闭经（amenorrhea）课件_1

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1、AmenorrheaDIWENM.D.,Ph.D.,Professor&ChairmanDepartmentOfObstetrics&GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicineAmenorrheaAmenorrheaistheabsenceofmenstruation.PrimaryAbsenceofmensesbyage16withnormalsecondarysexualcharacteristics.Absenceofmensesbyage14withoutsecondarys

2、exualdevelopment.SecondaryAbsenceofmensesfor6monthsinapreviouslymenstruatingfemale.EventsofPubertyThelarche(breastdevelopment)RequiresestrogenPubarche/adrenarche(pubichairdevelopment)RequiresandrogensEventsofPubertyMenarcheRequires:GnRHfromthehypothalamusFSHandLHfromthepituitar

3、yEstrogenandprogesteronefromtheovariesNormaloutflowtractP1P5P4P3P2Tanner’sClassificationofamenorrheahypothalamicamenorrheapituitaryamenorrheaovarianamenorrheauterineamenorrheaEtiologyhypothalamicamenorrheaPsychologicalstress5a-ReductasedeficiencyAnorexianervosa,weightlossIncrea

4、sedexerciselevelsKallmannsyndromedrug-inducedamenorrheaSpace-occupyinglesionofCNSEtiologypituitaryamenorrheatumorEmptysellasyndromeSheehansyndromeEtiologyovarianamenorrheaGonadaldysgenesisTurnersyndrome:lowhairline,webneck,shieldchest,andwidelyspacednipplesSwyersyndromeresistan

5、tovarysyndromePrematureovarianfailureTunnerstagingAcanthosisnigransStriaeTypicalfeaturesofTurnerSyndromeEtiologyuterineamenorrheaAbsenceofuterusAshermansyndromeanatomicabnormalitiesofthereproductivetractImperforateHymenImperforateHymenMayer-Rokitansky-Kuster-HauserSyndrome(uter

6、o-vaginalagenesis)15%ofprimaryamenorrheaNormalsecondarydevelopment&externalfemalegenitaliaNormalfemalerangetestosteronelevelAbsentuterusanduppervagina&normalovariesKaryotype46-XX15~30%renal,skeletalandmiddleearanomaliesAndrogenInsensitivityNormalbreastsbutnosexualhairNormallook

7、ingfemaleexternalgenitaliaAbsentuterusanduppervaginaKaryotype46,XYMalerangetestosteronelevelTreatment:gonadectomyafterpuberty+HRTDiagnosisHistoryPhysicalexaminationPhysicalexaminationbeginswithvitalsigns,includingheightandweight,andwithsexualmaturityratingsLaboratoryevaluationV

8、E-pregtestTSH,PROLACTIN’,Prog.challengetestwithdrawalb