By Kenneth J. Ryan MD, Ross S. Berkowitz MD, Robert L. Barbieri MD, Andrea E. Dunaif MD

KISTNER'S GYNECOLOGY AND WOMEN'S overall healthiness makes a speciality of the complete sufferer care of the girl. The 23 chapters are divided into 3 components: gynecology review, reproductive procedure and illness, and reproductive existence cycle. Chapters are geared up through either organ structures and ailment with emphasis at the evaluate of universal difficulties and their clinical administration. analysis and remedy algorithms were further all through to advertise systematic considering and logical judgements, which complement scientific potency. * positive aspects 23 chapters which specialise in overall sufferer care and emphasize the overview and clinical administration of universal difficulties. * Lists key concerns in bankruptcy establishing outlines, permitting the reader to study themes lined and to test bankruptcy insurance at a look. * contains therapy algorithms which express therapies at a look to aid and concentration scientific decision-making.

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A less common cause of secondary amenorrhea is infiltrative diseases of the hypothalamus (lymphoma, histiocytosis). Hypothyroidism occasionally appears as secondary amenorrhea, probably because of changes in GnRH production. The single most common cause of secondary amenorrhea of pituitary origin is hyperprolactinemia resulting from a prolactinoma (18% of cases). Other pituitary causes of secondary amenorrhea include empty sella syndrome, Sheehan syndrome, and Cushing disease (1% of cases). Prolactinomas Many pituitary tumors are monoclonal, indicating that a somatic mutation in a single progenitor cell is the cause of the tumor formation.

In these circumstances, surgical removal of the gonads is necessary. If pelvic ultrasonography shows that the uterus is absent, the probable diagnosis is mullerian agenesis. Secondary Amenorrhea Secondary amenorrhea is present when a woman who has been menstruating has not had a period for more than three cycle intervals, or 6 months. A common cause of secondary amenorrhea is pregnancy, and this possibility can be excluded by measuring the circulating hCG. After excluding pregnancy, the most common causes of secondary amenorrhea are hypothalamic dysfunction (35% of cases); pituitary disease (19% of cases); ovarian failure (10% of cases); polycystic ovary disease (30% of cases); and uterine disease (5% of cases).

This accelerated follicular destruction leads to premature ovarian failure. Ovarian failure can be caused by chemotherapy (especially alkylating agents such as cyclophosphamide), radiotherapy (as little as 500 cGy to the ovaries), wedge biopsy of the ovaries, and infections (Koyama, 1977). There is no specific therapy for ovarian failure. Women with premature ovarian failure are at a high risk for osteoporosis and cardiovascular disease caused by hypoestrogenism; estrogen replacement therapy should be offered unless specific contraindications exist.

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