spindola Camargo

    2015-01-01

    Swyer syndrome is caused by abnormal sex differentiation during the embryonic period, resulting in incomplete intrauterine masculinization and undifferentiated gonads. The current case report describes a patient with Swyer syndrome associated with stage 3 gonadal dysgerminoma who has survived for 23 years. At age 18, this patient sought assistance for primary amenorrhea from the Gynecological Services Department of the University of Brasília Hospital. A physical examination revealed that the patient was at Tanner stage 4 with respect to axillary hair, breasts, and pubic hair; she presented with a eutrophic vagina and a small cervix. She was treated with a combination of estrogens and progestogens to induce cycling. Approximately 4 years later, a complex tumor was found and resected; a histopathological analysis revealed that this tumor was a right adnexal dysgerminoma with peritoneal affection. The patient was also subjected to chemotherapy. Her follow-up has continued to the present time, with no signs of tumor recurrence. In conclusion, this report describes an extremely rare case in which Swyer syndrome was associated with ovarian dysgerminoma; relative to similar patients, the described patient has survived for an unusually prolonged time. PMID:25960730

  11. Fetal age estimation using MSCT scans of deciduous tooth germs.

    Science.gov (United States)

    Minier, Marie; Maret, Delphine; Dedouit, Fabrice; Vergnault, Marion; Mokrane, Fathima-Zohra; Rousseau, Hervé; Adalian, Pascal; Telmon, Norbert; Rougé, Daniel

    2014-01-01

    Evaluation of fetal age is an essential element in many fields such as anthropology, odontology, paleopathology, and forensic sciences. This study examines the correlation between fetal age, femoral diaphyseal length (considered as the gold standard), and deciduous tooth germs of fetuses aged 22 to 40 weeks amenorrhea (WA) based on computed tomography (MSCT) reconstructions. Qualitative and quantitative studies of femoral and deciduous tooth germ lengths were performed on 81 fetuses (39 females and 42 males). R software was used for statistical analyses. Intra-observer and inter-observer variabilities and the interclass correlation coefficient (ICC) were calculated. Correlation coefficients (R (2)) and linear regression equations were calculated. Intra- and inter-observer variabilities were very satisfactory (intra-observer ICC ≥ 0.96, inter-observer ICC ≥ 0.95). Femoral length was significantly correlated with age (R (2) = 0.9). The correlation coefficient between age and height, width, and dental volume was R (2) ≥ 0.73. Tooth germs were good indicators of fetal age. Our method appears to be reliable and reproducible, and the results of this study agreed with those of the literature. The dental formula provided a precise estimation of fetal age between 25 and 32 WA. Tooth germs were reliable indicators of fetal age, and multislice computed tomography was shown to be an innovative and reliable technology for this purpose. PMID:23828625

  12. Fetal age estimation using MSCT scans of the mandible.

    Science.gov (United States)

    Minier, Marie; Dedouit, Fabrice; Maret, Delphine; Vergnault, Marion; Mokrane, Fathima-Zohra; Rousseau, Hervé; Adalian, Pascal; Telmon, Norbert; Rougé, Daniel

    2014-05-01

    The purpose of this study was to examine a documented fetal collection, to carry out morphometric analysis of femoral length and of the mandible, and to develop diagnostic standards for estimating fetal age at death based on multislice computed tomography (MSCT) reconstructions. The sample was composed of 81 fetuses, whose ages were recorded in weeks of amenorrhea (WA) between 20 to 40 WA. The measurements made were femoral length (FL) and six distances and four angles of the mandible. Femoral length was measured in 81 fetuses (39 females and 42 males). Morphometric study of the mandible was carried out in 65 fetuses (31 females and 34 males), as the mandible was missing in 16 fetuses. R software was used for statistical analyses. Coefficient correlation (R(2)) and linear regression formulas were calculated. Intra-observer and inter-observer variabilities were very satisfactory (intra-class correlation coefficient ≥0.95). Our method appears to be reliable and reproducible. Femoral length was most strongly correlated with age (R(2) = 0.9). The measurement of six distances and four mandible angles from four landmark positions showed a correlation similar to the femoral length correlation (R(2) ≥ 0.72). The results of this study agreed with those of the literature. We conclude that the mandible is a reliable indicator for estimating fetal age at death. Moreover, MSCT has been shown to be an innovative and reliable technology for this purpose. PMID:24213737

  13. Two diagnoses become one? Rare case report of anorexia nervosa and Cushing’s syndrome

    Directory of Open Access Journals (Sweden)

    Sawicka N

    2013-03-01

    Full Text Available Nadia Sawicka,* Maria Gryczyńska,* Jerzy Sowiński, Monika Tamborska-Zedlewska, Marek Ruchała Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland*These authors contributed equally to this workAbstract: Hypothalamic-pituitary-adrenal axis impairment in anorexia nervosa is marked by hypercortisolemia, and psychiatric disorders occur in the majority of patients with Cushing’s syndrome. Here we report a patient diagnosed with anorexia nervosa who also developed Cushing’s syndrome. A 26-year-old female had been treated for anorexia nervosa since she was 17 years old, and also developed depression and paranoid schizophrenia. She was admitted to the Department of Endocrinology, Metabolism, and Internal Medicine with a preliminary diagnosis of Cushing’s syndrome. Computed tomography revealed a 27 mm left adrenal tumor, and she underwent laparoscopic adrenalectomy. She was admitted to hospital 6 months after this procedure, at which time she did not report any eating or mood disorder. This is a rare case report of a patient with anorexia nervosa in whom Cushing’s syndrome was subsequently diagnosed. Diagnostic difficulties were caused by the signs and symptoms presenting in the course of both disorders, ie, hypercortisolemia, osteoporosis, secondary amenorrhea, striae, hypokalemia, muscle weakness, and depression.Keywords: anorexia nervosa, Cushing’s syndrome, adrenalectomy, osteoporosis

  14. Physicochemical characterization and toxicity of decursin and their derivatives from Angelica gigas.

    Science.gov (United States)

    Mahat, Bimit; Chae, Jung-Woo; Baek, In-Hwan; Song, Gyu-Yong; Song, Jin-Sook; Cho, Seong-Kwon; Kwon, Kwang-Il

    2012-01-01

    Angelica gigas NAKAI is used to treat dysmenorrhea, amenorrhea, menopause, abdominal pain, injuries, migraine, and arthritis. The present study provided a physicochemical and toxicological characterization of compounds in A. gigas NAKAI (decursin, decursinol angelate, diketone decursin, ether decursin, epoxide decursin and oxim decursin). Diketone decursin (173.16 μg/mL) and epoxide decursin (122.12 μg/mL) exhibited >100 μg/mL kinetic solubility after applying nephelometry, suggesting a highly soluble compound. The Student’s t-test revealed significant differences in the pKa ranges of the compounds by automatic titration from capillary electrophoresis (pautomatic titration analysis. A parallel artificial membrane permeability assay demonstrated permeability coefficients of <10 x 10⁻⁶ cm/s for all of the compounds, suggesting poor permeability. Ether decursin exhibited a toxic effect after being applied to mouse (NIH 3T3, EC₅₀: 57.9 μM) and human (HT-29, EC₅₀: 36.1 μM; Hep-G2, EC₅₀: 4.92 μM) cells. Additionally, epoxide and oxim decursin were toxic through acute oral toxicity (four and three deaths of Institute of Cancer Research (ICR) mice) and mutation toxicity testing by applying Salmonella typhimurium cells with and without S9. Although diketone decursin exhibited less permeability, it is potentially valuable pharmacological compound that should be investigated. PMID:22791156

  15. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Harrington, Brian C; Jimerson, Michelle; Haxton, Christina; Jimerson, David C

    2015-01-01

    Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for bulimia nervosa (e.g., criterion for frequency of binge episodes decreased to an average of once per week). In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders. Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. For low-weight patients with anorexia nervosa, virtually all physiologic systems are affected, ranging from hypotension and osteopenia to life-threatening arrhythmias, often requiring emergent assessment and hospitalization for metabolic stabilization. In patients with frequent purging or laxative abuse, the presence of electrolyte abnormalities requires prompt intervention. Family-based treatment is helpful for adolescents with anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior therapy, is effective for most patients with bulimia nervosa. The use of psychotropic medications is limited for anorexia nervosa, whereas treatment studies have shown a benefit of antidepressant medications for patients with bulimia nervosa. Treatment is most effective when it includes a multidisciplinary, teambased approach. PMID:25591200

  16. Interventions to Improve Postpartum Family Planning in Low- and Middle-Income Countries: Program Implications and Research Priorities.

    Science.gov (United States)

    Cleland, John; Shah, Iqbal H; Daniele, Marina

    2015-12-01

    This article provides programmatic guidance and identifies future research priorities through a review of interventions to improve postpartum contraception. Thirty-five interventions in low- and middle-income countries were identified and classified according to timing and nature of administration: antenatal, postnatal, both ante- and postnatal, and integration with other services. With the exception of single, short antenatal interventions, the evidence of impact is positive but incomplete. A major gap in knowledge concerns demand for, and means of promoting, immediate postpartum family planning services in Asia and Africa. Counseling before discharge is likely to have an impact on subsequent contraceptive uptake. Integration of family planning into immunization and pediatric services is justified, but policy and program obstacles remain. A case for relaxing the strict conditions of the lactational amenorrhea method (LAM) is strong, but qualitative evidence on the perspectives of women on pregnancy risks is required. Despite the gaps in knowledge, the evidence provides useful guidance for strategies to promote postpartum family planning, in ways that take different contexts into account. PMID:26643491

  17. High-Dose Hook Effect in 17-Hydroxyprogesterone Assay in a Patient with 21-Hydroxylase Deficiency.

    Science.gov (United States)

    Parlak, Mesut; Ellidağ, Hamit Yaşar; Türkkahraman, Doğa

    2015-12-01

    Congenital adrenal hyperplasia (CAH) describes a group of disorders characterized by enzyme defects in adrenal steroidogenesis. 21-hydroxylase deficiency (21-OHD) is the most commonly encountered form. The analysis of steroids in pediatric cases requires high-sensitivity assays. A 14-year-old Syrian girl was referred for evaluation of short stature, amenorrhea, and hirsutism. On physical examination, breast development was Tanner stage 1. She had a phallic clitoris with a single urogenital orifice. Laboratory findings revealed primary adrenal deficiency with high androgen levels and low levels of 17-hydroxyprogesterone (17-OHP), (breast development was noted along with a decrease in testosterone level and an increase in estrogen level. To our knowledge, this is the first case report of hook effect for 17-OHP immunoassay in a patient with 21-OHD. High-dose hook effect should be suspected in patients with CAH when the test results are incompatible with one another. Additionally, this case demonstrates that a high testosterone level can block aromatase activity and consequently also estrogen production and breast development. PMID:26777045

  18. Congenital cloaca: Long-term follow-up results with emphasis on outcomes beyond childhood.

    Science.gov (United States)

    Rintala, Risto J

    2016-04-01

    Persistent cloaca remains a challenge for pediatric surgeons and urologists. Reconstructive surgery of cloacal malformations aims to repair the anorectum, urinary tract, and genital organs, and achieve fecal and urinary continence as well as functional genital tract capable for sexual activity and pregnancy. Unfortunately, even in most experienced hands these goals are not always accomplished. The endpoint of the functional development of bowel, urinary, and genital functions is the completion of patient's growth and sexual maturity. It is unlikely that there will be any significant functional improvement beyond these time points. About half of the patients with cloaca attain fecal and urinary continence after their growth period. The remaining half stay clean or dry by adjunctive measures such as bowel management by enemas or ACE channel, and continent urinary diversion or intermittent catheterization. Problems related to genital organs such as obstructed menstruations, amenorrhea, and introitus stenosis are common and often require secondary surgery. Encouragingly, most adolescent and adult patients are capable of sexual life despite often complex vaginal primary and secondary reconstructions. Also, cloacal malformation does not preclude pregnancies, although they still are quite rare. Pregnant patients with cloaca require special care and follow-up to guarantee uncomplicated pregnancy and preservation of anorectal and urinary functions. Cesarean section is recommended for cloaca patients. The self-reported quality of life of cloaca patients appears to be comparable to that of female patients with less complex anorectal malformations. PMID:26969236

  19. [Dietary carotenodermias].

    Science.gov (United States)

    Bonnetblanc, J M; Bonafé, J L; Vidal, E

    1987-01-01

    Four cases of carotenodermia are presented, secondary to marked ingestion of carotenoid-rich vegetables. The first case was a 34 year old woman who presented with yellow palms and soles while on Weight Watchers diet. Loss of weight was accompanied by irregular menses. The second case was a 21 year old woman with orange palms and soles probably due to lycopenemia by tomatoes rich regimen. The third case is a 52 year old woman with the same type of diet as in case 1, associated with high cholesterol level. The fourth case is a 1.5 year old boy with a high intake of commercially available meals ("petits pots"). All the patients were free of disease usually associated with high level of carotenemia. Irregular menses or amenorrhea may be observed in such cases, either due to the rapid weight of loss, or as a manifestation of psychiatric disorder, and anorexia nervosa is possibly encountered. The toxicity of carotenoids is unproven and others substances ingested with high content vegetables diets are possible answerables. PMID:3434946

  20. Ruptured ectopic pregnancy in rudimentary horn

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    Nivedita A. Goverdhan

    2016-04-01

    Full Text Available A unicornuate uterus with a rudimentary horn is a rare mullerian abnormality which may cause many gynaecological and obstetrical complications like infertility, endometriosis, hematometra, abortions, and preterm deliveries; and is usually associated with urinary tract anomalies. Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures, leading to life -threatening intraperitoneal hemorrhage, which usually presents in the second or third trimester. A 23 year old G2P1L1 in lactational amenorrhea was admitted to the labour room with haemorrhagic shock. Provisionally diagnosed as ruptured ectopic pregnancy, patient was taken for laparotomy after resuscitation. Intraoperative findings were: haemoperitoneum of 3 liters, unicornuate uterus with a ruptured left rudimentary non-communicating horn containing products of conception, and macroscopically normal fallopian tubes and ovaries. The left adnexa were attached to the rudimentary horn. Excision of the rudimentary horn was done. The fetus, weighing about 250 grams, was recovered en-sac from the peritoneal cavity. There is a need for an increased awareness of rudimentary horn pregnancy especially in developing countries where the possibility of detection before pregnancy or before the rupture is unlikely, and precious time is lost in shifting these women to the referral hospital. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1247-1250

  1. The Female Athlete Triad.

    Science.gov (United States)

    Weiss Kelly, Amanda K; Hecht, Suzanne

    2016-08-01

    The number of girls participating in sports has increased significantly since the introduction of Title XI in 1972. As a result, more girls have been able to experience the social, educational, and health-related benefits of sports participation. However, there are risks associated with sports participation, including the female athlete triad. The triad was originally recognized as the interrelationship of amenorrhea, osteoporosis, and disordered eating, but our understanding has evolved to recognize that each of the components of the triad exists on a spectrum from optimal health to disease. The triad occurs when energy intake does not adequately compensate for exercise-related energy expenditure, leading to adverse effects on reproductive, bone, and cardiovascular health. Athletes can present with a single component or any combination of the components. The triad can have a more significant effect on the health of adolescent athletes than on adults because adolescence is a critical time for bone mass accumulation. This report outlines the current state of knowledge on the epidemiology, diagnosis, and treatment of the triad conditions. PMID:27432852

  2. Adverse Event Burden, Resource Use, and Costs Associated with Immunosuppressant Medications for the Treatment of Systemic Lupus Erythematosus: A Systematic Literature Review

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    A. Oglesby

    2013-01-01

    Full Text Available This paper assessed the burden of adverse events (AEs associated with azathioprine (AZA, cyclophosphamide (CYC, mycophenolate mofetil (MMF, methotrexate (MTX, and cyclosporine (CsA in patients with systemic lupus erythematosus (SLE. Thirty-eight publications were included. Incidence of AEs ranged from 42.8% to 97.3%. Common AEs included infections (2.4–77%, gastrointestinal AEs (3.2–66.7%, and amenorrhea and/or ovarian complications (0–71%. More hematological cytopenias were associated with AZA (14 episodes than MMF (2 episodes. CYC was associated with more infections than MMF (40–77% versus 12.5–32%, resp. or AZA (17–77% versus 11–29%, resp.. Rates of hospitalized infections were similar between MMF and AZA patients, but higher for those taking CYC. There were more gynecological toxicities with CYC than MMF (32–36% versus 3.6–6%, resp. or AZA (32–71% versus 8–18%, resp.. Discontinuation rates due to AEs were 0–44.4% across these medications. In summary, the incidence of AEs associated with SLE immunosuppressants was consistently high as reported in the literature; discontinuations due to these AEs were similar across treatments. Studies on the economic impact of these AEs were sparse and warrant further study. This paper highlights the need for more treatment options with better safety profiles.

  3. Sheehan's syndrome: a single centre experience

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    E. Sunil

    2013-01-01

    Full Text Available Background: Sheehan's syndrome (SS occurs as a result of ischaemic pituitary necrosis due to severe postpartum haemorrhage. It is one of the most common causes of hypopituitarism in developing countries. Objective: To study the clinical profile of patients with SS presenting to the Endocrinology Department at a tertiary care teaching hospital in South India. Methods: All patients diagnosed as SS during the study period of 2007-2012 were identified. Their clinical, biochemical, hormonal, radiological and bone mineral density (BMD data were collected. Results: Eighteen patients were identified. Median age of diagnosis was 40 years [interquartile range (IQR = 32-51 years; median (IQR diagnostic delay was 11 (5-17 years]. Failure to resume menstruation and lactation failure was the most common clinical presentation. The median total tetraiodothyronine (T4, peak stimulated cortisol, stimulated growth hormone (GH, and prolactin (PRL levels were low. The gonadotropins [follicle stimulating hormone (FSH and luteinizing hormone (LH] were inappropriately normal in the presence of amenorrhea. Hyponatremia was the most common electrolyte abnormality seen in 14 patients. Seven patients had anaemia and five of them had normocytic normochromic anaemia. BMD assessment (n = 9 was suggestive of low bone mass. Conclusion: SS resulted in multiple pituitary hormone deficiencies in all the patients. Hyponatremia, anaemia, and low bone mass were frequently seen in patients with SS.

  4. Adolescents with Special Needs: Clinical Challenges in Reproductive Health Care.

    Science.gov (United States)

    Quint, Elisabeth H

    2016-02-01

    Adolescents with special needs have unique reproductive health care needs related to their physical and cognitive issues. This review discusses some of the most common concerns that are encountered in clinical practice, as the clinician will partner with the adolescent and her family to guide her through the pubertal transition and to help navigate the risks and rights of reproduction. Families often seek anticipatory guidance before menarche on menstrual hygiene, abuse risk and sexuality and can be reassured that most teens with special needs do very well with menstruation. The clinician needs to evaluate the teenager's reproductive knowledge as well her risk for abuse and coercion and her ability to consent to sexual activity, if she requests contraception. Menstrual management is mostly based on the impact of the menstrual cycles on the teenager's life and activities. The adolescents may have a decreased ability to tolerate menses or pain, or experience changes in seizure pattern or altered mood. Hormonal treatment is often used to assist with menstrual hygiene, cyclical mood changes or dysmenorrhea. The goal of treatment can be complete amenorrhea, alleviate pain or regulate and decrease menstrual flow. The unique risks and benefits of hormonal treatment for this special population are highlighted. PMID:26542013

  5. Evaluation of Clinical Features of Female Patients with Macroprolactinemia

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    Göksun Ayvaz

    2011-09-01

    Full Text Available Aim: Macroprolactin is a high-molecular-weight form of prolactin. It has been suggested that macroprolactin has no clinical importance because of its decreased or limited bioactivity. Although screening for macroprolactinemia is recommended especially in patients with idiopathic hyperprolactinemia; recent studies reported that patients with macroprolactinemia may have some hyperprolactinemia symptoms. Currently, the causes of the symptoms as well as the treatment and follow-up of this group of patients are not clear. In our study, we aimed to retrospectively evaluate and compare the clinical characteristics and gonadal hormone levels of patients with macroprolactinemia and hyperprolactinemia.Materials and Methods: Forty patients with macroprolactinemia and 15 patients with hyperprolactinemia who referred to Obstetrics and Gynecology Hospital were examined.Results: We observed that the patients with macroprolactinemia had similar menstrual disturbances (oligomenorrhea/amenorrhea to the patients with hyperprolactinemia. There was no statistically significant difference between the two groups with respect to FSH, LH and estradiol levels. The frequencies of galactorrhea (p=0.002, headache (p=0.04 and positive radiological finding (p=0.001 were higher in patients with hyperprolactinemia. Infertility rate was found to be increased in women with macroprolactinemia (p=0.02.Conclusion: Patients with macroprolactinemia may have very similar clinic symptoms to those with hyperprolactinemia. Therefore, macroprolactin levels should be measured regardless of the symptoms of hyperprolactinemia in patients with elevated prolactin levels. Türk Jem 2011; 15: 62-5

  6. Macroprolactinoma resistente aos agonistas dopaminérgicos: relato de caso Macroprolactinoma resistant to dopamine agonists: a case report

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    Rosana Maria dos Reis

    2004-09-01

    Full Text Available Os macroprolactinomas são tumores benignos hipofisários, secretores de prolactina, manifestando-se com amenorréia, galactorréia e disfunção gonadal. O tratamento de primeira escolha é clínico, com agonistas dopaminérgicos. O tratamento cirúrgico é reservado para os raros casos que não respondem ao tratamento clínico, intolerância à medicação ou nos casos agudos quando ocorre a hemorragia intra-tumoral. Descrevemos o caso de uma paciente portadora de macroprolactinoma submetida a duas ressecções cirúrgicas e resistente ao tratamento clínico, com evolução não usual.Macroprolactinomas are benign prolactin-secreting pituitary tumors, causing amenorrhea, galactorrhea and gonadal dysfunction. Clinical treatment with dopamine agonists is the first-choice therapy. Surgery is indicated for the rare cases that are resistant to clinical treatment, when there is intolerance to the medication, or intratumoral hemorrhage is detected. We describe the case of a female patient with macroprolactinoma submitted to two surgical procedures and resistant to clinical treatment, with unusual evolution.

  7. A case of an ectopic prolactinoma.

    Science.gov (United States)

    Simsir, Ilgin Yildirim; Kocabas, Gokcen Unal; Sahin, Serap Baydur; Erdogan, Mehmet; Cetinkalp, Sevki; Saygili, Fusun; Yilmaz, Candeger; Ozgen, Ahmet Gokhan

    2012-02-01

    A 34-year-old female presented to our clinic with a 1.5 year history of secondary amenorrhea and galactorrhea. Prolactin (PRL) level was found to be 151.89 ng/ml. Pituitary imaging was reported to be normal. An examination of the patient revealed that PRL level was still high so the dose of cabergoline was further increased and subsequently, bromocriptine was added to the treatment. There was no reduction in PRL levels in controls. A scanning was performed to look for an ectopic focus. Abdominal computerized tomography revealed a heterogenous mass lesion originating from the uterus. Octreotide scintigraphy was performed and we observed an involvement consistent with the mass in the uterus. The patient underwent abdominal total hysterectomy. PRL dropped to 0.4 ng/ml the next day after the operation. The pathology result was a low-grade malignant mesenchymal tumor. Prolactin was found to be immunohistochemically negative. However, galactorrhea disappeared postoperative and PRL levels are still low. Elevated levels of PRL, resistant to bromocriptine and cabergoline, rapidly returned to normal after hysterectomy, which obviously indicates that hyperprolactinemia was associated with the myoma of the uterus. PMID:21780951

  8. Evaluation and management of galactorrhea.

    Science.gov (United States)

    Huang, Wenyu; Molitch, Mark E

    2012-06-01

    Galactorrhea is commonly caused by hyperprolactinemia, especially when it is associated with amenorrhea. Hyperprolactinemia is most often induced by medication or associated with pituitary adenomas or other sellar or suprasellar lesions. Less common causes of galactorrhea include hypothyroidism, renal insufficiency, pregnancy, and nipple stimulation. After pathologic nipple discharge is ruled out, patients with galactorrhea should be evaluated by measurement of their prolactin level. Those with hyperprolactinemia should have pregnancy ruled out, and thyroid and renal function assessed. Brain magnetic resonance imaging should be performed if no other cause of hyperprolactinemia is found. Patients with prolactinomas are usually treated with dopamine agonists (bromocriptine or cabergoline); surgery or radiation therapy is rarely required. Medications causing hyperprolactinemia should be discontinued or replaced with a medication from a similar class with lower potential for causing hyperprolactinemia. Normoprolactinemic patients with idiopathic, nonbothersome galactorrhea can be reassured and do not need treatment; however, those with bothersome galactorrhea usually respond to a short course of a low-dose dopamine agonist. PMID:22962879

  9. [Prolactinoma].

    Science.gov (United States)

    Glezer, Andrea; Bronstein, Marcello D

    2014-03-01

    Prolactinomas are the most common pituitary adenomas that affect young women at fertile age. Hyperprolactinemia causes hypogonadism, menstrual irregularities or amenorrhea in women, low serum testosterone levels in men, and infertility and sexual dysfunction in both men and women. Macroprolactinomas may cause cephalea, visual disturbance, and hypopituitarism. Clinical treatment with dopamine agonists is the gold standard, with cabergoline as the first choice due to its greater efficiency and tolerability. In about 20% of the cases, treatment is partially or completely ineffective, a situation in which surgery, in general by transsphenoidal route, is indicated. Radiotherapy is indicated only in the control of tumor growth in invasive/aggressive cases. In invasive macroprolactinoma, the necessary approach, in general, is the combination of several therapeutic modalities, including debulking and recently-approved drugs, such as temozolamide. As for pregnancy, the drug of choice to induce ovulation still is bromocriptine. In the cases of microprolactinomas and intrasselar macroprolactinomas, the treatment with dopaminergic agonists may be suspended after pregnancy is confirmed. In macroprolactinomas, management should be individualized. PMID:24830588

  10. Macroprolactinemia in a patient with invasive macroprolactinoma: a case report and minireview.

    Science.gov (United States)

    Elenkova, Atanaska; Abadzhieva, Zdravka; Genov, Nikolai; Vasilev, Vladimir; Kirilov, Georgi; Zacharieva, Sabina

    2013-01-01

    Background. Macroprolactin, the high-molecular prolactin isoform, is considered to be an inactive in vivo product with extrapituitary origin. Patients with macroprolactinemia are usually asymptomatic, with negative pituitary imaging. Based on these data, most authors do not recommend treatment and long-term followup in subjects with macroprolactinemia. However, there is evidence for overlapping clinical features among subjects with hyperprolactinemia due to monomeric or "big big" PRL isoform. Case Presentation. We present a 35-year-old female patient with secondary amenorrhea, mild obesity, hirsutism, headache and blurred vision. Hormonal evaluation revealed an extreme hyperprolactinemia (PRL = 10 610 mIU/L) almost exclusively due to macroprolactin isoform (MPRL = 10 107 mIU/L; recovery after PEG precipitation 4.7%) and hypogonadotropic hypogonadism. An invasive pituitary macroadenoma was visualized on MRI, and cabergoline therapy was initiated. Disappearance of clinical signs and symptoms, normalization of gonadotropin levels, and restoration of regular ovulatory menstrual cycles after 1 year of treatment are arguments in favor of preserved-macroprolactin bioactivity in this case. The significant decrease in MPRL levels and tumor volume in response to dopamine agonist therapy is suggestive for the tumoral origin of this isoform. Conclusions. Although macroprolactinemia is considered to be a benign condition, pituitary imaging, dopamine agonist treatment, and prolonged followup should be recommended in some particular cases. PMID:23401806

  11. Management of primary dysmenorrhea in young women with frameless LNG-IUS

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    Wildemeersch D

    2014-06-01

    Full Text Available Dirk Wildemeersch,1 Sohela Jandi,2 Ansgar Pett,2 Thomas Hasskamp3 1Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium; 2Gynecological Outpatient Clinic, Berlin, Germany; 3GynMünster, Münster, Germany Abstract: The objective of this paper is to discuss the potential advantages of intrauterine treatment with a frameless levonorgestrel (LNG-releasing intrauterine system (IUS in young women presenting with primary dysmenorrhea associated with heavy menstrual bleeding. The paper is based on clinical reports of 21 cases of primary and secondary dysmenorrhea treated with the frameless LNG-IUS. Three typical examples of young women between 16 and 20 years of age, who presented with moderate-to-severe primary dysmenorrhea associated with heavy menstrual bleeding, are presented as examples. Following pelvic examination, including vaginal sonography, a frameless LNG-IUS, releasing 20 µg of LNG/day, was inserted. The three patients developed amenorrhea, or scanty menstrual bleeding, and absence of pain complaints within a few months. We conclude that continuous, intrauterine progestogen delivery could be a treatment of choice of this inconvenient condition. In addition, the good experiences with the frameless LNG-IUS in other studies suggests that the frameless design may be preferred over a framed LNG-IUS, as the absence of a frame, resulting in optimal tolerance, is particularly advantageous in these women. Keywords: heavy menstrual bleeding, contraception, FibroPlant, intrauterine system

  12. [Celiac disease. Risk factors for women in reproductive age].

    Science.gov (United States)

    Stazi, A V; Mantovani, A

    2000-05-01

    In the past coeliac disease, or intolerance to gluten, has been considered a rare disease in infancy, whose most important signs were chronic diarrhea with malabsorption and reduced growth. However, besides this classical form, there are a number of other clinical and subclinical forms which may appear even in the adult life and without any overt intestinal sign. The alterations may affect, e.g., the liver, thyroid, skin and the female and male reproductive system. The overall prevalence of the different forms of coeliac disease in Western Europe is at least 1:300. The aim of the present paper is to describe and evaluate the effects of coeliac disease on female reproduction. Such effects include delayed menarche, amenorrhea, infertility and early menopause. Epidemiological studies show that besides reduced fertility, affected women are at higher risk of reproductive problems such as pregnancy loss, low birthweight of offspring and reduced duration of breastfeeding. There are no adequate studies to evidentiate a possible increase of birth defects; nevertheless, coeliac disease induces malabsorption, with deficiencies of nutritional factors essential to prenatal development such as iron, folic acid and vitamin K. The mechanisms underlying the reproductive alterations are still awaiting clarification; however, an interaction among specific nutritional deficiencies, endocrine imbalances and immune disturbances is suspected. As for the other effects associated to the coeliac disease, the possible prevention or treatment of the reproductive effects is only the lifelong maintenance of a gluten-free diet. PMID:11048475

  13. A risk factor for female fertility and pregnancy: celiac disease.

    Science.gov (United States)

    Stazi, A V; Mantovani, A

    2000-12-01

    Celiac disease is a genetically-based intolerance to gluten. In the past, celiac disease has been considered a rare disease of infancy characterized by chronic diarrhea and delayed growth. Besides the overt enteropathy, there are many other forms which appear later in life; target organs are not limited to the gut, but include liver, thyroid, skin and reproductive tract. It is now recognized that celiac disease is a relatively frequent disorder; the overall prevalence is at least 1:300 in Western Europe. Celiac disease may impair the reproductive life of affected women, eliciting delayed puberty, infertility, amenorrhea and precocious menopause. Clinical and epidemiological studies show that female patients with celiac disease are at higher risk of spontaneous abortions, low birth weight of the newborn and reduced duration of lactation. No adequate studies are available on the rate of birth defects in the progeny of affected women; however, celiac disease induces malabsorption and deficiency of factors essential for organogenesis, e.g. iron, folic acid and vitamin K. The overall evidence suggests that celiac disease patients can be a group particularly susceptible to reproductive toxicants; however, the pathogenesis of celiac disease-related reproductive disorders still awaits clarification. At present, like the other pathologies associated with celiac disease, the possible prevention or treatment of reproductive effects can only be achieved through a life-long maintenance of a gluten-free diet. PMID:11228068

  14. IUGR Management: New Perspectives

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    N. Giuliano

    2014-01-01

    Full Text Available Aim of the Study. Analyzing velocimetric (umbilical artery, UA; ductus venosus, DV; middle cerebral artery, MCA and computerized cardiotocographic (cCTG (fetal heart rate, FHR; short term variability, STV; approximate entropy, ApEn parameters in intrauterine growth restriction, IUGR, in order to detect early signs of fetal compromise. Population Study. 375 pregnant women assisted from the 28th week of amenorrhea to delivery and monitored through cCTG and Doppler ultrasound investigation. The patients were divided into three groups according to the age of gestation at the time of delivery, before the 34th week, from 34th to 37th week, and after the 37th week. Data were analyzed in relation to the days before delivery and according to the physiology or pathology of velocimetry. Statistical analysis was performed through the t-test, chi-square test, and Pearson correlation test (P<0.05. Our results evidenced an earlier alteration of UA, DV, and MCA. The analysis between cCTG and velocimetric parameters (the last distinguished into physiological and pathological values suggests a possible relation between cCTG alterations and Doppler ones. The present study emphasizes the need for an antenatal testing in IUGR fetuses using multiple surveillance modalities to enhance prediction of neonatal outcome.

  15. Effects of weight gain and resumption of menses on reduced bone density in patients with anorexia nervosa.

    Science.gov (United States)

    Iketani, T; Kiriike, N; Nakanishi, S; Nakasuji, T

    1995-04-15

    The bone mineral density (BMD) of the lumbar vertebrae (L2-L4) and of the whole body were measured in cross-sectional and longitudinal studies in female patients with eating disorders, using dual photon absorptiometry before and after weight gain with or without resumption of menses. In the cross-sectional study, the low-body-weight anorectic patients, with or without bulimia nervosa, were found to have lower BMD of the lumbar vertebrae associated with severe weight loss, low physical activity, and earlier onset and longer duration of amenorrhea. In the longitudinal study, 11 patients attained subnormal body weight (70%SBW or = 85%SBW, 6 patients of them resumed regular menses) after treatment. The BMD of the lumbar vertebrae was found to increase with weight gain, but not to the control level. The BMD was further increased with the resumption of menses in patients with anorexia nervosa. These results suggest that resumption of menses, in addition to weight gain, is essential to normalize reduced bone mineral density. PMID:7619974

  16. Effect of Hydro Alcoholic Ginger Extracts on the Body Weight, Testis Weight and Spermatogenesis in Male Rats Undergoing Chemotherapy with Cyclophosphamide

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    E Sharifi

    2010-03-01

    Full Text Available Introduction: Cyclophosphamide is used as an anti cancer medicine in chemotherapy. This is an alkalizing medicine and causes the binding of DNA strands, breaking of DNA and control of protein synthesis and RNA. The side effects of this medicine include lack of appetite, nausea, reduction in activity of sexual lymph nodes, causing amenorrhea, azoospermia and oligospermia. Ginger includes many compounds, some of which are shogaols, gingerols, pyrogallols and sesquiterpenes. Ginger has anti nauseating, anti cancer, anti oxidant effects and eliminates free radicals. This medicine is used along with cyclophosphamide to reduce its destructive side effects in the body. Methods: For 21 days, the rats were fed with ginger and cyclophosphamide. After 21 days, the animals were weighed and rendered unconscious. Their testes were removed and tissue samples were provided from their testes. Results: The results showed that cyclophosphamide alone reduces body weight, testes weight and spermatogenesis as compared to the control group. In other experimental groups that were fed with ginger and cyclophosphamide, increased dosage of ginger increased the body weight, the testes weight and spermatogenesis in comparison to the other experimental groups. Conclusion: It seems that compounds present in ginger are anti tumoral and control the production of active metabolites. Therefore, if administered together with Cyclophosphamide, it can be useful and effective in patients undergoing chemotherapy.

  17. Turner syndrome presented with tall stature due to overdosage of the SHOX gene

    Science.gov (United States)

    Seo, Go Hun; Kang, Eungu; Cho, Ja Hyang; Lee, Beom Hee; Choi, Jin-Ho; Kim, Gu-Hwan; Seo, Eul-Ju

    2015-01-01

    Turner syndrome is one of the most common chromosomal disorders. It is caused by numerical or structural abnormalities of the X chromosome and results in short stature and gonadal dysgenesis. The short stature arises from haploinsufficiency of the SHOX gene, whereas overdosage contributes to tall stature. This report describes the first Korean case of Turner syndrome with tall stature caused by SHOX overdosage. The patient presented with primary amenorrhea and hypergonadotropic hypogonadism at the age of 17 years. Estrogen replacement therapy was initiated at that time. She displayed tall stature from childhood, with normal growth velocity, and reached a final height of 190 cm (standard deviation score, 4.3) at the age of 30 years. Her karyotype was 46,X, psu idic(X)(q21.2), representing partial monosomy of Xq and partial trisomy of Xp. Analysis by multiplex ligation-dependent probe amplification detected a duplication at Xp22.3-Xp22.2, encompassing the PPP2R3 gene near the 5'-end of the SHOX gene through the FANCD gene at Xp22.2. PMID:26191517

  18. ROLE OF LACTATION IN FAMILY PLANNING

    Directory of Open Access Journals (Sweden)

    Surekha Kishore

    2010-06-01

    Full Text Available Objectives: 1. To evaluate the role of Lactational Amenorrhea Method (LAM as a spacing method. 2. To assess knowledge attitude and practices regarding breastfeeding. 3. To bring awareness regarding importance of breastfeeding on child health and as a method of family planning so that exclusive breast feeding is promoted. Study Design: Cross sectional study. Setting: In rural village of district Wardha. Study Universe : All the lactating mothers who had2 children (one of which was less than 3 years. Study Variables: Duration of Breast Feeding, LAM, Importance of Breast Feeding. Knowledge of Colostrum, Awareness of Breast Feeding, etc. Statistical analysis used: Percentages and proportions. Result: A total 42 families were included in the survey of which 26 (61.9% belongs to nuclear families with majority of the women 19(45.2% in the age group of 20-25 yrs, 20 (47.6% were illiterate and 18(42.8% families were of lower Socio Economic Status. A directly proportional relationship was found between duration of Breastfeeding & LAM and period of LAM & age of youngest child when the mother delivered again. Only 31% knew about the importance of breastfeeding. 16.6% of woman initiated Breast Feeding within 1/2 hr.

  19. An unbalanced translocation unmasks a recessive mutation in the follicle-stimulating hormone receptor (FSHR) gene and causes FSH resistance

    Science.gov (United States)

    Kuechler, Amla; Hauffa, Berthold P; Köninger, Angela; Kleinau, Gunnar; Albrecht, Beate; Horsthemke, Bernhard; Gromoll, Jörg

    2010-01-01

    Follicle-stimulating hormone (FSH) mediated by its receptor (FSHR) is pivotal for normal gametogenesis. Inactivating FSHR mutations are known to cause hypergonadotropic hypogonadism with disturbed follicular maturation in females. So far, only very few recessive point mutations have been described. We report on a 17-year-old female with primary amenorrhea, hypergonadotropic hypogonadism and disturbed folliculogenesis. Chromosome analysis detected a seemingly balanced translocation 46,XX,t(2;8)(p16.3or21;p23.1)mat. FSHR sequence analysis revealed a novel non-synonymous point mutation in exon 10 (c.1760C>A, p.Pro587His), but no wild-type allele. The mutation was also found in the father, but not in the mother. Furthermore, molecular-cytogenetic analyses of the breakpoint region on chromosome 2 showed the translocation to be unbalanced, containing a deletion with one breakpoint within the FSHR gene. The deletion size was narrowed down by array analysis to approximately 163 kb, involving exons 9 and 10 of the FSHR gene. Functional studies of the mutation revealed the complete lack of signal transduction presumably caused by a changed conformational structure of transmembrane helix 6. To our knowledge, this is the first description of a compound heterozygosity of an inactivating FSHR point mutation unmasked by a partial deletion. This coincidence of two rare changes caused clinical signs consistent with FSH resistance. PMID:20087398

  20. Cushing syndrome and the anesthesiologist, two case reports

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    Rudin Domi

    2011-01-01

    Full Text Available Cushing′s syndrome (CS is associated with reduced life quality and increased mortality, mostly due to cardiovascular disease. The features of this syndrome are central obesity, moon facies, facial plethora, supraclavicular fat pads, buffalo hump, and purple striae. Other complications include hyperglycemia, hypertension, proximal muscle weakness, skin thinning, menstrual irregularities, amenorrhea and osteopenia. These make perioperative and anesthetic management difficult and present a challenge to the operating team, especially the anaesthesiologist. In this paper, we present two such cases of CS, which were treated with adrenalectomy. We aim to highlight the special care and precautions that need to be taken while administering anesthesia, and in the post operatory period. Anaesthesia induction in the two cases of CS was done prior to the adrenalectomy procedure and special pre and post operative care was taken. Continuous intra operative monitoring of vitals and checking for the stability of the haemodynamics was performed. With adequate care and using advanced anesthetic techniques, the patients showed uneventful post operative recovery. Though the anesthetic management of patients with CS is difficult, desired results can be achieved with continuous monitoring and special precautions.

  1. A Case of Mayer-Rokitansky-Kuster-Hayser Syndrome with Absence of the Right Thumb

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    Pal Ranabir

    2008-01-01

    Full Text Available A 14-year-old feminine adolescent, presented with congenital absence of right thumb, scoliosis, severe anemia, primary amenorrhea without secondary sexual characteristics, except for normally developed breasts. In the genital area, there was a pair of ill developed labia majora fused at upper end with a whirling pattern containing inside the urethral opening. The lower end of genitalia had loose skin folds containing adequate amounts of rugae with a raphe, mimicking the texture of scrotal skin. There was no vaginal orifice. Diagnostic work-up included routine hematological studies, skeletal radiography, renal ultrasonography, and renal scan to demonstrate possible association between the congenital genitourinary and skeletal anomalies. Ultrasound imaging studies confirmed that she had structures close to uterus with hematometra, but vagina and ovary were not found. Sonologically, the left kidney could not be visualized. Renal scan confirmed agenesis of the left kidney and hypoplastic, parenchymally insufficient, right kidney. Cytogenetic karyotyping revealed a 46, XX karyotyping and the presence of Barr chromatin body. Based on the clinical examination and investigations, a diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome was established with associated limb and skeletal deformities.

  2. Primary radiotherapy of prolactinomas. Eight- to 15-year follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Mehta, A.E.; Reyes, F.I.; Faiman, C.

    1987-07-01

    Eight women with amenorrhea, galactorrhea, and hyperprolactinemia, of whom six had macroadenomas and two had microadenomas, were treated with conventional (cobalt-60) external radiotherapy, and their progress was monitored for eight to 15 years. Normoprolactinemia was established in five of these patients after two to 13 years (median, nine years). A recurrence was treated surgically in one patient, and stable prolactin values and roentgenographic features have been maintained in two patients. Hypopituitarism has developed in only one patient to date, and no other complications of radiotherapy have been observed. These findings, together with the few previous reports on the long-term effects of radiotherapy on macroprolactinomas, have been compared with the long-term results following surgery or dopamine agonist therapy. The normalization of prolactin values is considerably delayed following radiotherapy compared with the other two therapeutic modalities. However, radiotherapy affords permanent normalization without recurrence in a larger percentage of patients than does surgery and avoids the considerable ongoing cost and inconvenience of daily drug ingestion. The long-term development of hypopituitarism appears to be an acceptably small risk of radiotherapy. Thus, conventional radiotherapy is an attractive treatment option, particularly for macroprolactinomas; adjunctive bromocriptine can be used while awaiting the longer-term benefits of radiotherapy.

  3. Rheumatoid Arthritis, Kartagener’s Syndrome, and Hyperprolactinemia: Who Started It?

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    Hussein Halabi

    2016-01-01

    Full Text Available We report a case of an 18-year-old girl who presented to our hospital with history of recurrent respiratory infections, amenorrhea, and symmetric polyarthritis. She was diagnosed with rheumatoid arthritis (RA, Kartagener’s syndrome (KS, and hyperprolactinemia. There have been very few case reports in the literature of RA occurring in the setting of KS, theoretically proposed to be due to chronic stimulation of the immune system by recurrent infections. Furthermore, hyperprolactinemia has been hypothesized to mirror RA disease activity and case reports of treatment with dopamine agonists have led to the speculation of whether or not they represent a new line of experimental treatment in the future. Our patient was found to have both KS and hyperprolactinemia together in the setting of RA, and based on our literature search, this is the first reported case of such a combination. This strikes a very intriguing question: are these three conditions interlinked by a yet to be defined association? And treatment of which condition leads to the resolution of the other?

  4. Primary radiotherapy of prolactinomas. Eight- to 15-year follow-up

    International Nuclear Information System (INIS)

    Eight women with amenorrhea, galactorrhea, and hyperprolactinemia, of whom six had macroadenomas and two had microadenomas, were treated with conventional (cobalt-60) external radiotherapy, and their progress was monitored for eight to 15 years. Normoprolactinemia was established in five of these patients after two to 13 years (median, nine years). A recurrence was treated surgically in one patient, and stable prolactin values and roentgenographic features have been maintained in two patients. Hypopituitarism has developed in only one patient to date, and no other complications of radiotherapy have been observed. These findings, together with the few previous reports on the long-term effects of radiotherapy on macroprolactinomas, have been compared with the long-term results following surgery or dopamine agonist therapy. The normalization of prolactin values is considerably delayed following radiotherapy compared with the other two therapeutic modalities. However, radiotherapy affords permanent normalization without recurrence in a larger percentage of patients than does surgery and avoids the considerable ongoing cost and inconvenience of daily drug ingestion. The long-term development of hypopituitarism appears to be an acceptably small risk of radiotherapy. Thus, conventional radiotherapy is an attractive treatment option, particularly for macroprolactinomas; adjunctive bromocriptine can be used while awaiting the longer-term benefits of radiotherapy

  5. Rheumatoid Arthritis, Kartagener's Syndrome, and Hyperprolactinemia: Who Started It?

    Science.gov (United States)

    Halabi, Hussein; Mulla, Israa

    2016-01-01

    We report a case of an 18-year-old girl who presented to our hospital with history of recurrent respiratory infections, amenorrhea, and symmetric polyarthritis. She was diagnosed with rheumatoid arthritis (RA), Kartagener's syndrome (KS), and hyperprolactinemia. There have been very few case reports in the literature of RA occurring in the setting of KS, theoretically proposed to be due to chronic stimulation of the immune system by recurrent infections. Furthermore, hyperprolactinemia has been hypothesized to mirror RA disease activity and case reports of treatment with dopamine agonists have led to the speculation of whether or not they represent a new line of experimental treatment in the future. Our patient was found to have both KS and hyperprolactinemia together in the setting of RA, and based on our literature search, this is the first reported case of such a combination. This strikes a very intriguing question: are these three conditions interlinked by a yet to be defined association? And treatment of which condition leads to the resolution of the other? PMID:26904347

  6. Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview

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    Atanaska Elenkova

    2013-01-01

    Full Text Available Background. Macroprolactin, the high-molecular prolactin isoform, is considered to be an inactive in vivo product with extrapituitary origin. Patients with macroprolactinemia are usually asymptomatic, with negative pituitary imaging. Based on these data, most authors do not recommend treatment and long-term followup in subjects with macroprolactinemia. However, there is evidence for overlapping clinical features among subjects with hyperprolactinemia due to monomeric or “big big” PRL isoform. Case Presentation. We present a 35-year-old female patient with secondary amenorrhea, mild obesity, hirsutism, headache and blurred vision. Hormonal evaluation revealed an extreme hyperprolactinemia (PRL = 10 610 mIU/L almost exclusively due to macroprolactin isoform (MPRL = 10 107 mIU/L; recovery after PEG precipitation 4.7% and hypogonadotropic hypogonadism. An invasive pituitary macroadenoma was visualized on MRI, and cabergoline therapy was initiated. Disappearance of clinical signs and symptoms, normalization of gonadotropin levels, and restoration of regular ovulatory menstrual cycles after 1 year of treatment are arguments in favor of preserved-macroprolactin bioactivity in this case. The significant decrease in MPRL levels and tumor volume in response to dopamine agonist therapy is suggestive for the tumoral origin of this isoform. Conclusions. Although macroprolactinemia is considered to be a benign condition, pituitary imaging, dopamine agonist treatment, and prolonged followup should be recommended in some particular cases.

  7. Eating disorders throughout female adolescence.

    Science.gov (United States)

    Dominé, F; Dadoumont, C; Bourguignon, J-P

    2012-01-01

    Eating disorders (EDs) are conditions which are becoming more and more widespread among adolescents and they often lead them to seek the opinion of a professional health caregiver, including gynecologists and pediatricians. EDs, and particularly anorexia nervosa (AN), are usually classified as psychological or psychiatric disorders, but they may have major somatic implications and complications as osteoporosis, nutritional deficiencies, cerebral atrophy, cardiac and metabolic disorders. A key issue in the management is prevention or reduction of both the serious somatic consequences and the important mental health consequences (e.g. depression, psychosocial withdrawal, phobia and suicide), integrating different perspectives (psychological or psychiatric - individual and familial -, genetic, nutritional, pediatric, gynecological). Adolescence is a critical period for the onset of EDs though they may also involve younger children. In this case, the consequences on the development (height, weight, puberty) can also be significant. In this review, we will focus on eating disorders in adolescent girls with an emphasis on AN. We describe variations in ED characteristics and their management depending on age at occurrence. A possible ED should be considered by pediatricians consulted about delayed female growth and puberty as well as gynecologists in patients with primary or secondary amenorrhea or infertility. PMID:22846535

  8. Endolymphatic radiotherapy in malignant lymphomas. A clinical evaluation of 285 patients

    International Nuclear Information System (INIS)

    The authors report treatment of inguinal and retroperitoneal lymph nodes of 285 malignant lymphomas (143 Hodgkin's disease and 142 lymphoreticular sarcomas) with Lipiodol Fluide 131I (endolymphatic radiotherapy). From 1961 to 1966 the radioactive contrast material was injected in doses ranging from 0.2 to 2.5 mc/cc (10 cc each foot). Adequately opacified nodes responded promptly with marked and progressive reduction in size. When indicated, a second administration of Lipiodol 131I in a dose of 2.5 mc/cc was always feasible. Several factors prevented a homogeneous and satisfactory distribution of radioactive contrast material throughout the iliac and the para-aortic nodes in one third of the cases. Therefore, in many instances patients had to be treated with external radiation therapy. Histopathologic examination of lymph nodes removed at exploratory laparotomy (four cases) or at autopsy (ten cases) confirmed that Lipiodol 131I did not fill all the iliac and para-aortic nodes and that destruction of lymphomatous tissue was often incomplete. Recurrences were seen mostly in abnormal adequately filled nodes opacified with high doses of Lipiodol 131I. In Hodgkin's disease they occurred particularly in the para-aortic area and in lymphoreticular sarcomas in the inguinal and iliac chains. Side effects were minimal. They included amenorrhea, pulmonary insufficiency, hepatic failure and hemolytic anemia. Clinical and histologic signs of pulmonary and hepatic fibrosis were not seen

  9. The Use of High-Density SNP Array to Map Homozygosity in Consanguineous Families to Efficiently Identify Candidate Genes: Application to Woodhouse-Sakati Syndrome

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    Molly B. Sheridan

    2015-01-01

    Full Text Available Two consanguineous Qatari siblings presented for evaluation: a 17-4/12-year-old male with hypogonadotropic hypogonadism, alopecia, intellectual disability, and microcephaly and his 19-year-old sister with primary amenorrhea, alopecia, and normal cognition. Both required hormone treatment to produce secondary sex characteristics and pubertal development beyond Tanner 1. SNP array analysis of both probands was performed to detect shared regions of homozygosity which may harbor homozygous mutations in a gene causing their common features of abnormal pubertal development, alopecia, and variable cognitive delay. Our patients shared multiple homozygous genomic regions; ten shared regions were >1 Mb in length and constituted 0.99% of the genome. DCAF17, encoding a transmembrane nuclear protein of uncertain function, was the only gene identified in a homozygous region known to cause hypogonadotropic hypogonadism. DCAF17 mutations are associated with Woodhouse-Sakati syndrome, a rare disorder characterized by alopecia, hypogonadotropic hypogonadism, sensorineural hearing loss, diabetes mellitus, and extrapyramidal movements. Sequencing of the coding exons and flanking intronic regions of DCAF17 in the proband revealed homozygosity for a previously described founder mutation (c.436delC. Targeted DCAF17 sequencing of his affected sibling revealed the same homozygous mutation. This family illustrates the utility of SNP array testing in consanguineous families to efficiently and inexpensively identify regions of genomic homozygosity in which genetic candidates for recessive conditions can be identified.

  10. Basketball injuries in children

    International Nuclear Information System (INIS)

    Basketball is a popular, worldwide sport played outdoors and indoors year-round. Patterns of injury are related to abrupt changes in the athlete's direction, jumping, contact between athletes, the hard playing surface and paucity of protective equipment. Intensity of play and training in the quest of scholarships and professional careers is believed to contribute to an increasing occurrence of injury. Radiologists' appreciation of the breadth of injury and its relation to imaging and clinical findings should enhance the care of these children. Some of the patterns of injury are well known to radiologists but vary due to age- and size-related changes; the growing skeleton is affected by differing susceptibilities from biomechanical stresses at different sizes. Beyond screening radiographs, the accuracy of MRI and CT has improved diagnosis and treatment plans in this realm. Investigations to detect symptoms and signs in an attempt to prevent the tragedy of sudden cardiac death in basketball players may lead to MRI and CTA studies that compel radiologists to evaluate cardiac function along with myocardial and coronary artery anatomy. Worthy of mention also is the female athlete triad of disordered eating, amenorrhea, and osteoporosis that is observed in some young women participating in this and other sports. (orig.)

  11. A de novo Reciprocal X; 9 Translocation in A Patient with Premature Ovarian Failure

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    Faezeh Azizi

    2013-01-01

    Full Text Available Premature ovarian failure (POF causes hypergonadotrophic amenorrhea in 1-3%of females, occurring before the age of 40 among women with chromosomal rearrangementsin the long arm of the X chromosome 'critical region'. In this article,we report a case of POF and primary amenorrheain a girl with a de novo reciprocaltranslocation between chromosomes X and 9. The proband was a 17 years oldgirl with a history of irregular menstruation and high level of follicle-stimulatinghormone (FSH (151 mlU/mL and luteinizing hormone (LH (56 mlU/mL. In ultrasoundexamination, left ovarian gonad was atrophic without any follicles. Rightovarian gonad was not seen. Cytogenetical analysis was performed on the patientand her parents. Her karyotype results was 46, X, rcp (X; 9 (q24; q13 dn. Herparents had normal karyotype. This reciprocal translocation between chromosomeX and 9 and observed POF in the patient suggest either the disruption of a criticalgene expression due to 'position effect' or deletion of one or more POF-related genesin the disrupted long arm of the affected X chromosome.

  12. A Comparison Study of Oral RU486/Cytotec and Vacuum Aspiration for Termination of Early Preganacy

    Institute of Scientific and Technical Information of China (English)

    杜明昆; 应玉娣; 郑怀美; 闻珍; 倪如珏

    1996-01-01

    Objective : This study is to compare the personal acceptability and effect of Oral RU486/PG versus surgical vacuum aspiration on termination of early pregnancy. Method: Subjects were recruited by their voluntary choice of methods. One hundred women aged 20~34 with amenorrhea of 35~42 days chose the medical method (RU486 600 mg on the lst day and cytotec 0. 4 mg on the 3rd day). One hundred women aged 20~34 with amenorrbea < 56 days chose vacuum aspiration. Subjects were asked to return on the 17th day in the medical group and 14th day in the surgical group for follow-up. Results: Complete abortion rates in the medical and surgical groups were 89% and 100% respectively. The main reason for choosing medicalabortion was "less painful" (94%) while that for choosing surgical abortion was "quick and saving time (55 % ), with removing or insering IUD (45 % ) following surgical abortion", Conclusion : For pregnancy termination RU486/Cytotec (PGE1) and vacuum aspiration are both highly acceptable, Each method has its own advantages and disadvantages and they can not replace each other. Selective use can provide advantages of either method. The earlier the termination, the safer the event.

  13. Partial trisomy 9p22 to 9p24.2 in combination with partial monosomy 9pter in a Syrian girl

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    Moassass Faten

    2010-10-01

    Full Text Available Abstract Background Partial trisomy of the short arm of chromosome 9 is among the most common autosomal structural chromosomal anomalies leading to chromosomal imbalance in human. Clinical characteristics are craniofacial dysmorphism including hypertelorism, prominent nose, deep-set eyes, and down-slanting palpebral fissures. The degree of clinical severity in partial trisomy 9p roughly correlates with the size of the chromosomal imbalance. Therefore, breakpoints as well as clinical findings need to be precisely defined for differential diagnosis. Results Chromosomes of a young female were analyzed due to primary amenorrhea, short stature, developmental delay and a characteristic facial appearance. Cytogenetic analysis using GTG banding identified a karyotype 46, XX, add(9pter. Surprisingly the application of high resolution molecular cytogenetic techniques characterized a partial trisomy 9p24.2-p22 and partial monosomy 9pter-p24.2. To the best of our knowledge only four similar case were reported by now. Conclusion Attempts for genotype-phenotype correlations for partial trisomy 9p might have been hampered by the fact that more complex, cryptic aberrations were neither considered nor detected in comparable clinical cases.

  14. Myeloid Leukemia while on Dasatinib Therapy

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    Monika Conchon

    2010-01-01

    Full Text Available Here we report the case of an 18-year-old woman with chronic myeloid leukemia (CML who became pregnant while undergoing treatment with dasatinib. Before pregnancy, she received imatinib mesylate therapy but could not tolerate the treatment. The regimen was then changed to dasatinib at a dose of 70 mg b.i.d. While she was in hematological remission and on dasatinib therapy, she became pregnant. The unplanned pregnancy was identified after the patient had experienced four weeks of amenorrhea. Because the patient elected to continue the pregnancy to term, dasatinib was stopped immediately. Meanwhile, CML hematological relapse occurred and then she was treated with interferon- (IFN- (9 million IU/day throughout the pregnancy without a complete hematological response. She successfully gave birth to a male baby at 33 weeks by cesarean section delivery with no sequelae or malformations. Although this experience is limited to a single patient, it provides a useful contribution for counselling patients inadvertently exposed to dasatinib during pregnancy.

  15. Comparison of Continuation Rates and Reasons of Discontinuation for Cyclofem and Depot -medroxyprogesterone acetate in Rural Areas of East Azerbaijan Province, Iran

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    Robab Hassanzadeh

    2012-03-01

    Full Text Available Objective: In this study continuation rate and reasons for discontinuation of Depot-medroxyprogestroneacetate (DMPAand Cyclofem have been compared.Materials and methods: A retrospective cohort study was conducted with 422 women (202 Cyclofemand220 DMPA userswho had started using the methods 12-24 months before the study in East Azerbaijanhealth houses. Data were collected by reviewing the records and interview with the clients and analysedusing Kaplan-Meier and Cox Regression.Results: The 3, 6, 9, 12 months continuation rate were 56%, 37%, 30%, 27% respectively for Cyclofemversus 75%, 59.5%, 48%, 42.5% for DMPA. Menstrual changes were reported significantly more by theDMPA users than the Cyclofem users (85% vs. 73%, P=0.008 as the main reason for thediscontinuation, the difference mainly reflected of amenorrhea (50% vs. 23%, P=0.003. None of DMPAusers and 11% of Cyclofem users claimed frequency of visits and lack of method supplies as their maindiscontinuation reason.Conclusion: Discontinuation rate was high for the both methods but it was higher for Cyclofem.Thecommon side effects mentioned as the main reasons for discontinuation of the both methods are nothealth threatening. Therefore, health care providers may help to improve their continuation rate byappropriate consultation.

  16. Menstrual and reproductive function repair in patients with polycystic ovary syndrome and obesity by correcting of glucose intolerance

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    O I Lineva

    2008-06-01

    Full Text Available The aim of the study was to investigate the effect of sibutramine on metabolic and hormonal parameters in women with PCOS and obesity. Materials and methods. The study included 53 women aged 18 to 35 years (mean age 31,3 ± 1,1 years with PCOS and obesity. All patients received therapy with sibutramine. The total treatment duration was 6 months. The treatment was evaluated monthly nature of the menstrual cycle, anthropometric parameters (body weight, BMI, ON, ON, ON / OF. The Results. The studies found that after 3 months of treatment with weight loss was 8,1 ± 0,31 kg, after 6 months - 13,1 ± 0,78 kg (p <0,05. Results of the survey of women included in this study strongly support the negative impact of obesity on the functional state of the reproductive system, evidenced by the high incidence of anovulation, rhythm disturbances of menstruation (amenorrhea up to, infertility. Conclusions. The obtained results once again confirm the high efficacy and safety of sibutramine to reduce body mass, suggest correction of metabolic, hormonal disorders and positive impact on women's reproductive health. This allows us to consider the use of sibutramine in women with PCOS and obesity as a way to restore the endocrine function of the reproductive system.

  17. Use-effectiveness of six-month injections of DMPA as a contraceptive.

    Science.gov (United States)

    McDaniel, E B; Pardthaisong, T

    1974-05-15

    The use of depot-type injections of the contraceptive medroxyprogesterone acetate (DMPA) was studied in 1132 women for up to 5 1/2 years. Continuation rates, reasons for discontinuation, method failure rates, and bleeding patterns were considered. The women received a dose of 400 mg DMPA in aqueous suspension (injected into the deltoid muscle) every six months. In addition, each patient received an oral dose of .04 mg ethynl estradiol for 10 days each lunar month. Of the original acceptors, 36.4 percent used the method for the full 5 1/2 years. The major reasons for discontinuation of DMPA injections were bleeding problems (including amenorrhea) and such other medical reasons as palpitation, abdominal pain, headache, weakness, and dizziness. A total of 26 women became accidently pregnant while using DMPA during the 5 1/2 years. Advantages of DMPA injections were the simplicity, safety, and effectiveness of the method, and the psychological appeal of an injectable contraceptive. PMID:4823385

  18. [Acceptability of medroxyprogesterone acetate in rural areas of Mexico].

    Science.gov (United States)

    Velasco Murillo, V; Cervantes Bustamante, A; Correu Azcona, S; García López, E

    1981-03-01

    361 retrospective surveys were carried out among users of medroxyprogesterone acetate (MPA) given in a trimestral regimen of 150 mg/dose in rural areas of 3 Mexican states. Gynecology-obstetric antecedents, previous experience with oral contraceptives (OCs), effects of injections on the menstrual cycle, causes of method suspension, and opinion concerning administration of medication were analyzed. 78.6% of the patients were multigravidae with 4 or more pregnancies; 39.1% were former users of OCs, and 23.4% had stopped taking them because of side effects. The side effects of MPA on the menstrual cycle were: amenorrhea (19.8%); hemorrhage/cycle of 10-30 days in 14.7%; and hemorrhage/cycle of 30 or more days in 11.6%. Only 14.7% of users stopped the injections and of these, 80.3% did so due to menstrual cycle disorders. 99.7% of the users thought the method was comfortable as a family planning procedure. (author's) PMID:6459270

  19. Anorexia nervosa in a pediatric renal transplant recipient and its reversal with cyclosporine.

    Science.gov (United States)

    Okechuku, Gyongyi; Boulos, Andrew K; Herman, Lettie; Upadhyay, Kiran

    2015-05-01

    We report a 16-yr-old female who developed AN within a month after renal transplantation and its resolution after switching from tacrolimus to cyclosporine. Her initial maintenance immunosuppressive regimen after renal transplantation consisted of tacrolimus, mycophenolate, and steroid. She had 7 kg weight loss within the first month of transplant with subsequent 10, 12, 17, and 19 kg loss after three, five, seven, and nine months of transplant, respectively. Besides weight loss and disturbances in body image, the patient developed alopecia, bradycardia, and persistent secondary amenorrhea. Upon switching to cyclosporine from tacrolimus nine months after transplant, she started regaining weight with 5 kg gain within two months and 10 kg after four months. She restarted her menstrual cycle, alopecia and bradycardia resolved, and her body image disturbance improved. Here, we describe a very unusual neuropsychiatric side effect of tacrolimus and its resolution with another calcineurin inhibitor, cyclosporine, in an adolescent renal transplant recipient. PMID:25661468

  20. [Questions by adolescents about dieting].

    Science.gov (United States)

    Bloch, A

    1989-12-15

    In recent years there has been increasing concern and involvement of Israeli adolescents with dieting. An increase in the incidence of obesity has been emphasized by the mass media. This has been marked by an increase in the number of questions on dieting sent anonymously by 12 to 14 year-olds to a column in a popular youth magazine about adolescent sexuality. These letters include requests for diets to prevent obesity in general and fatness of certain parts of the body in particular, such as the thighs or buttocks; questions as to side-effects of diets already started, particularly amenorrhea; and questions about the onset of bulimia and anorexia nervosa, expressing fear of the consequences. This study gives examples of the questions and the answers, and indicates the professions of those to whom the applicants were referred for further diagnosis and treatment. Newer techniques of health education with regard to adolescent dieting are urgently needed so that the health staff can promote insight and indicate the need for treatment at as early a stage as possible. The use of mass media in a suitable manner is critical, given the increase in diet-advertising. PMID:2620891