A physiological approach to the differential diagnosis and treatment of primary amenorrhoea

Polycystic ovaries in association with müllerian anomalies

The polycystic ovary syndrome, whose etiopathogenesis is not clearly understood, has a wide spectrum of clinical presentations, and may co-exist with other pathologic conditions. In this study, we evaluated the prevalence of ultrasound-defined polycystic ovaries (PCO) in patients with müllerian anomalies (n = 167), and those without müllerian anomalies (n = 3165) from 1990 to 1994, in a population markedly composed of infertility patients. PCO were found in 50 (29.9%) patients in the study group, compared to 637 (20.1%) patients in controls (P < 0.01). Müllerian anomalies were further grouped according to the American Fertility Society (AFS) classification and it was found that patients with the septate uteri and bicornuate uteri malformations had a higher prevalence of PCO than the controls (P < 0.001, P < 0.05, respectively). Although a difference existed in the percentage of PCO in patients with unicornuate uteri and didelphic uteri compared to controls, this difference did not reach statistical significance (P > 0.05). We conclude that, as PCO are more prevalent in certain müllerian anomalies, an embryogenetic defect may also be involved in the etiopathogenesis of PCO.

The investigation of female gonadal dysfunction

An approach to the investigation of ovarian dysfunction has been presented here with a particular emphasis on the importance of effective imaging of the ovary and uterus by ultrasonography. Essential endocrine investigations in the various clinical manifestations of altered ovarian function have been placed in the context of recent research on the control of female reproduction.

Delayed sexual development: a study of 252 patients

A series of 252 patients with abnormalities of pubertal development are reported. Ovarian failure, followed by Rokitansky syndrome and then physiologic delay, are the most frequently encountered etiologies. Other etiologies are diverse and numerically less frequent. The average age of presentation, patient's height, somatic anomalies, diagnostic errors, and subsequent reproductive potential of each diagnostic group are reported. Only 35 (14%) of all patients presenting with abnormalities of pubertal development had subsequent normal reproductive potential. All of these patients were in the physiologic delay category.

Primary amenorrhea associated with hirsutism, acanthosis nigricans, dermoid cysts of the ovaries and a new type of insulin resistance

We describe a 15 1/2 year old presenting with primary amenorrhea, hirsutism, acanthosis nigricans and insulin resistance. Ovarian vein catheterization studies revealed bilateral excess plasma testosterone and androstenedione secretion, and at surgery multiple dermoid cysts of both ovaries were found in association with polycystic ovaries. The suggestion that the dermoid cysts may be causative in the evolution of the polycystic ovarian disease has been made. The mechanism of the insulin resistance appears to be at the post receptor level. The acanthosis nigricans diminished following surgery with normalization of the plasma androgens.

Laparoscopy and gonadal biopsy for assessment of gonadal function in primary amenorrhoea

Twenty patients with primary amenorrhoea have been investigated by laparoscopy and gonadal biopsy, endocrine and chromosomal studies. Laparoscopy and gonadal biopsy made the major contribution to the diagnosis, prognosis, and management of the patients and provided a method for study of the functional anatomy of the ovary.

Possible X-autosomal translocation in a girl with gonadal dysgenesis

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