Amenorrhea: A Case-Based, Clinical Guide

✍ Scribed by Nanette F. Santoro, Genevieve Neal-Perry

• Publisher: Humana Press
• Year: 2010
• Tongue: English
• Leaves: 222
• Series: Contemporary Endocrinology
• Category: Library

✦ Table of Contents

Amenorrhea: A Case-Based, Clinical Guide (Contemporary Endocrinology)
Front-matter
Amenorrhea
Copyright
Preface
Contents
Contributors
Chapter 1: The Hypothalamic-Pituitary-Ovarian Axis
Introduction
The Neuroendocrine Axis
Hypothalamus
Anatomy
Physiology
GnRH Neurons
Hypothalamic Neuropeptides and GnRH Neurons
Neuropeptide Y
Proopiomelanocortin
Kisspeptin
Hypothalamic Neurotransmitters and GnRH Neurons
Pituitary
Embryology and Anatomy
The Anterior Pituitary
The Posterior Pituitary
Pituitary Gonadotropins
FSH
LH
Prolactin
The Ovary
Ovarian Embryology
Ovarian Anatomy
Follicular Development and Atresia
Early Follicular Development
Secondary Follicles
Antral Follicle
Ovarian Physiology
Estrogen
Progesterone
Inhibin
Activin
Follistatin
Summary
References
Chapter 2: The Mechanism of Menstruation
The Endometrium During the Menstrual Cycle
Proliferative Phase
Secretory Phase
Endometrial Growth Regulation
Ovarian Steroids
Growth Factors
Endometrial Stem cells
Endometrial Vessels
Endometrial Vascular Supply
Regulation of Endometrial Vessel Growth
Menstruation
Loss of Vascular Integrity
Matrix Metalloproteins (MMPs) and Tissue Breakdown
Endometrial Re-epithelialization
Vascular Repair
Summary
References
Chapter 3: Amenorrhea Due to Idiopathic Hypogonadotropic Hypogonadism and Kallmann Syndrome
Case Study
Development of the Hypothalamic-Pituitary-Gonadal Axis
The Diagnosis of Delayed Puberty
Hypogonadism
Idiopathic Hypogonadotropic Hypogonadism
The Genetic Basis of IHH/KS
Chromosome Analysis
Molecular Analysis
Treatment
Case Discussion
References
Chapter 4: Polycystic Ovary Syndrome
Introduction
Clinical and Endocrine Characteristics of Main PCOS Phenotypes
Amenorrhea and PCOS: Prevalence and Clinical Significance
Abdominal Obesity as the Main Determinant of the Severity of PCOS Phenotype
Adolescent PCOS: Specific Problems and Diagnosis
Treatment of PCOS
Clinical Case No. 1
Questions
Answer and Comment
Follow-Up
Conclusions
References
Chapter 5: Primary Ovarian Insufficiency
A Clinical Vignette
Introduction
The Clinical Spectrum of POI
Etiologies
Idiopathic
Genetic
X Chromosome Abnormalities
Autosomal Gene Abnormalities
Other Gene Abnormalities
Autoimmune Dysfunction
Iatrogenic/Environmental
Evaluation of Hypergonadotropic Amenorrhea
History
Physical Examination
Laboratory Evaluation
Emotional Assessment
Delivering the Diagnosis
Psychologic Impact
Sexual Impact
Treatment
Genetic Counseling
Family Planning
Medical Therapy
Preventative Therapy
Back to the Vignette
References
Chapter 6: Hyperprolactinemia and Pituitary Causes of Amenorrhea
Introduction
Case
Causes of Hyperprolactinemia
Physiologic Causes
Pregnancy
Nipple Stimulation
Macroprolactinemia
Medications
Psychiatric Medications
Antipsychotics
Antidepressants
Other Medications
Pathophysiologic Causes
Lactotroph Adenoma
Mass Effect/Trauma
Primary Hypothyroidism
Chronic Renal Failure
Clinical Findings in Hyperprolactinemia
Reproductive Dysfunction
Galactorrhea
Bone Loss
CNS Disturbances
Treatment of Hyperprolactinmeia
Other Pituitary Causes of Amenorrhea
Non-Lactotroph Adenomas and Sellar Masses
Sheehan’s Syndrome
Infiltrative and Infectious Causes
Lymphocytic Hypophysitis
Hereditary Hemochromatosis
Other
Iatrogenic and Other Causes of Pituitary-Associated Amenorrhea
Surgery
Radiation
Traumatic Brain Injury and Subarachnoid Hemorrhage
Genetic Causes
Diagnostic Evaluation
History
Physical Examination
Case Correlation
References
Chapter 7: Amenorrhea Associated With the Female Athlete Triad: Etiology, Diagnosis, and Treatment
Introduction
A New Model
The Prevalence of Athletic Amenorrhea
The Etiology of Athletic Amenorrhea
Physiological Considerations
Psychological Considerations
Bone Health Considerations
Diagnosis and Treatment
Conclusions
References
Chapter 8: The Role of Body Weight in Menstrual Disturbances and Amenorrhea
Low Body Weight and Menstrual Disturbances
Case 1
Eating Disorders – Definition
Epidemiology of Eating Disorders and Weight-Related Amenorrhea
Clinical Presentation
Pathophysiology
Diagnostic Workup
Therapeutic Algorithms
Obesity and Menstrual Disturbances
Case 2
Defining Excess Body Mass
Epidemiology of Obesity and Menstrual Dysregulation
Clinical Presentation
Pathophysiology
Diagnostic Workup
Therapeutic Algorithms
References
Chapter 9: Natural and Surgical Menopause
Defining the menopausal transition
Ovarian follicular depletion is the primary driver of the menopausal transition
Endocrine changes in the menopausal transition
Inhibin and reproductive aging
Alterations in the hypothalamic-pituitary-ovarian (HPO) axis with reproductive aging
Symptoms of the menopausal transition
Hot flashes
Urogenital symptoms
Bone
Surgical Menopause
Summary
References
Chapter 10: Clinical Implications of Prolonged Hypothalamic Amenorrhea
Case Scenario
Baseline Biochemical Evaluation
Followup Biochemical Evaluation
Overview
Neuroendocrinology of FHA
Behavioral Correlates of FHA
Potential Health Implications of FHA
Treatment Considerations
Conclusion
References
Chapter 11: Long-Term Implications of Oophorectomy at the Time of Hysterectomy for Benign Disease
Introduction
Arguments for and Against Oophorectomy
Long-Term Risks of Hysterectomy
Long-Term Risks of Oophorectomy in Premenopausal Women
Hot Flashes, Mood, and Quality of Life
Urogenital Atrophy
Sexual Function
Central Nervous Effects: Cognitive Thought, Memory, Depression, Parkinson’s Disease
Osteoporosis and Hip Fracture
Quality of Life: Lens Opacities, Body Mass
Cardiovascular Disease
Long-Term Risks of Oophorectomy in Postmenopausal Women
Hormone Production in the Postmenopausal Ovary
Controversies on Postmenopausal Ovarian Enzyme Activity
Osteoporosis and Hip Fracture
Quality of Life
Examining the Effect of Oophorectomy on Overall Mortality
Controversies on Hormone Replacement
Conclusions
References
Chapter 12: Ethnicity and Amenorrhea
Ethnic Variations in Menstrual Physiology
Menarche
Menstruation
Ovulation/Anovulation
Ovarian Insufficiency
Menopausal Transition
Variations in Cultural Beliefs and Attitudes Toward Normal and Abnormal Menstrual Cycles
Menstrual Symptoms
Contraceptive-Induced Amenorrhea
Racial Differences in Hysterectomy
Menopause
Summary
References
Index