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1. Amenorrhea Mayurasakorn N.

4. Hypergonadotropic hypogonadism Hypogonadotropic hypogonadism Autoimmune Hemochromatosis Lymphocytic hypophysis Surgery Irradiation Sheehan sd Hyperprolactin Pituitary tumor Empty sella Pituitary TB,syphilis,Encephalitis/menigitis,Sarcoidosis Mump Oophoritis Infection /infiltration Craniopharyngioma, Germinoma,Hamartoma,Teratoma,Metastasis Ovarian tumor Tumor Irradiation Chemotherapy Trauma Anorexia nervosa Stress Exercise Nutrition-related Autoimmune Metabolic Hypothalamus Ovary

6. Most common causes

12. Hypothalamus Hyperprolactinemia Ovary Pituitary PCOS Outflow tract Cushing’s sd Thyroid MRI hypothalamus, pituitary FSH,LH, autoimmune MRI pituitary U/S ovary,testosterone Dexamethasone supression test Thyroid function test prolactin Hysterosalpingogram,hysteroscopy Investigations

13. Pregnancy test TSH ,PRL,FSH TSH Hypothyroid PRL Hyperpro-lactinemia FSH Premature ovarian failure Hypogonadotropic Normogonadotropic PCOS Outflo w Clinical PRL > 40 mg/dL FSH > 40 mIU/mL

15. Prog.challenge test Withdrawal bleeding No withdrawal bleeding Chronic anovulation Testosterone, DHEA-S,17 hydroxyprogesterone T,DHEA-S,LH mild PCOS T,DHEA-S marked Androgen-secreting tumor 17-hydroxyprogesterone CAH Idiopathic anovulation

16. No withdrawal bleeding Est,progest.challenge test Hypothalamic- pituitary failure hypoestrogenic outflow tract. Withdrawal bleeding No Prog.challenge test

24. Tanner Staging Stage 1 : prepubertal Stage 2 : breast bud Stage 3 : further enlarge of breast & areolar ,no seperation Stage 4: areolar & papilla form second mound Stage 5 : mature, only projection of papilla

25. Tanner Staging Stage1 : villus hair Stage 2 : Sparse growth of slightly pigmented hair along labia (11.9 years) Stage 3 : C oarser, curled and pigmented; spreads across pubes (12.7 years) Stage 4 : Adult-type hair but no spread to medial thigh (13.4 years) Stage 5 : Adult-type hair with spread to medial thigh but not up linea alba (14.6 years)

26. Secondary sex characteristic No Yes Pubic hair Yes Uterus No Androgen insentivity syndrome Imperforate hymen Yes No Mullerian agenesis As secondary amenorrhea PV

27. Secondary sex characteristic No ( normal cervix and uterus not include ambiguous) FSH E Primary Gonodal failure Constitutional delay Kallman sd Hypothalamus-pituitary Karyotype XX,XY,XO

32. Imperforate hymen

42. PCOS : Polycystic Ovarian Syndorme

50. Turner Syndrome