1. CASE PRESENTATION (4)(6)(7)

2. Case 1: 17 yo female with primary amenorrhea • Normal pubertal development • Normal health • No family history of delayed puberty • Not involved in athletics • Does well in school • Not taking any meds

3. Case 1: Physical Exam • Thin young woman (10% below IBW) • Normal genitalia • No galactorrhea • Tanner stage 4 Laboratory values • Urine and serum B-HCG negative • Prolactin, FSH, TSH all normal

4. Case 1: Further history Patient’s parents concerned about her eating habits (very low fat intake and restricting calories)

5. Diagnose in case 1: Hypothalamic Amenorrhea • Etiology is most likely inadequate caloric and fat intake. • Patient should be referred for evaluation for an eating disorder. • Chances of normal menstruation are very good if patient takes in adequate calories.

6. Diagnose in case 1: Hypothalamic Amenorrhea • Etiology is most likely inadequate caloric and fat intake. • Patient should be referred for evaluation for an eating disorder. • Chances of normal menstruation are very good if patient takes in adequate calories.

7. Case 2:32 years old woman with secondary amenorrhea • Menarche at age 12 • Periods have always been irregular • Now amenorrhea for resent 10 months • Overweight • Wants to get pregnant

8. Case 2: Physical Exam • Obese female • Acne • Normal genitalia • Mild hirsutism

9. Case 2: Laboratory findings • Urine B-HCG negative • TSH, FSH and Prolactinnormal • Testosterone 180 ng/mL • Pelvic U/S findings show polycystic ovaries

10. U/S findings in PCOS

11. Case 3: 29 yo woman with 18-month h/o amenorrhea • Normal development • No family history of amenorrhea • Does not exercise excessively or restrict diet • Denies galactorrhea • Has h/o abortion with subsequent D & C

12. Case 3:Physical Exam • Normal exam • No galactorrhea

13. Case 3: Laboratory findings • Urine B-HCG negative • Prolactinnormal • TSH, FSH, LH all was normal

14. Case 3: Further work-up • Fails Provera challenge • Fails 1-month trial of estrogen + progesterone • Pelvic U/S shows no uterine stripe • Hysteroscope confirms diagnosis of…Asherman’s Syndrome