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Aim. To determine genealogical and cytogenetic features in girls aged 12-17 years with secondary amenorrhea. Methods. The analysis of pedigrees was conducted in 25 families of girls with secondary amenorrhea (main group) and in 25 families of healthy girls in the laboratory of medical genetics of SI "ICAHC NAMS". Cytogenetic analysis was carried out in the blood lymphocytes of the girls of the main and control groups in vitro. The control group consisted of 25 healthy peer girls with a regular menstrual cycle without somatic pathology. The data obtained were analyzed statistically using the Student's t-test in Excel programs. Results. The hereditary burden on non-inflammatory (hormone-dependent) gynecological diseases was found in 60.0% of families, in 86.6% of cases – along the maternal line, in 6.7% – along the paternal line, in 6.7% – on both lines at the same time; 40.0% of girls had no hereditary burden. The total incidence of gynecological (non-inflammatory) diseases among relatives of three degrees of kinship was 13.6%, which was almost three times higher than the frequency in relatives of healthy girls (5.1%, p < 0.001). Cytogenetic analysis conducted in girls of the main group showed an increase in both the overall level of chromosomal disorders (6.2%), and their individual types (3.2%. 3.0%, 1.56%) compared to the frequency in healthy girls. Conclusions. Family accumulation of gynecological (non-inflammatory) diseases in the pedigree of girls with secondary amenorrhea has been established. Cytogenetic features in the blood lymphocytes of sick girls are revealed compared to healthy peers. Keywords: girls, pedigrees, cytogenetic indices, secondary amenorrhea.

espanolEl fallo ovarico prematuro (FOP) es un defecto ovarico primario caracterizado por la ausencia de menarquia (amenorrea primaria) o agotamiento prematuro de los foliculos ovaricos antes de los 40 anos (amenorrea secundaria). Como en el caso de menopausia fisiologica, FOP se presenta por manifestaciones tipicas del climaterio: infertilidad asociado con palpitaciones, intolerancia al calor, sofocos, ansiedad, depresion, fatiga. Esta condicion es bioquimicamente caracterizada por niveles bajos de hormonas gonadales (estrogenos e inhibinas) y altos niveles de gonadotropinas (LH y FSH) (amenorrea hipergonadotropica). Mas alla de la infertilidad, los defectos hormonales pueden causar graves consecuencias neurologicas, metabolicas o cardiovasculares y conducir a la aparicion temprana de osteoporosis. La heterogeneidad de FOP tambien se refleja en la variedad de posibles causas, que incluyen autoinmunidad, farmacos toxicos y defectos geneticos. Esta afeccion tiene un fuerte componente genetico. Las anomalias del cromosoma X (por ejemplo, el sindrome de Turner) representan las principales causa de amenorrea primaria asociada con disgenesia ovarica. A pesar de la descripcion de varios genes candidatos, la causa de FOP permanece indeterminada en la gran mayoria de los casos. El manejo incluye la sustitucion del defecto hormonal por preparaciones de estrogeno / progestina. El La unica solucion actualmente disponible para el defecto de fertilidad en mujeres con reserva folicular ausente es donacion de ovulos. EnglishPremature ovarian failure (PFO) is a primary ovarian defect characterized by the absence of menarche (primary amenorrhea) or premature depletion of the ovarian follicles before age 40 (secondary amenorrhea). As in the case of physiological menopause, FOP is presented by typical manifestations of the climacteric: infertility associated with palpitations, intolerance to heat, hot flashes, anxiety, depression, fatigue. This condition is biochemically characterized by low levels of gonadal hormones (estrogens and inhibins) and high levels of gonadotropins (LH and FSH) (hypergonadotropic amenorrhea). Beyond infertility, hormonal defects can cause serious neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis. The heterogeneity of FOP is also reflected in the variety of possible causes, including autoimmunity, toxic drugs, and genetic defects. This condition has a strong genetic component. X chromosome abnormalities (eg, Turner syndrome) represent the leading cause of primary amenorrhea associated with ovarian dysgenesis. Despite the description of several candidate genes, the cause of FOP remains undetermined in the vast majority of cases. Management includes replacement of the hormonal defect with estrogen / progestin preparations. The only solution currently available for the fertility defect in women with absent follicular reserve is egg donation.

Vitamin D deficiency is considered a major public health problem worldwide and has been reported as having an association with depression. However, studies on the association between vitamin D deficiency and depressive symptoms in secondary amenorrhea (SA) patients are still scarce. This study examined the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and depressive symptoms among Korean women with SA. In this cross-sectional observational study, 78 patients with SA were initially recruited. Clinical and biochemical parameters, including serum 25(OH)D level, were measured. Data from 63 SA patients who met the study inclusion criteria and completed psychiatric assessments were finally analyzed. We analyzed their association with depression using a hierarchical regression model. The average serum 25(OH)D level was 34.40 ± 24.02 ng/mL, and 41.3% of the women with SA were vitamin D-deficient (

This is a pictorial review on the radiological approach to patients with amenorrhea using a level-based framework. The prevalence of amenorrhea is 3 to 4% with wide-ranging causes involving multiple clinical disciplines. Normal menstruation depends on complex coordinated hormonal functions of the hypothalamic-pituitary-ovarian axis exerting its effect on an intact uterine end-organ and outflow tract. A disruption of any of these factors may result in amenorrhea. Categorizing the causes of primary and secondary amenorrhea into uterine, ovarian/gonadal, and intracranial levels provides a logical framework for its evaluation. A systematic level-based approach by targeted ultrasound of the pelvic structures is suggested, with different aims in primary versus secondary amenorrhea. Pelvic sonographic findings of various conditions within the uterine and ovarian/gonadal levels are illustrated. Conditions due to an intracranial cause result in downstream effects on the uterus and ovaries and can often be suspected based on a combination of clinical assessment, ultrasound findings, and laboratory investigations. By correlating pelvic ultrasound findings with underlying pathology, the clinical radiologist is able to provide useful diagnostic information in the management of these patients.

This study aimed to determine the prevalence of female athlete triad risk factors among female international volunteers based on the development and income status of their country of service. A total of 2164 past volunteers completed a retrospective survey. Countries’ income and development statuses were coded using the respective annual United Nations World Economic Situations and Prospects reports. Independent t-tests, ANOVAs, and Pearson’s Chi-Squared tests were used to assess group differences; corresponding odds ratios were calculated. Volunteers in nondeveloped (OR = 2.25, CI = 1.85–2.75) and non-high-income (OR = 2.17, CI = 1.75–2.70) countries had over twice the odds of experiencing secondary amenorrhea. More volunteers who served in nondeveloped countries reported an increase in exercise while serving (p = 0.005). Those who served in a nondeveloped (OR = 1.52, CI = 1.16–1.98) or non-high-income (OR = 1.45, CI = 1.08–1.94) country had higher odds of weight loss. However, volunteers serving in nondeveloped (OR = 0.52, CI = 0.44–0.63) and non-high-income (OR = 0.50, CI = 0.4–0.61) countries were less likely to report food insecurity compared to those in developed and high-income countries. Bone mineral density was within the expected range regardless of income and development status. Female volunteers who served in nondeveloped and non-high-income countries experienced higher odds of secondary amenorrhea, which was likely influenced by an increase in exercise and higher odds of weight loss.

The abnormal menstrual flow indicates heavy menses and scanty menstrual flow, both in amount and duration with associated symptom of pain in lower abdomen or back or vagina and can be counted as Vataja Rajodushti, Kshinartava and Artavakshaya in Ayurveda classics. Aims and objectives: In Ayurvedic classic, Uttarabasti is indicated in Yonivyapada (gynecological problems), Artava nasha (secondary amenorrhea), Artava Dosha (menstrual disorder) etc. Vatadosha is the prime cause of Yoni vyapada. Uttara basti has Vatashamak as well as Ropana and Shodhana property. Sahacharadi taila is indicated in Vata disorders including oligomenorrhea. Shatapushpa (Anethum sowa Kurz.) Churna is Arthavajanan. Materials and methods: From OPD 30 patients were selected randomly and divided into 15 patients in each Group A and Group B. Group A was given Shatapushpa churna orally 3times per day for 3 months and Sahacharadi taila Uttaravasti for 3 consecutive cycles. Group B was given placebo. Results were analysed by statistical analysis. Results and conclusion: Properties of Shatapushpa churna, Saacharadi taila with Uttarbasti might improve menstrual irregularities and bring down to normalcy.

Aim of the work: To detect the frequency of secondary amenorrhea in a cohort of Egyptian systemic lupus erythematosus (SLE) patients and to identify potentially related key-players. Patients and methods: The medical records of 140 adult SLE patients above 18 and less than 40 years were revised regarding clinical characteristics, immunological features and medications received. The SLE disease activity index (SLEDAI) and damage index (SLICC-DI) were recorded. Patients were divided into two groups: patients who developed secondary amenorrhea and those having normal menstrual cycles. Results: The mean age of the patients was 26.8 ± 5.7 years, the median disease duration was 3.5 years. The patients had renal involvement in 69.3%, neuropsychiatric in 23.6% and cardiac in 37.9%. Cyclophosphamide (CYC) was received by 52.1% and steroids by 139 patients. Secondary amenorrhea was found in 44 patients (31.4%); 36 (81.8%) of them were ≤32 years old. Patients with secondary amenorrhea had a higher frequency of positive anti-double stranded deoxyribonucleic acid (ds-DNA) antibodies (75% vs 50%; p = 0.04) and a shorter disease duration (median 2 years vs 4.5 years; p = 0.005). Lupus nephritis, renal failure, neuropsychiatric manifestations, cardiac involvement and receiving CYC and high-dose steroids tended to be more frequent in those with secondary amenorrhea compared to those without. The median SLICC-DI was higher in those with amenorrhea compared to those without (p = 0.2) Conclusion: Cyclophosphamide is not the only key-player for the development of secondary amenorrhea in SLE; other factors as the shorter disease duration, presence of autoantibodies and major organ involvements may be implicated. Keywords: Systemic lupus erythematosus, Secondary amenorrhea, Egyptian, Disease duration, Anti ds-DNA

In the study group of 92 girls aged 13 to 17 years with secondary amenorrhea (SA), and the control group of 54 age-matched girls with regular menstrual cycle, the levels of testosterone and sex hormone-binding globulin (SHBG) have been estimated; free androgen index (FAI) has been calculated. Not only normal or increased FAI values, but also low FAI levels have been found. The FAI value was connected to the intensity of hirsutism syndrome, the duration of amenorrhea, the values of the body weight index and the menarche date., У 92 девочек 13-17 лет с вторичной аменореей и 54 девочек того же возраста с регулярным менструальным циклом определены уровни тестостерона, сексстероидсвязывающего глобулина (ССГ), рассчитан индекс свободных андрогенов. Показано, что у девочек-подростков с вторичной аменореей обнаруживается не только нормальный и повышенный, но и сниженный индекс свободных андрогенов. Величина индекса свободных андрогенов связана с выраженностью гирсутного синдрома, длительностью аменореи, показателями индекса массы тела и временем появления первой менструации., У 92 дівчаток 13-17 років із вторинною аменореєю і 54 дівчаток того ж віку з регулярним менструальним циклом визначені рівні тестостерону, сексстероїдзв’язуючого глобуліну (ССГ), розрахований індекс вільних андрогенів. Показано, що в дівчаток-підлітків із вторинною аменореєю виявляється не тільки нормальний і підвищений, але і знижений індекс вільних андрогенів. Величина індексу вільних андрогенів пов'язана з вираженістю гірсутного синдрому, тривалістю аменореї, показниками індексу маси тіла і часом появи першої менструації.

We present a rare case of a pituitary tuberculoma masquerading as pituitary adenoma with pituitary apoplexy-like presentation in a 31-year-old female, who had symptoms suggestive of acute secondary adrenal insufficiency with secondary amenorrhea. After initial evaluation which was suggestive of pituitary adenoma, she underwent endoscopic transnasal pituitary tumor excision. Histopathology revealed features of pituitary tuberculoma. She was subsequently started on four drug anti-tubercular therapy and is on follow-up. Although uncommon, tuberculomas, especially in the pituitary gland, are known for behaving like pituitary adenomas, by impairment of pituitary hormonal function and by exerting pressure effects on surrounding vital intracranial structures. Diagnostic challenges, treatment modality, and literature review are presented in this case report. Pituitary tuberculoma even though a rare entity should be borne in mind as a differential diagnosis in a patient manifesting with pituitary apoplexy-like syndrome.

APS (autoimmune polyglandular syndrome) is defined as the coexistence of at least two kinds of endocrine autoimmune diseases. APS type 3 comprises autoimmune thyroid diseases and other autoimmune diseases but does not involve autoimmune Addison’s disease. So far, APS-3 combined with isolated gonadotropin-releasing hormone (GnRH) reduction caused by the suspected autoimmune hypothalamic disease has not been reported. We recently received a 43-year-old woman with a one-year history of Graves’ disease (GD) and a four-month history of type 1 diabetes presented with hyperthyroidism and hyperglycemia. After the GnRH stimulation test, she was diagnosed with secondary amenorrhea attributed to suspected autoimmune Hypothalamitis and APS type 3 associated with Graves’ disease and Latent Autoimmune Diabetes (LADA). According to this case, the hypothalamus cannot be spared from the general autoimmune process. It is recommended to carry out the GnRH stimulation test when encountering APS patients combined with secondary amenorrhea.

Perforated transverse vaginal septum (TVS) leading to secondary amenorrhea in unmarried girl is a rare entity. A 20 years old unmarried girl presented to gynaecology OPD with history of amenorrhea since one month and 12 days, pain lower abdomen with swelling since 7 days and difficulty in voiding urine since 2 days. She had history of regular menstrual cycles since the age of 13 years. Local examination revealed pinkish mass bulging through introitus. MRI showed vaginal outlet obstruction with haematocolpos and haematometra. Diagnosis was confirmed and case was successfully managed during examination under anaesthesia. This case highlights the evolution from perforated transverse low vaginal septum with normal and regular menstrual cycles to a complete septum (due to retained menstrual blood and tissue debris) which leads to secondary amenorrhea.

Purpose A clinical case presenting secondary amenorrhea accompanied by an adrenal adenoma and hyperprogesteronemia is described in this study. Methods Selective catheterization and sampling of adrenal and ovarian veins were performed. Results The source of hyperprogesteronemia was located in the right adrenal gland. A progesterone-producing tumor in the right adrenal gland was diagnosed and removed. Twenty-six days after tumor resection, menstruation occurred. Conclusions Progesterone-producing tumors should be considered with the presence of an adrenal mass and hyperprogesteronemia. Combined adrenal and ovarian venous sampling may help to identify the source of progesterone secretion.

This study was conducted in the city of Tikrit – Salaha-Din General Hospital for the period from November 2017 to June 2018 to compare the effects of dysmenorrhea and secondary amenorrhea in blood glucose concentrations, cholesterol, and some hormones FSH, LH, PRL, Progesterone, Estrogen, and Testosterone in women in Tikrit. Salahal-Den government the number of women with dysmenorrhea, secondary amenorrhea, and healthy (30) in all women group respectively. 5ml blood was withdrawn from all women in the study and the serum was separated by common laboratory methods. The results showed no significant differences between all study groups in blood glucose concentrations, while women with secondary amenorrhea were significantly higher (P≤0.05) in cholesterol concentrations compared to the healthy group and significantly higher (P≤0.01) for women with secondary amenorrhea in FSH, LH, PRL, Progesterone, E2, Testosterone compared to the group of women with dysmenorrhea and the group of healthy. The group of women with dysmenorrhea was significantly higher (P≤0.05) in Progesterone, Testosterone concentrations comported with the healthy women group and Women with dysmenorrhea. We conclusion that secondary amenorrhea was a more effective in increasing concentrations of hormones that prevent the occurrence of ovulation compared with the dysmenorrhea effects. http://dx.doi.org/10.25130/tjps.24.2019.028

Objectives: Describe spotting practices of anorexia nervosa in a patient with secondary amenorrhea and low BMI. Methods: Epidemiological observational descriptive multicentric study conducted in the form of survey of professional practices using self-questionnaire among general practitioners, gynecologists and midwives in hospitals and private practice. The duration of the study was 5 months. Results: Professionals searched an hypogonadotrophic hypogonadism while eliminating differential diagnoses of secondary amenorrhea. They looked for clues in the interview that could point to the diagnosis of anorexia nervosa. Conclusion: The diagnosis of anorexia nervosa can be done from the clinical examination and the questioning, but also using confirmation of an hypogonadotrophic hypogonadism. The lack of framework for identifying anorexia nervosa makes it difficult for professionals to make the diagnosis.; Objectifs : Décrire les pratiques de repérage de l’anorexie mentale chez une patiente présentant une aménorrhée secondaire et un IMC bas. Méthodes : Étude épidémiologique observationnelle descriptive multicentrique menée sous la forme d’une enquête de pratiques professionnelles à l’aide d’auto-questionnaire auprès des médecins généralistes, gynécologues et sages-femmes du milieu hospitalier ou libéral. La durée de l’étude était de 5 mois. Résultats : Les professionnels investiguaient un hypogonadisme hypogonadotrope tout en éliminant les diagnostics différentiels de l’aménorrhée secondaire. Ils recherchaient dans l’interrogatoire des indices pouvant orienter le diagnostic vers une anorexie mentale. Conclusion : Le diagnostic d’anorexie mentale peut se faire à partir de l’examen clinique et de l’interrogatoire, mais aussi avec la confirmation d’un hypogonadisme hypogonadotrope. Le manque de référentiel sur le repérage de l’anorexie mentale met en difficulté les professionnels pour faire le diagnostic.

Resumen: La anovulación ocurre en el 30 % de la Infertilidad y la amenorrea secundarla en el 4% de mujeres en edad reproductiva. Ambas alteraciones se pueden tornar crónicas conllevando riesgos de hiperestrogenismo e hipoestrogenismo crónicos. Tanto la anovulación como la amenorrea secundaria tienen las mismas causas endocrinas, excepto que la amenorrea tiene una adicional de causa uterina. No obstante existen muchas clasificaciones etiológicas, unas combinan la amenorrea secundaria con la primaria, otras se enfocan más a la anovulación y algunas agrupan las etiologías en compartimentos, sin lograr hacerlo en forma integral. El objetivo es revisar las clasificaciones etiológicas de anovulación y amenorrea secundaria, junto con la actualización de cada una de esas causas, a fin de seleccionar la clasificación que las agrupe integralmente para enfocar el manejo en forma fácil y práctica. Para ello, se revisó la literatura médica reciente en libros de texto, PubMed, Ovid, Clinical guidelines y Cochrane library, con palabras claves. Se concluye que la clasificación etiológica integral en cinco compartimentos es una guía fácil de seguir, para lograr el diagnóstico de cada una de esas causas, actualmente, cuando existen medicamentos y procedimientos quirúrgicos seguros para manejarlas como anovulación o como amenorrea secundaria. Abstract: Anovulation occurs in 30% of infertility and secondary amenorrhea In 4% of women In reproductive age. Both alterations can become chronic, carrying risks of chronic hyperestrogenism and hypoestrogenism. Both anovulation and secondary amenorrhea have the same endocrine causes, except that amenorrhea has an additional uterine cause. However, there are many etiological classifications, some combine secondary and primary amenorrhea, others focus more on anovulation and some group the etiologies into compartments, without achieving a comprehensive approach. The objective is to review the etiological classifications of anovulation and secondary amenorrhea, together with the update of each one of these causes, in order to select the classification that can integrally groups them so that to their management can be focused on an easy and practical way. For this purpose, recent medical literature in textbooks, PubMed, Ovid, Clinical guidelines and Cochrane library was reviewed with key words. It is concluded that the comprehensive etiological classification in five compartments is an easy guide to follow to achieve the diagnosis of each of these causes, currently, when there are drugs and safe surgical procedures to manage them as anovulation or secondary amenorrhea. Resumo: A anovulação ocorre em 30 % da Infertilidade e a amenorreia secundária em 4 % de mulheres em idade reprodutiva. Ambas as alterações podem se tornar crônicas, implicando riscos de hiperestrogenismo e hipoestrogenismo crônicos. Tanto a anovulação quanto a amenorreia secundária têm as mesmas causas endócrinas, exceto que esta última tem ainda causa uterina. Contudo, existem muitas classificações etiológicas, umas combinam a amenorreia secundária com a primária, outras se focam mais na anovulação, e algumas agrupam as etiologias em compartimentos sem poder fazer isso de forma integral. O objetivo é revisar as classificações etiológicas de anovulação e amenorreia secundária, junto com a atualização de cada uma dessas causas, a fim de selecionar a classificação que as agrupe integralmente para focar o manejo de forma fácil e prática. Para isso, foi revisada a literatura médica recente em textos consultados em PubMed, Ovid, Clinical guidelines e Cochrane library, a partir de palavras-chave. Conclui-se que a classificação etiológica integral em cinco compartimentos é um guia fácil de seguir para obter o diagnóstico de cada uma dessas causas, atualmente, quando existem medicamentos e procedimentos cirúrgicos seguros para manejá-las como anovulação ou como amenorreia secundária.

This article provides an approach to amenorrhea and is intended for pre-clinical and clerkship medical students. Primary amenorrhea refers to the absence of menarche by 15 years or 3 years post thelarche while secondary amenorrhea is the cessation of menses for 3 months in women with a previously regular cycle or for 6 months in women with previously irregular menses. While amenorrhea can be physiological it can also reflect an anatomical or more complex hormonal problem that students must learn to identify and investigate.

Background: Menarche is an important milestone in a feminine reproductive life, and regular menstrual cycles reflect normal functioning of the hypothalamic-pituitary-ovarian axis, a vital sign of women's general health. Aim of the study: We explored the age at menarche and the following menstrual cycles characteristics among 85 unmarried Transfusion-Dependent β-Thalassemia (TDT) women, born between 1965 and 1995, concerning iron chelation therapy (ICT) with desferrioxamine (DFO) and nutritional status, assessed by body mass index (BMI). Results: 53 adolescents who had begun ICT before the age of 10 years experienced menarche at 13,7 ± 1,6 years (mean ± DS), whereas 32 who began treatment after ten years experienced menarche significantly later (15.5 ± 1.9 yrs; p: 0.001). At the age of menarche: BMI-Z score (n= 67, - 0,09 ±1) was inversely correlated with both age at starting ICT (r = - 0,39; p = 0001) and age at menarche (- 0,45, p = 0,0001). Serum ferritin levels (SF) were significantly correlated with the age at starting chelation therapy (n = 79; r = 0,34; p = 0,022). In 56 TDT adolescents who developed secondary amenorrhea (SA), the SF levels were significantly higher (4,098 ± 1,907 ng/mL) compared to 23 TDT adolescents with regular menstrual cycles (2,913±782 ng/mL; p = 0,005). Nutritional status of "thinness" at menarche was associated with a lower prevalence of subsequent regular menstrual cycles and a higher prevalence of early SA. Conclusion: An early ICT in TDT patients was associated with a normal "tempo" of pubertal onset and a higher frequency of subsequent regular menstrual cycles. In TDT patients, who developed SA, a diagnosis of acquired central hypogonadism was made, mainly due to the chronic exposure to iron overload, however other potential causes linked to nutritional status, deficient levels of circulating nutrients, and the chronic disease itself cannot be fully excluded.

Highlights • Vesicouterine fistula is pathological communication between the bladder and uterus or cervix. • Symptoms of VUF were secondary amenorrhea and cyclic hematuria with history of previous cesarean section (concluded as Youssef’s syndrome). • Surgical approach is contemplated as definitive management of the VUF following caesarean section. • A group of women was able to have normal period after fistula repair., Vesicouterine fistula (VUF) is an abnormal communication between the bladder and uterus, occurring 1–4% of all urogenital fistulas. Diagnosis is still a challenge because symptoms may appear late or fistula may be missed even after repeated examination. A 37-year old woman who has two children born through caesarean section complained of the absence of menstruation for the past three years. At the same time point, she experienced cyclic haematuria and amenorrhea. The diagnosis was made through ultrasonography, cystoscopy and hysteroscopy. She was then managed with laparoscopic bladder fistula repair continued with total laparoscopic hysterectomy. The VUF can present as an undesirable consequence of caesarean section.

Intrauterine adhesions have been recognized as a cause of secondary amenorrhea since the end of the nineteenth century [1].

Secondary amenorrhea is not uncommon in the adolescent female population. There are multiple etiologies to consider, and a comprehensive evaluation is often pursued. Sometimes, however, despite a thorough workup, the diagnosis remains unclear. Here, we report an unusual cause of secondary amenorrhea in a 15-year-old girl. Our patient presented with secondary amenorrhea after a 4-year history of regular menstrual cycles. Her evaluation was notable for very low FSH and low estradiol but normal LH; pregnancy, adrenal, thyroid, prolactin studies, and brain magnetic resonance imaging scan did not reveal a cause of her amenorrhea. Her transabdominal ultrasound showed an enlarged right ovary, initially suggestive of a hemorrhagic cyst. Inhibin A and B were measured because of the persistently low FSH; these were found to be very elevated, concerning for an inhibin-producing tumor. The patient had surgical removal of her right ovary; pathology revealed a juvenile granulosa-cell tumor. Postoperatively, the patient had normalization of serum inhibin A and B and resumption of normal menstrual cycles. This report illustrates that careful consideration of laboratory findings and other studies is essential for correctly identifying the underlying cause of secondary amenorrhea, particularly when the results are not consistent with common causes of this condition.