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Primary Amenorrhea Testing Algorithm

The document provides guidelines for testing related to primary amenorrhea. It outlines the initial tests that should be ordered including pregnancy tests and hormone levels. It then provides guidance on further tests and potential diagnoses depending on the results of the initial tests.

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661 views1 page

Primary Amenorrhea Testing Algorithm

The document provides guidelines for testing related to primary amenorrhea. It outlines the initial tests that should be ordered including pregnancy tests and hormone levels. It then provides guidance on further tests and potential diagnoses depending on the results of the initial tests.

Uploaded by

farmasi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Primary Amenorrhea Testing

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INDICATIONS FOR TESTING


Lack of menstrual flow by age 14 and absence of secondary sexual characteristics
or lack of menstrual flow by age 16 and presence of secondary sexual characteristics

ORDER
Beta-hCG, Urine Qualitative or
Beta-hCG, Serum Qualitative to exclude pregnancy

Positive Negative

Pregnant Physical and pelvic examination


Normal May also consider pelvic ultrasound if
unable to confirm presence of uterus

ORDER
Thyroid Stimulating Hormone with Reflex to Free Anatomic abnormality
Thyroxine
Prolactin
Lutenizing Hormone, Folicle Stimulating Hormone
Uterus absent Uterus present

Elevated Abnormal
TSH, prolactin
prolactin TSH
Transverse vaginal
ORDER septum
Perform an MRI Thyroid Imperforate hymen
on the head Disease LH and FSH results Testosterone, Free and Total
(Includes Sex Hormone Binding Abnormal cervical os
Globulin), Females or Children Other vaginal
abnormality (5%)

Elevated Normal

Primary Functional
ovarian hypothalamic
failure amenorrhea High Normal

X-chromosome Eating disorder, exercise, weight loss


Stress, chronic illness ORDER
abnormality Chromosome Analysis
Turner syndrome Delayed puberty (20%)
FSH receptor Gonadotropin releasing hormone (GNRH)
deficiency deficiency (20%) consider MRI
Autoimmune Pituitary disorders (2%) consider MRI 45, X and
46,XY 46,XX
gonadal destruction Medication-induced (chemotherapy, oral variants
contraceptives, antidepressants, antipsychotics)

Are one of the following 5 alpha Rokitansky Ulrich


Androgen reductase Kster Turner
symptoms present? insensitivity deficiency syndrome syndrome

Virilization
Hypertension

ORDER
Testosterone, Free and Total
(Includes Sex Hormone Binding
Globulin), Females or Children
Consider 17-
hydroxylase
deficiency Elevated
Not elevated

Consider ORDER
PCOS Androgen-secreting
Dehydroepiandrosterone DHEAS elevated
tumor
Sulfate, Serum
2006 ARUP Laboratories. All rights reserved. Revised 03/27/2014 www.arupconsult.com

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