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DR Medhat MRCP

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Hormone results Possible diagnosis Secondary tests<br />

LH FSH Estradiol Prolactin Testosterone<br />

↓ ↓ ↓ N N<br />

↓ ↓ ↓ ↑/↑↑ N<br />

↑ ↑ ↓ N N<br />

Hypogonadotrophic amenorrhoea<br />

I. Hypothalamic failure<br />

- Sever stress , muscular exercise<br />

- Severe chronic illness (celiac,CF,CKD,CLD)<br />

- Severe weight loss (anorexia nervosa)<br />

II. Pituitary failure<br />

- Tumors : craniopharyngioma,NF. adenoma<br />

- Trauma : head injury, surgical remova<br />

- Pituitary apoplexy (hge/infarct inside tumor)<br />

- Shehan`s syndrome : post partum he + pit.<br />

infarction<br />

III. Idiopathic GnRH ,FSH,LH deficiency<br />

IV. Hyperprolactinemia<br />

- Pituitary prolactinoma<br />

- Endocrine : 1ry hypothyroidism, acromegaly<br />

- Drugs : dopamine antagonists,SSRI,antipscych<br />

Hyper gonadotrophic amenorrhoea<br />

Ovarian damsge/failure<br />

- Irradiation , drugs (Endoxan)<br />

- Premature ovarian failure<br />

Ovarian absence (oophorectomy)<br />

Normogonadotrophic amenorrhoea<br />

- MRI/ Pituitary<br />

- Full pituitary function tests<br />

- MRI/pituitary<br />

- TSH , T3 & T4<br />

- Karyotype analysis for POF<br />

↑/N N N N/mild↑ N/mild↑ 1- Polycystic ovary syndrome<br />

- U.S /ovaries.<br />

↑ LH/FSH ratio<br />

N/↓ N/↓ N/↓ N ↑↑↑ 2- Androgen secreting tumors - Imaging ovary/adrenals<br />

N N N N N 3- Anatomical defect (Asherman syndr) - Examination under anaesth

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