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Hyperprolactinemia is a frequent condition in clinical practice, responsible for 20–25% of secondary amenorrhea cases. We performed an electronic survey among members of the Brazilian Society of Metabolism and Endocrinology (SBEM) and the Brazilian Federation of Association of Gynecology and Obstetrics (FEBRASGO) to assess diagnostic and therapeutic preferences for management of hyperprolactinemia. Electronic addresses of SBEM and FEBRASGO members were obtained from the directories of these societies, and these members were invited, through electronic messages (e-mail), to answer an online questionnaire that included 10 questions about the treatment of micro and macroprolactinomas, maximum dose of dopamine agonist, how to exclude primary hypothyroidism and macroprolactinemia, hyperprolactinemia and pregnancy. We received responses to the questionnaire by e-mail from 521 SBEM members and 233 FEBRASGO members. The results of this survey demonstrate that there are many area of agreement between SBEM and FEBRASGO members and most of their responses follow the latest Endocrine Society Guideline. Relative to a survey performed several years ago, our findings show that SBEM members have incorporated some of latest recommendations in this field. The principal issues of concern for both groups are duration of dopamine agonist treatment for patients with microprolactinoma and dopamine agonist withdrawal during pregnancy.

Premature ovarian failure (POF) is a complex disorder that affects approximately 1% of women. POF is characterized by the depletion of functional ovarian follicles before the age of 40 years, and clinically, patients may present with primary amenorrhea or secondary amenorrhea. Although some genes have been hypothesized to be candidates responsible for POF, the etiology of most of the cases is idiopathic, with the underlying causes still unidentified because of the heterogeneity of the disease. In this review, we consider some mutant mouse models that exhibit phenotypes which are comparable to human POF, and we suggest that the use of these mouse models may help us to gain a better understanding of the molecular mechanisms underlying POF in humans.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disease of women of reproductive age, yet it remains undiagnosed for many women. The reason the syndrome is often not diagnosed or is misdiagnosed is because PCOS can present with a variety of abnormalities that can be present in other endocrine dysfunctions and problems. Concerns about abnormal menses, an inability to conceive, or cosmetic problems often are what bring these women into the clinical setting. The disease is the result of a defect in the hypothalamic-pituitary-ovarian circuit, but the cause is unknown. With appropriate diagnosis and management, the patient may delay or prevent negative physical and psychological consequences brought on by this syndrome.

Objective: Here, we present a case of ACTH-dependent pituitary macroadenoma (Cushing's disease) resulting in secondary amenorrhea mimicking polycystic ovary syndrome (PCOS). Case Report: A 20-year-old nulligravid woman had been suffering from oligomenorrhea, amenorrhea, and moderate hirsutism since the age of 18 years. She visited a gynecologic clinic where PCOS was impressed according to the clinical manifestation and ultrasound finding. The patient responded to medication in the 1st year, but gradually failed to induce menses. She was advised to visit the endocrinology department for secondary amenorrhea and endocrine survey. Physical examination revealed central obesity, supraclavicle fatpad, abdominal striae, and myopathy of four limbs. Endocrine studies revealed: serum prolactin 21 ng/mL (3.0-20 ng/mL), FSH 5.69 mIU/mL (3.4-10.0 mIU/mL), LH 1.01 mIU/mL (1.1-11.6 mIU/mL), E2 < 20 pg/mL (follicular phase 53-258 pg/mL), ACTH 110 pg/mL (0-46.0 pg/mL), cortisol 26.7 μg/dL at 8 a.m. (5.0-25 μg/dL), cortisol 21.3 μg/dL at 11 p.m. (half of normal morning value). Right pituitary macroadenoma was diagnosed through a series of dexamethasone tests and MRI. The patient received staging surgery including transsphenoidal adenomectomy and right frontotemporal craniotomy. As a result, the patient's physical condition gradually improved, and her menstrual cycle became regular with medication after the operation in the outpatient follow-up. Conclusion: PCOS is a common disease resulting in secondary amenorrhea. However, Cushing's syndrome resulting from pituitary macroadenoma should also be considered. Therefore, a careful history, observation, physical examination, and endocrine studies can differentiate between patients with PCOS and Cushing's disease.

A complex mosaicism involving the X chromosome was found in a 35-year-old female affected by secondary amenorrhea and short stature. Her karyotype was: 45,X[20]/46,X,del(X)(pter-->q26::qter)[15]/46,X,idic(X)(pter-->q26::q26-->pter)[9]. No cell contained both abnormal X chromosomes. This observation would suggest a possible mechanism underlying the formation of isodicentric chromosomes.

Objective To compare two dosages of oral micronized progesterone (P) and placebo for withdrawal bleeding and side effects. Design Prospective, randomized, double-blind. Setting Academic institution. Participants: Out of 190 screened with oligomenorrhea/amenorrhea, 60 who qualified completed the study. Interventions A 10-day course of (1) oral micronized P 300mg, (2) oral micronized P 200mg, or (3) placebo. Main Outcome Measures Withdrawal bleeding, side effects, and changes in lipids. Endogenous estradiol (E 2 ) concentrations at baseline and P concentrations during treatment were correlated with bleeding response. Results Withdrawal bleeding occurred in 90% of women taking 300mg, 58% of women taking 200mg, and 29% of women taking placebo ( P P =not significant). Lipid concentrations were unchanged. Endogenous E 2 and treatment P concentrations were of limited predictive value for withdrawal bleeding. Conclusions Progesterone 300mg induced significantly more withdrawal bleeding than placebo, with similar side effects. Bleeding response cannot be predicted reliably from E 2 and P concentrations.

Abnormal genital bleeding and secondary amenorrhea (cessation of menses) are common gynecologic complaints that can indicate serious physical problems. Abnormal genital bleeding is the most common reason for a gynecological office visit and a leading indication for dilatation of the cervix and curettage of the uterus. One of four women with abnormal genital bleeding may have serious physical problems. Although pregnancy is the most common cause of secondary amenorrhea, other conditions related to abnormal pregnancy, functional disorders, physiological changes, or pathology also must be considered. Procedures for evaluating abnormal genital bleeding and secondary amenorrhea are discussed. Information is provided to assist nurses in collecting and assessing data and planning interventions to promote the health of women with these common problems.

PubMedID: 9179808 A cytogenetic study of 77 adolescent girls with primary or secondary amenorrhea was performed. A pathologic or male karyotype was found in 18 (26.4%) of 68 patients with primary amenorrhea. In 1 (11.1%) of 9 patients with secondary amenorrhea, 46,XX/47,XXX mosaicism was recovered. The importance of the cytogenetic investigations in patients with primary or secondary amenorrhea was discussed.

Objective The aim of this study was to evaluate the prevalence of hyperprolactinemia in adolescents and young women with menstrual problems. Study Design This study included 1704 young women with menstruation-related problems. The patients were classified into group I (age, 11-20 years) or group II (age, 21-30 years); the prevalence of hyperprolactinemia was analyzed according to age and categories of menstruation-related problems. Results For primary amenorrhea and oligomenorrhea, the prevalence of hyperprolactinemia was low in both groups. However, hyperprolactinemia was a relatively common cause of secondary amenorrhea (5.5% for group I and 13.8% for group II, respectively); it was more frequent in group II ( P = .001); the prevalence of prolactinoma was also higher in group II ( P = .015). For abnormal uterine bleeding, hyperprolactinemia was more common in group II (2.6% for group I and 9.4% for group II; P Conclusion Hyperprolactinemia is not rare in young women with menstruation-related problems; its prevalence varies according to age and manifestations.

Objective To review the diagnostic possibilities that exists when the workup of amenorrhea reveals an isolated LH elevation; and to examine the effect of inhibin B on LH levels in vivo. Design Case report. Setting University hospital. Patient(s) A 20-year-old woman presented with secondary amenorrhea. Her FSH measurement was low, and the LH level was elevated. The recognition that this was an unusual pattern led to the diagnosis of a rare but very treatable inhibin B–producing thecoma, despite the fact that results on the initial pelvic ultrasound examination performed 10 months after presentation of amenorrhea were relatively unremarkable. Intervention(s) Surgical removal of an ovarian thecoma. Main Outcome Measure(s) Gonadotropins, E 2 , inhibin B, menstrual bleeding, and fertility. Result(s) Removal of the ovarian thecoma resulted in a normalization of FSH, LH, and inhibin B levels and a return of spontaneous menses 28 days later. Pregnancy occurred with the third postoperative menstrual cycle, followed by the delivery of a healthy full-term girl. Conclusion(s) Inhibin B–producing sex cord granolosa–stromal cell tumors should be considered in women who present with amenorrhea with isolated LH elevations, even in the setting of a previously normal pelvic ultrasound report. Diagnostic considerations that arise in the workup of amenorrhea when there is an isolated elevation in LH that is accompanied by normal or low FSH levels are reviewed. This rare clinical presentation provides the opportunity to observe the impact of inhibin B on gonadotropins in vivo.

INTRODUCTION AND STUDY OBJECTIVE: The association between pulmonary tuberculosis (TB) and female reproductive health problems is not well addressed. This study was done at Assiut University and Woman's Health University Hospitals to estimate the effect of pulmonary TB on menstrual patterns and fertility of women in childbearing age.This study composed of 429 women with pulmonary TB of childbearing age (study group) and 100 age-matched healthy women (control group). A detailed medical history was obtained, and a clinical examination, routine investigations of pulmonary TB and transvaginal ultrasonography (TVS) were performed for all cases. Hysterosalpingography, combined laparoscopy and hysteroscopy were done for infertile women whenever indicated.Menstrual abnormalities were reported in 66% of women in the study group. Secondary amenorrhea (112 cases, 26.5%, P0.001) and hypomenorrhea (86 cases, 20%, P0.001) were significantly higher in the study group than controls (2% and 3%, respectively). TVS diagnosed functional ovarian cysts in 85 patients in the study group (19.8%). After completing anti-tuberculosis treatment, 76% of women with menstrual abnormalities (162/213) resumed normal menstrual cycles. Among the 68 cases who sought fertility within 1 year after completion of treatment, TB peritubal and fine intrauterine adhesions were confirmed by laparoscopy and hysteroscopy in two and one infertile woman, respectively (0.7% of study group).TB had marked reversible effect on the menstrual cycle but minimal association with genital TB and infertility. Pretreatment counseling of pulmonary TB women should include information on these reversible changes. Persistence of menstrual abnormalities or presence of infertility after completion of treatment should stimulate investigation for the possibility of genital tract involvement.

A 31-year-old patient was studied because of secondary amenorrhea and mental retardation. Sex chromatin in buccal smears revealed the presence of single and double Barr bodies. Hormonal studies were consistent with primary ovarian failure and the histology of the gonads showed a fibrous cortex with very few primordial follicles. Sex chromatin studies of the gonad and chromosome analysis in peripheral blood cultures confirmed the presence of XX/XXX mixoploidy. Reports on this type of anomaly are scarce and no cytogenetic and histological data on the gonads are available for comparison. Sex chromatin in addition to chromosome studies appear particularly relevant in detecting the mixoploid forms of X-polysomies, and the presence of the chromosome anomaly in the gonad may be of primary importance to establish the degree of gonadal failure and reproductive risk.

Balanced translocations involving an X chromosome and an autosome have been infrequently reported. A patient with a balanced X-autosome translocation 46,X,rcp(X;4)(q26;q21) who exhibited early secondary amenorrhea and gonadal dysgenesis is described. In an effort to explain the varied phenotypic expressions encountered in female cases of balanced X-autosome translocations, evidence will be provided to suggest an extension of the minimal limits of the "critical region" in the long arm of the X chromosome from A-B, as described by Sarto and associates, to new minimal limits C-D.

Thirty women with secondary amenorrhea and hyperprolactinemia were studied; galactorrhea was present in 25 of them, and 18 were infertile. Serum prolactin (PRL) levels were high in all cases, between 26 and 120 ng/ml. All women were treated with bromocriptine in increasing doses from 2.5 to 5.0 or 7.5 mg daily, according to the response obtained, for 4 months. In 27 patients a PRL determination was performed during treatment; values returned to normal (up to 20 ng/ml) in 23 women and remained high in 4. Galactorrhea disappeared in 21 of 25 women. Ovulatory menses were re-established in 17 patients (56.6%). Seven women became pregnant (38.8%), one of them after bromocriptine and clomiphene were given simultaneously in the same cycle. According to our results and a literature review the following conclusions may be drawn: (1) bromocriptine is a useful therapeutic tool for re-establishing menstruation and inducing ovulation in patients with the hyperprolactinemic-amenorrhea syndrome; (2) the association of bromocriptine and clomiphene could be the next step in the treatment of patients who fail to ovulate with bromocriptine alone.

Menstrual dysfunction is common in adolescents who are involved in intensive athletic activity or who are limiting their nutritional intake excessively. The mechanism for hypothalamic amenorrhea in athletes and dieters is not yet fully understood. Other causes of menstrual dysfunction due to pregnancy, central lesions, hormone imbalance, or ovarian failure should be excluded in the athlete with amenorrhea. Amenorrheic patients who have sufficient estrogen effect on their endometrium to have withdrawal bleeding following exposure to progestins should be cycled with progestins on a regular basis to prevent endometrial hyperplasia. Estrogen replacement with cyclic progestin should be considered in the hypoestrogenic adolescent with prolonged amenorrhea. The long-term consequences of hypothalamic amenorrhea in adolescents remain to be determined.

Twelve women of normal weight (ages 17 to 36 years) with scanty menstrual bleeding were studied. They had no signs of virilization, gynecologic or endocrine pathology, or past history of hormonal treatment. Five women (group 1) experienced withdrawal bleeding after a 3-day course of chlormadinone acetate (2 mg/day) and the other seven did not (group 2). Daily venous blood samples were obtained 10 to 15 days afterward for 5 consecutive days of no treatment (control period) and during the next 5 days while the women received paramethasone acetate (PA), 2 mg/day (treatment period). In each plasma sample the concentrations of 17beta-estradiol (E2) and luteinizing hormone (LH; LER-907) were determined. The mean plasma E2 levels in group 1 were 35 +/- 8 and 86 +/- 10 pg/ml during the control and treatment periods, respectively (P less than 0.001), and the mean plasma LH levels were 28 +/- 6 and 94 +/- 34 ng/ml, respectively (P less than 0.001). No significant changes in plasma E2 and LH levels were observed in group 2 in either period. During the control period, the plasma E2 level in group 2 (14 +/- 2 pg/ml) was lower than that in group 1 (P less than 0.01); however, plasma LH levels were similar in both groups. The administration of PA for 5 months induced monthly ovulation in group 1 but not in group 2. These data suggest that the best results are obtained in women with optimal pretreatment levels of plasma E2.

Women who exercise heavily may develop secondary amenorrhea. Since the mechanism of so-called "runner's amenorrhea" has not been conclusively established, the authors examined the occurrence of amenorrhea in one of the most intensively exercising groups of female runners in the United States (average, 70 miles/week): those women participating in the marathon trials for the 1984 Olympics. Nineteen percent of these Olympic runners were amenorrheic. When compared with eumenorrheic marathon runners, these amenorrheic runners were significantly ( P μ g/dl; P

Luteinizing hormone-releasing hormone (LH-RH), at a dose level of 10μg, was administered intravenously to 31 patients, 9 with oligomenorrhea and 22 with secondary amenorrhea. A serum luteinizing hormone level higher than 45 mIU/ml at 30 or 45 minutes after injection was considered to be a "positive response" to LH-RH. All 9 patients in the oligomenorrheic group and 11 of the 22 patients with secondary amenorrhea had a "positive" response. The patients were then treated with increasing doses of clomiphene citrate until an ovulatory dose was reached. Eight of the nine patients with oligomenorrhea ovulated with doses of up to 150mg of clomiphene daily for 5 days. Of the 11 patients in the group with secondary amenorrhea who had a "positive" response to LH-RH, 7 ovulated at a dose of 150mg (or less) of clomiphene citrate, while only 1 of the 11 patients with a "negative" response ovulated while receiving a similar dosage of clomiphene. These results suggest that a simplified LH-RH test might be of value in selecting the level of therapy for ovulation induction.

Two new cases of unilateral streak gonad syndrome are presented. The review of the literature makes it possible to clearly delineate the anatomical, endocrinological and genetic aspects of this syndrome, characterized by secondary amenorrhea, sterility, a streak gonad in the left adnexa and a hypoplastic ovary in the other, while uterus and tubes are normal. Particular attention is devoted to the etiopathogenesis of the syndrome, as well as to the problem of spontaneous sexual development and ovarian function in the streak gonad syndrome.

Endocrinologic studies were done on a patient with “gonadotropin-resistant ovaries” syndrome presenting with secondary amenorrhea, increased secretion of gonadotropins, and unstimulated ovarian follicles. The feedback effects of estrogen upon the hypothalamic pituitary axis seemed to be present. Plasma levels of estradiol and estrone were in the low normal range. The levels of androgens in the plasma were slightly elevated, and the elevated levels appeared to be ovarian in origin. Clomiphene did not alter the levels of follicle-stimulating hormone (FSH) and luteinizing hormone significantly but increased the levels of estrone and estradiol. Histologic confirmation of unstimulated follicles and elevated levels of the gonadotropins, particularly FSH, are essential for diagnosis.

Serum estradiol (E 2 ), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels were measured in blood samples obtained prior to and at frequent intervals for 360 or 480minutes following the subcutaneous administration of gonadotropin-releasing hormone (Gn-RH) to eight normal women and nine patients with hypothalamic secondary amenorrhea. In the normal subjects given 100 μ g of Gn-RH on day 7 of the menstrual cycle, there was no significant increase in the mean E 2 concentration above basal levels. Six women with secondary amenorrhea received GnRH, 100 μ g, for 4 successive days; frequent blood samples were obtained on days 1 and 4. On day 1, the mean E 2 concentration at 360minutes was significantly greater than the mean basal level. On day 4 no significant increase in E 2 was detected, although the mean LH and FSH responses and basal E 2 level were not different from those of day 1. Four women with secondary amenorrhea received daily doses of 500 μ g of Gn-RH for 7days. Significant increases in mean serum E 2 concentration (100 to 150pg/ml) were noted at 6 and 8hours after administration on day 1 and at 8hours on day 4. No significant rise in E 2 was detected on day 7. The mean LH and FSH responses did not differ from those observed in women who received the 100- μ g dose, and there were no significant differences in responses on successive days of Gn-RH administration. The repeated daily administration of high doses of Gn-RH did not result in hormonal evidence of follicular maturation. Induction of follicular maturation in women with secondary amenorrhea may require frequent or continuous administration of Gn-RH to replicate more closely the sustained elevation of FSH concentration observed during the early phase of the normal menstrual cycle. Since no E 2 response was observed in normal women during the early follicular phase, ovarian responsiveness to LH and/or FSH may differ at various stages of follicular maturation.

During the period January, 1978 to June, 1979, a total of 900 college students was seen in a university student health center. Among these, 14.6% (131/900) had menstrual disorders. Oligomenorrhea or secondary amenorrhea, the chief complaint in 72.5% (95/131) students, accounted for 10.6% (95/900) of the total population. When a selected group of students with oligomenorrhea/amenorrhea was investigated, most had elevated levels of luteinizing hormone (LH) and normal/low levels of follicle-stimulating hormone (FSH) suggestive of polycystic ovary syndrome (PCO). The significance of these findings in the development of oligomenorrhea/amenorrhea and PCO under stress is discussed.This paper examines the prevalence and types of menstruation disorders among 900 female students attending the student health service of a large coeducational university during the period 1/78 to 6/79. Each student was subjected to a careful history and physical examination as well as counseling with regard to the physiology of menstrual cycle and possible causes. Laboratory tests for pituitary, ovarian, thyroid, and adrenal function were performed, and blood samples were collected and assayed for various hormones. Of the 900 students, 131 (14.6%) complained of menstrual disorders unrelated to oral contraceptive use. 90 (72.5%) out of the 131 had oligomenorrhea or secondary amenorrhea and accounted for 10.6% of all women visiting the student health service. The onset of oligomenorrhea or amenorrhea was not associated with oral contraceptive use. Based on clinical features and gonadotropin values, 3 groups of oligomenorrhea/amenorrhea patients were identified: group 1, hypogonadotropic associated with simple weight loss (n=1); group 2, normagonadotropic of unknown etiology (n=6); and group 3, elevated luteinizing hormone with normal/low follicle-stimulating hormone suggestive of polycystic ovary syndrome (PCO) (n=12). The true incidence of PCO in this series is not known because of the incomplete endocrine profile of the college students. Stressful events (physical, emotional, social) and/or the competitive life style at the college campus may contribute to the incidence of oligomenorrhea/amenorrhea, but carefully designed prospective studies are needed to substantiate this.

Thirty-five patients with secondary amenorrhea and an associated gonadotropinestrogen deficiency were treated in 233 cycles with clomiphene, 100 mg. per day for 5 days each cycle. The pretreatment mean duration of amenorrhea was 2.4 years. Eighty per cent of the patients ovulated in one or more cycles of treatment and 35 per cent became pregnant. No correlation was found between the pretreatment Metopirone pituitary function test results and the success of clomiphene treatment. This form of therapy is discussed. (See addendum.)

Twenty-six patients with secondary amenorrhea and inappropriate lactation have been studied. There was no apparent cause in 8, while in 18, precipitating factors were present. Urinary estrogens were low, and assay of human growth hormone (HGH) in 9 patients did not reveal a constant pattern. Seventeen patients submitted to diagnostic gonadotropin stimulation and each showed a response compatible with potentially normal ovarian function. Nine patients without detectable lesions have been, or are being, treated with clomiphene citrate and/or human gonadotropins. All 9 have or had apparent ovulation, and 5 so far have conceived. Lactation has stopped in each of these 9 patients, but in none of those untreated.

Eatrone, estradiol-17β and estriol were isolated and identified from the urine of normal menstruating women, and from a case of secondary amenorrhea with apparently no increased urinary PSH. Quantitative estimation by fluorometry, coupled with tracing of added labelled estrone and estradiol-17β, throughout the various stages of the isolation procedure, confirmed the reliability of the fluorometric method. Neither of the estrogens could be isolated from urine of a patient with secondary amenorrhea with increased PSH excretion, nor from a patient with bilateral ovarieotomy. In both cases the fluorometric values were close to zero.

The frequency rates of secondary amenorrhea when examined epidemiologically appear to be quantitatively related to separation from home and family and to the extent of the threat associated with such separation. In peacetime circumstances the rates are low but increase to 100 per cent in those about to be executed. Such amenorrhea definitely antedates the malnutrition which is associated with many of the situations where high rates occurred. In the large majority of instances, amenorrhea developed immediately after the separation. The prognosis is excellent if the stress can be adapted to or removed. However, when the amenorrhea is preceded by evidence of psychosexual immaturity, neurotic or psychotic, the prognosis is more dubious. There is some evidence that age of menarche and age at separation influence the rates.

A female, aged 31, who had amenorrhea for ten years, received 25,500 rat units of antophysin over a period of eleven months in manner stated above, had four menstrual or pseudomenstrual periods, finally conceived and gave birth to a living child. The points of interest in this case are: 1. Menstruation or pseudomenstruation was restored after a ten-year period of secondary amenorrhea. 2. Patient conceived and carried to full term, giving birth to living child. 3. Despite the absence of a cyclic curve of estrone, treatment was attempted. 4. Patient was treated over a period of eleven months. Had treatment ceased at six months or less, the hormonal product would probably have been blamed for failure. 5. Treatment was given at thirty-day intervals, establishing a so-called cycle for treatment. 6. This case is not reported in order to represent the sole type of treatment for all cases of secondary amenorrhea. However, it suggests that we might some day arrive at the proper dosage and proper time of cycle for hormonal treatment of amenorrhea.