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Slide No. 9: (2 Marks)

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Imperforate Hymen The most serious complication of this operation: Infection A 16-years girl with delayed menarche Slide No. 7: Name three possible complains? 1. – PowerPoint PPT presentation

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Title: Slide No. 9: (2 Marks)


1
Slide No. 9 (2 Marks)
A 15 years female complaining of delayed
menarche Findings(A) Inspection of abdomen
(B) Inspection of vulva
  • Most Probable Diagnosis Imperforate Hymen
  • Treatment Hymenectomy or Hymontomy

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Slide No. 5 (2 Marks)
A 16-years girl with delayed menarche
  • What is your diagnosis? Imperforate Hymen
  • The most serious complication of this operation
    Infection

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Slide No. 7
Ovarian findings
Ultrasonography
Laparoscopy
Gross appearance
  • Name three possible complains?
  • 1. Hirsutism.
  • 2. Oligmenorrhea / amenorrhea.
  • 3. Infertility.

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SLIDE 1
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SLIDE 2
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SLIDE 9
UTERUS
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Ultrasonography
Abdominal Examination
During surgery
Local Examination
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Imperforate hymen
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Utero-vaginal Agenisis Mayer-Rokitansky-Kuster-Ha
user syndrome
  • 15 of 1ry amenorrhea
  • Normal breasts and Sexual Hair development
    Normal looking external female genitalia
  • Normal female range testosterone level
  • Absent uterus and upper vagina Normal ovaries
  • Karyotype 46-XX
  • 30 renal,10 skeletal and middle ear anomalies
  • Treatment STERILE ? Vaginal creation(Dilatation
    VSVagino-plasty)

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Androgen insensitivityTesticular feminization
syndrome
  • X-linked recessive gene.
  • Absent cytosol receptors
  • Normal breasts but no sexual hair
  • Normal looking female external genitalia
  • Absent uterus and upper vagina
  • Karyotype 46, XY
  • Male range testosterone level
  • Treatment gonadectomy after puberty HRT
  • ? Vaginal creation (dilatation VS Vaginoplasty )

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Slide No. 10 (2 Marks)
A 18-years girl with primary amenorrhea
146 cm.
Ovary
Uterus
  • What is the most probable diagnosis Turners
    syndrome
  • Sure diagnosis is by Karotyping (45 0X)

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Turners syndrome
Mosaic (46-XX / 45-XO)
(Classic 45-XO)
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Ovarian dysgenesis
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AMENORRHEAAbsent or poor secondary sex
Characteristics
FSH Serum level
Low / normal
High
Hypogonadotropic hypogonadim
Gonadal dysgenesis
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Hypogonadotrophic Hypogonadism
  • Normal hight
  • Normal external and internal genital organs
    (infantile)
  • Low FSH and LH
  • MRI to R/O intra-cranial pathology.
  • 30-40 anosmia (kallmanns syndrome)
  • Sometimes ? constitutional delay
  • Treat according to the cause (HRT), potentially
    fertile.

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Cushings syndrome
  • Clinical suspicion Hirsutism, truncal obesity,
    purple striae,? BP
  • If Suspicion is high
  • dexamethasone suppression test (1 mg PO 11 pm
    ) and obtaine serum cortisol level at 8 am
  • lt 5 µg/ dl excludes cushings
  • 24 hours total urine free cortisol level to
    confirm diagnosis
  • 2 forms adrenal tumour or ACTH hypersecretion
    (pituitary or ectopic site)

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Weight-related amenorrhoeaAnorexia Nervosa
  • 1o or 2o Amenorrhea is often first sign
  • A body mass index (BMI) lt17 kg/m²? menstrual
    irregularity and amenorrhea
  • Hypothalamic suppression
  • Abnormal body image, intense fear of weight gain,
    often strenuous exercise
  • Mean age onset 13-14 yrs (range 10-21 yrs)
  • Low estradiol ? risk of osteoporosis
  • Bulemics less commonly have amenorrhea due to
    fluctuations in body wt, but any disordered
    eating pattern (crash diets) can cause menstrual
    irregularity.
  • Treatment ? body wt. (Psychiatrist referral)

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Exercise-associated amenorrhoea
  • Common in women who participate in sports (e.g.
    competitive athletes, ballet dancers)
  • Eating disorders have a higher prevalence in
    female athletes than non-athletes
  • Hypothalamic disorder caused by abnormal
    gonadotrophin-releasing hormone pulsatility,
    resulting in impaired gonadotrophin levels,
    particularly LH, and subsequently low oestrogen
    levels

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Ashermans syndrome
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