Amenorrhea laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Initial laboratory tests for evaluating amenorrhea include pregnancy test, thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), and prolactin (PRL). Second line laboratory tests include free and total testosterone, dehydroepiandrosterone sulfate (DHEAS), and also progesterone challenge test.

Laboratory Findings

Disease Laboratory tests
Pregnancy test TSH T4 Anti-TPO Ab Anti-TSH-R Ab PRL LH FSH Estradiol Prog. Testosterone DHEAS AD 17-OH-prog. Insulin FBS Insulin resistance indexes ACTH Cortisol Markers of ovarian tumors Prog. challenge test Leptin Inhibin
Pregnancy Positive +/- - - - - - - - - - - - - - - - - -
Hypothyroidism - ↑↑ +/- - - - - - - - - - - - - - - - - -
Hyperthyroidism - ↓↓ - - - - - - - - - - - - - - - - - -
Thyroiditis - ↑↑ ↓↓ Positive - - - - - - - - - - - - - - - - -
Graves' disease - ↓↓ ↑↑↑ - Positive - - - - - - - - - - - - - - - -
Hyperprolactinemia - - - - - ↑↑ - - - - - - - - - - - - -
Prolactinoma - - - ↑↑↑ ↓↓ ↓↓ - - - - - - - - - - - - -
Hypothalamic disease - ↓↓ ↓↓ - - ↓↓ ↓↓ ↓↓ ↓↓ ↓↓ - - - - - - - - - - - ↓↓ -
Premature ovarian failure - - - - - - ↑↑ ↑↑ ↓↓ ↓↓ - - - - - - - - - - - ↓↓
Androgen insensitivity syndrome - - - - - - ↑↑ ↑↑ ↓↓↓ ↓↓↓ - - - - - - - - - -
Polycystic ovary syndrome (PCOS) - - - - - - - - - - Positive - -
Congenital adrenal hyperplasia (CAH) - - - - - - - - - - - - - - - - -
ACTH-secreting adenoma - - - - - ↓↓ ↓↓ ↓↓ ↓↓ - - - - - - - - - - -
Ovarian adenocarcinoma - - - - - - - - - - - - - - - Positive - - -
HPO axis immaturity - - - - - - ↓↓ ↓↓ ↓↓ ↓↓ - - - - - - - - - - Positive - -
Imperforate hymen - - - - - - - - - - - - - - - - - - - - - - -
Asherman's syndrome - - - - - - - - - - - - - - - - - - - - - - -
Abbreviations: TSH: Hemoglobin, T4: Thyroxin, Anti-TPO Ab: Anti-thyroid peroxidase antibodies, Anti-TSH-R Ab: Anti-thyroid stimulating hormone antibodies, PRL: Prolactin, LH: Luteinizing hormone, FSH: Follicle stimulating hormone, Prog.: Progesterone, DHEAS: Dehydroepiandrosterone sulfate, AD: Delta 4-androstenedione, 17-OH-Prog.: 17-hydroxyprogesterone, FBS: Fasting blood sugar, ACTH: Adrenocorticotropic hormone, HPO axis: Hypothalamus-pituitary-ovary axis.

Biochemical Tests

Urine or serum pregnancy test

  • Some patients with amenorrhea may have positive urine or serum pregnancy test, which is usually suggestive of pregnancy-induced amenorrhea.[2]

Thyroid function tests

Prolactin (PRL)

Basal plasma gonadotropins

Estradiol

Progesterone

Free and total testosterone

Dehydroepiandrosterone sulfate (DHEAS)

Delta 4-androstenedione

17-hydroxyprogesterone

Fasting insulin

Fasting glucose (FBS)

Insulin resistance indexes

Adrenocorticotropic hormone (ACTH)

Cortisol

Markers of ovarian tumors

Progesterone challenge test

Leptin

  • Some patients with amenorrhea may have reduced concentration of leptin, which is usually suggestive of amenorrhea due to hypothalamic disorders.[14]

Inhibin

  • Some patients with amenorrhea may have reduced concentration of inhibin, which is usually suggestive of amenorrhea due to ovarian failure.[9]

References

  1. Pereira K, Brown AJ (2017). "Secondary amenorrhea: Diagnostic approach and treatment considerations". Nurse Pract. 42 (9): 34–41. PMID 28832422. doi:10.1097/01.NPR.0000520832.14406.76. 
  2. Master-Hunter T, Heiman DL (2006). "Amenorrhea: evaluation and treatment". Am Fam Physician. 73 (8): 1374–82. PMID 16669559. 
  3. Rebar RW, Connolly HV (1990). "Clinical features of young women with hypergonadotropic amenorrhea". Fertil. Steril. 53 (5): 804–10. PMID 2110072. 
  4. Patel, S. S.; Bamigboye, V. (2009). "Hyperprolactinaemia". Journal of Obstetrics and Gynaecology. 27 (5): 455–459. ISSN 0144-3615. doi:10.1080/01443610701406125. 
  5. "Hyperprolactinemia and Associated Pituitary Prolactinomas. : Obstetrics & Gynecology". 
  6. 6.0 6.1 6.2 Deligeoroglou, Efthimios; Athanasopoulos, Nikolaos; Tsimaris, Pandelis; Dimopoulos, Konstantinos D.; Vrachnis, Nikolaos; Creatsas, G. (2010). "Evaluation and management of adolescent amenorrhea". Annals of the New York Academy of Sciences. 1205 (1): 23–32. ISSN 0077-8923. doi:10.1111/j.1749-6632.2010.05669.x. 
  7. 7.0 7.1 Santoro N (2003). "Mechanisms of premature ovarian failure". Ann. Endocrinol. (Paris). 64 (2): 87–92. PMID 12773939. 
  8. 8.0 8.1 Hughes, Ieuan A.; Deeb, Asma (2006). "Androgen resistance". Best Practice & Research Clinical Endocrinology & Metabolism. 20 (4): 577–598. ISSN 1521-690X. doi:10.1016/j.beem.2006.11.003. 
  9. 9.0 9.1 Beck-Peccoz P, Persani L (2006). "Premature ovarian failure". Orphanet J Rare Dis. 1: 9. PMC 1502130Freely accessible. PMID 16722528. doi:10.1186/1750-1172-1-9. 
  10. Timmreck, Lorna S.; Reindollar, Richard H. (2003). "Contemporary issues in primary amenorrhea". Obstetrics and Gynecology Clinics of North America. 30 (2): 287–302. ISSN 0889-8545. doi:10.1016/S0889-8545(03)00027-5. 
  11. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO (2004). "The prevalence and features of the polycystic ovary syndrome in an unselected population". J. Clin. Endocrinol. Metab. 89 (6): 2745–9. PMID 15181052. doi:10.1210/jc.2003-032046. 
  12. Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS (2006). "A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome". Hum. Reprod. Update. 12 (6): 673–83. PMID 16891296. doi:10.1093/humupd/dml036. 
  13. Teede H, Deeks A, Moran L (2010). "Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan". BMC Med. 8: 41. PMC 2909929Freely accessible. PMID 20591140. doi:10.1186/1741-7015-8-41. 
  14. Welt, Corrine K.; Chan, Jean L.; Bullen, John; Murphy, Robyn; Smith, Patricia; DePaoli, Alex M.; Karalis, Aspasia; Mantzoros, Christos S. (2004). "Recombinant Human Leptin in Women with Hypothalamic Amenorrhea". New England Journal of Medicine. 351 (10): 987–997. ISSN 0028-4793. doi:10.1056/NEJMoa040388. 




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