Reproductive and endocrine disease

Shujun Gao

Individual

• Each in normal position

• Each keeps normal activity

• Each has normal reaction

System

• Normal——interaction in balance

• Dysfunction——lost of balance

Inferior colliculus

GnRH

Pituitary gland

Gonadotropin

FSH LH

progestogenestrogen

Center stratum cutaneum

？？

Reproductive endocrine

axis

amenorrhea

• xxx ， 16-year-old with secondary sexual characters ，but absence of menstruation

• Question ： What is the diagnosis and how to treat?

Correlated knowledge

• The initiate and maintain of the normal menstruation

• Normal growth sequence of puberty

• Conditions of ovarian growth

• Physiologic function of ovarian

• Methods of examination of ovarian function

Causation and pathophysiology

• Hypothalamic amenorrhea

• Pituitary amenorrhea

• Ovarian amenorrhea

• Uterine amenorrhea

• Congenital dysplasia of low genital tract

• Dysfunction of other endocrine glands

Definition

• It is a common symptom ,not a disease

• Primary amenorrhea ： secondary sexual characters

not appears after 14-years or no menarche after 16-y

ears although secondary sexual characters appeared.

• Secondary amenorrhea ： cessation of the periods for

6months after menstruation has been established

Classification (one)

• Primary amenorrhea——most due to congenital diseases or functional disorder and deformed genital tract,about 5% 。

• Secondary amenorrhea——most due to secondary dysfunction or tumor,about 95% 。

Classification (two)

•Physiologic amenorrhea

•Pathological amenorrhea

Classification （ three ）

According to the anatomic site

• Congenital dysplasia of low genital tract

• Uterine amenorrhea

• Ovarian amenorrhea

• Pituitary amenorrhea

• Central nerve-hypothalamic amenorrhe

a

Classification （ four ） According to the level of sex hormone

• Hypergonadotropic hypogonadism ：

FSH≥30IU/L ， lesion presence in ovar

ian

• hypogonadotropic hypogonadism ：

FSH and LH both<5IU/L ， lesion pres

ence in center

Dysfunctional uterine bleeding

• Patient ——Troubled by dysfunctional uterine bleeding sees a doctor to resolve bleeding and to get normal menstruation

• Doctor —— you ， should know how to satisfy the patient

• To solve the problem, diagnosis, differential diagnosis and treatment should be mastered

• Patient ： 17-year-old ， 46kg• Chief complaint ： menstrual disorder for 2 months,vaginal bleeding for 18

days• Menstruation: 11year 5-7/20-30days 。 Pmp 2007.07.03 ,Lmp 2007 08.24 。• History of present illness: She had a heavy vaginal bleeding from September

5th, 2007 ,accompany with dizziness, vertigo and fatigue,and was hospitalized emergency

• Medical examination: T36.7 、 P88cpm 、 R21cpm 、 BP90/50mmg. depressed with an anemia face• Gynecology examination ： corpus ： middle position with normal size adnexa ： no masses• ultrasound: UT46× 45×40mm, EN10mm ROV31×28×23mm, LOV33×17×16mm. Cul-de-sac hydrops ： 18mm.

discussion

• diagnosis ： puberty dysfunctional uterine bleeding secondary anemia• Procedure of diagnosis: history of illness medical examination gynecological examination auxiliary examination ： urine HCG 、 ultrasound 、 sex hormone 、 blood routine.• Therapeutics ： sex hormone diagnostic curettage antibiotics treatment of anemia