Reproductive and endocrine disease

1. Reproductive and endocrine disease Shujun Gao

2. Individual • Each in normal position • Each keeps normal activity • Each has normal reaction

3. System • Normal——interaction in balance • Dysfunction——lost of balance

4. Center stratum cutaneum ？ Reproductive endocrine axis Inferior colliculus GnRH Pituitary gland Gonadotropin FSH LH progestogen estrogen

5. amenorrhea • xxx， 16-year-old with secondary sexual characters ，but absence of menstruation • Question ：What is the diagnosis and how to treat?

6. Correlated knowledge • The initiate and maintain of the normal menstruation • Normal growth sequence of puberty • Conditions of ovarian growth • Physiologic function of ovarian • Methods of examination of ovarian function

7. Causation and pathophysiology • Hypothalamic amenorrhea • Pituitary amenorrhea • Ovarian amenorrhea • Uterine amenorrhea • Congenital dysplasia of low genital tract • Dysfunction of other endocrine glands

8. Definition • It is a common symptom ,not a disease • Primary amenorrhea： secondary sexual characters not appears after 14-years or no menarche after 16-years although secondary sexual characters appeared. • Secondary amenorrhea：cessation of the periods for 6months after menstruation has been established

9. Classification (one) • Primary amenorrhea——most due to congenital diseases or functional disorder and deformed genital tract,about 5%。 • Secondary amenorrhea——most due to secondary dysfunction or tumor,about 95%。

10. Classification (two) • Physiologic amenorrhea • Pathological amenorrhea

11. Classification （three） According to the anatomic site • Congenital dysplasia of low genital tract • Uterine amenorrhea • Ovarian amenorrhea • Pituitary amenorrhea • Central nerve-hypothalamic amenorrhea

12. Classification （four） According to the level of sex hormone • Hypergonadotropic hypogonadism： FSH≥30IU/L，lesion presence in ovarian • hypogonadotropic hypogonadism： FSH and LH both<5IU/L，lesion presence in center

13. Dysfunctional uterine bleeding • Patient ——Troubled by dysfunctional uterine bleeding sees a doctor to resolve bleeding and to get normal menstruation • Doctor —— you， should know how to satisfy the patient • To solve the problem, diagnosis, differential diagnosis and treatment should be mastered

14. Patient： 17-year-old ， 46kg • Chief complaint：menstrual disorder for 2 months,vaginal bleeding for 18 days • Menstruation: 11year 5-7/20-30days。Pmp 2007.07.03 ,Lmp 2007 08.24。 • History of present illness: She had a heavy vaginal bleeding from September 5th, 2007 ,accompany with dizziness, vertigo and fatigue,and was hospitalized emergency • Medical examination: T36.7、P88cpm、R21cpm、BP90/50mmg. depressed with an anemia face • Gynecology examination： corpus：middle position with normal size adnexa：no masses • ultrasound: UT46× 45×40mm, EN10mm ROV31×28×23mm, LOV33×17×16mm. Cul-de-sac hydrops：18mm.

15. discussion • diagnosis：puberty dysfunctional uterine bleeding secondary anemia • Procedure of diagnosis: history of illness medical examination gynecological examination auxiliary examination：urine HCG、 ultrasound、 sex hormone、blood routine. • Therapeutics：sex hormone diagnostic curettage antibiotics treatment of anemia