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Almatrafi AM, Hibshi AM, Basit S. Exome Sequencing to Identify Novel Variants Associated with Secondary Amenorrhea and Premature Ovarian Insufficiency (POI) in Saudi Women. Biomedicines 2024; 12:785. [PMID: 38672141 PMCID: PMC11048260 DOI: 10.3390/biomedicines12040785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Post-pubertal disappearance of menstrual cycles (secondary amenorrhea) associated with premature follicular depletion is a heterogeneous condition. Patients with this disease have low levels of gonadal hormones and high levels of gonadotropins. It is one of the causes of female infertility and a strong genetic component is attributed as an underlying cause of this condition. Although variants in several genes have been associated with the condition, the cause of the disease remains undetermined in the vast majority of cases. Methodology and Materials: Ten Saudi married women experiencing secondary amenorrhea were referred to a center for genetics and inherited diseases for molecular investigation. A family-based study design was used. Intensive clinical examinations, including pelvic ultra-sonography (U/S) and biochemical evaluations, were carried out. Karyotypes were normal in all cases and polycystic ovarian syndrome (PCOS) was excluded by using Rotterdam consensus criteria. Patients' DNA samples were whole-exome sequenced (WES). Bidirectional Sanger sequencing was then utilized to validate the identified candidate variants. The pathogenicity of detected variants was predicted using several types of bioinformatics software. RESULTS Most of the patients have a normal uterus with poor ovarian reserves. Exome sequence data analysis identified candidate variants in genes associated with POI in 60% of cases. Novel variants were identified in HS6ST1, MEIOB, GDF9, and BNC1 in POI-associated genes. Moreover, a homozygous variant was also identified in the MMRN1 gene. Interestingly, mutations in MMRN1 have never been associated with any human disease. The variants identified in this study were not present in 125 healthy Saudi individuals. CONCLUSIONS WES is a powerful tool to identify the underlying variants in genetically heterogeneous diseases like secondary amenorrhea and POI. In this study, we identified six novel variants and expanded the genotype continuum of POI. Unravelling the genetic landscape of POI will help in genetic counselling, management, and early intervention.
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Affiliation(s)
- Ahmed M. Almatrafi
- Department of Biology, College of Science, Taibah University, Al Madinah Al Munawarah 42353, Saudi Arabia
| | - Ali M. Hibshi
- Department of Obstetrics & Gynecology, King Sulman Medical City-Madinah Maternity and Children Hospital, Al Madinah Al Munawarah 42319, Saudi Arabia;
| | - Sulman Basit
- Department of Basic Medical Sciences, College of Medicine, and Centre for Genetics and Inherited Diseases, Taibah University, Al Madinah Al Munawarah 42353, Saudi Arabia;
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Januś D, Kujdowicz M, Kaleta K, Możdżeń K, Radliński J, Taczanowska-Niemczuk A, Kiszka-Wiłkojć A, Maślanka M, Górecki W, Starzyk JB. Ultrasound-Histopathological Presentation of Thyroid and Ovary Lesions in Adolescent Patients with DICER1 Syndrome: Case Reports and Literature Overview. Children (Basel) 2024; 11:403. [PMID: 38671620 PMCID: PMC11049647 DOI: 10.3390/children11040403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND DICER1, a cancer predisposition syndrome (CPS), seems to escape timely diagnosis in pediatric patients. Case report 1: A 16-year-old female patient was referred to the endocrinology ward due to a large goiter. Her medical history indicated normal sexual maturation, with menarche occurring at 13.5 years. Over the past 2.5 years, she had developed pronounced androgenic symptoms, including a deepened male voice; facial, back, and neckline acne; hirsutism; and menstrual irregularities leading to secondary amenorrhea. A thyroid ultrasound identified a multinodular goiter (MNG) with cystic-solid lesions containing calcifications. An abdominal ultrasound identified a 5.7 × 6.9 cm solid mass in the right adnexal region, displacing the uterus to the left. Histopathological examination confirmed a Sertoli-Leydig cell tumor. The patient was subjected to a total thyroidectomy. Histopathology revealed benign follicular cell-derived neoplasms. Thyroid follicular nodular disease (TFND) was diagnosed bilaterally. DNA analysis using NGS, confirmed via the Sanger method, revealed a pathogenic heterozygotic variant c.2953C>T [p.Gln985*] in exon 18 of the DICER1 gene. Case report 2: A 12-year-old male patient was admitted to the pediatric surgery unit due to a 33 mL goiter. A month prior to his admission, the patient discovered a palpable nodule in his neck, accompanied by hoarseness. An ultrasound revealed MNG. Molecular analysis revealed a pathogenic heterozygotic variant c.2782C>T [p.Gln928*] in exon 17 of the DICER1 gene. Subsequently, a total thyroidectomy was performed, and histopathological examination revealed TFND bilaterally. CONCLUSIONS Recent advances in genetic evaluation and in histological approaches indicate that MNG/TFND, although rare in the pediatric population, when accompanied by characteristic ultrasound and histopathological features, and by additional features such as androgenization, may warrant assessment also of the DICER1 gene within CPS molecular panel screening.
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Affiliation(s)
- Dominika Januś
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
- Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital in Krakow, 30-663 Krakow, Poland
| | - Monika Kujdowicz
- Department of Pathomorphology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
- Department of Pathology, University Children’s Hospital in Krakow, 30-663 Krakow, Poland
| | - Konrad Kaleta
- Student Scientific Group of Pediatric Endocrinology, Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.K.); (K.M.); (J.R.)
| | - Kamil Możdżeń
- Student Scientific Group of Pediatric Endocrinology, Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.K.); (K.M.); (J.R.)
| | - Jan Radliński
- Student Scientific Group of Pediatric Endocrinology, Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.K.); (K.M.); (J.R.)
| | - Anna Taczanowska-Niemczuk
- Department of Pediatric Surgery, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.T.-N.); (A.K.-W.); (M.M.); (W.G.)
- Department of Pediatric Surgery, University Children’s Hospital in Krakow, 30-663 Krakow, Poland
| | - Aleksandra Kiszka-Wiłkojć
- Department of Pediatric Surgery, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.T.-N.); (A.K.-W.); (M.M.); (W.G.)
- Department of Pediatric Surgery, University Children’s Hospital in Krakow, 30-663 Krakow, Poland
| | - Marcin Maślanka
- Department of Pediatric Surgery, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.T.-N.); (A.K.-W.); (M.M.); (W.G.)
- Department of Pediatric Surgery, University Children’s Hospital in Krakow, 30-663 Krakow, Poland
| | - Wojciech Górecki
- Department of Pediatric Surgery, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.T.-N.); (A.K.-W.); (M.M.); (W.G.)
- Department of Pediatric Surgery, University Children’s Hospital in Krakow, 30-663 Krakow, Poland
| | - Jerzy B. Starzyk
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
- Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital in Krakow, 30-663 Krakow, Poland
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Novina N, Ritonga MA, Yusuf AS. Gonadotropin Levels and Underlying Diseases in Adolescent With Secondary Amenorrhea. Int J Womens Health 2023; 15:1397-1404. [PMID: 37701180 PMCID: PMC10493105 DOI: 10.2147/ijwh.s412482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose To provide characteristics and hormonal profiles of secondary amenorrhea cases in adolescent patients treated at Hasan Sadikin General Hospital in Bandung. Patients and Methods The study was retrospective in nature and involved the analysis of medical records from 2017 to 2022 for 44 adolescent patients aged 10-18 who had secondary amenorrhea. Results There were 44 adolescents included in this study after excluded 69 adults from 113 secondary amenorrhea cases. The majority of patients were 14-17 years old (38.63%), in senior high school (45.45%), had started menarche at 11 years old (45.45%), had normal nutritional status (65.91%), and had normal stature (65.91%). The underlying diseases found in most patients were systemic lupus erythematosus (SLE) and tuberculosis. Among the patients, 29 had FSH, LH, and estradiol levels measured. The results of hormonal assays showed a wide range of abnormal serum levels, with normal to low concentrations of FSH and low levels of LH and estradiol. The median (interquartile range) results for FSH, LH, and estradiol were 4.57 (0.64, 90.65), 1.635 (0.06, 55.76), and 24.3 (0.2, 154.71), respectively. Positive significant correlation between FSH and LH (p < 0.01) was found in children with secondary amenorrhea. Conclusion Hormonal assay for FSH, LH, and Estradiol showed a wide range of abnormal serum level. Normal to low concentration levels of FSH and low LH and estradiol. The majority of secondary amenorrhea patients are associated with autoimmune disease and infection.
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Affiliation(s)
- Novina Novina
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Mulyanusa Amarullah Ritonga
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Ach T, Saafi W, Nouira S, Ben Abdelkrim A. Secondary Amenorrhea Revealing a Giant Hamartoma of the Tuber Cinereum. Cureus 2023; 15:e40532. [PMID: 37461751 PMCID: PMC10350324 DOI: 10.7759/cureus.40532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
Hypothalamic hamartomas are benign tumors composed of ectopic neural and glial tissue. They have a low prevalence and are usually associated with central precocious puberty or epilepsy with gelastic seizures. The presentation beyond childhood is rare, and the symptoms are not the same as in childhood. Here, we report the case of a woman who presented with secondary amenorrhea and headaches revealing a giant hamartoma of the tuber cinereum (TC). The hormonal assessment showed moderate hyperprolactinemia. Synacthen testing was normal. Magnetic resonance imaging revealed a suprasellar hamartoma on the TC measuring 20 mm with sellar extension. The optic chiasma and cavernous sinuses were clear. Hyperprolactinemia was explained by mechanical compression of the pituitary stalk. The patient started cabergoline orally (1 mg per week) with an improvement of the prolactin levels and had a natural pregnancy six months later without incident. Surgery was not indicated due to the difficult transsphenoidal access and the absence of major clinical symptoms.
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Affiliation(s)
- Taïeb Ach
- Endocrinology, Farhat Hached University Hospital, Sousse, TUN
| | - Wiem Saafi
- Endocrinology, Farhat Hached University Hospital, Sousse, TUN
| | - Sawsen Nouira
- Endocrinology, Farhat Hached University Hospital, Sousse, TUN
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Shah S, Khan R, Bayrakdar K, Scott C. Vision Deficit Due to Pituitary Apoplexy. Cureus 2023; 15:e38649. [PMID: 37288197 PMCID: PMC10241991 DOI: 10.7759/cureus.38649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
Pituitary apoplexy means "sudden death" of the pituitary gland, usually caused by hemorrhage or infarction and often occurring in a pre-existing pituitary adenoma. In many cases, pituitary apoplexy is a medical and surgical emergency. Fast, efficient diagnosis and treatment are important in many cases. This case exemplifies an ideal lab workup and referral process to turn out best outcomes and prevent medical complications in our patient.
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Affiliation(s)
| | - Rumana Khan
- Internal Medicine, LewisGale Medical Center, Salem, USA
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Kim GM, Jeon GH. Correlation between Serum 25-Hydroxyvitamin D Level and Depression among Korean Women with Secondary Amenorrhea: A Cross-Sectional Observational Study. Nutrients 2022; 14:nu14142835. [PMID: 35889792 PMCID: PMC9315875 DOI: 10.3390/nu14142835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Vitamin D deficiency is considered a major public health problem worldwide and has been reported as having an association with depression. However, studies on the association between vitamin D deficiency and depressive symptoms in secondary amenorrhea (SA) patients are still scarce. This study examined the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and depressive symptoms among Korean women with SA. In this cross-sectional observational study, 78 patients with SA were initially recruited. Clinical and biochemical parameters, including serum 25(OH)D level, were measured. Data from 63 SA patients who met the study inclusion criteria and completed psychiatric assessments were finally analyzed. We analyzed their association with depression using a hierarchical regression model. The average serum 25(OH)D level was 34.40 ± 24.02 ng/mL, and 41.3% of the women with SA were vitamin D-deficient (<20 ng/mL). The total score of the Korean version of the Hamilton Depression Rating Scale (K-HDRS) was negatively related to serum 25(OH)D levels, free testosterone, and serum anti-Müllerian hormone (AMH) after adjusting for age and BMI (r = −0.450, p < 0.001; r = −0.258, p = 0.045; and r = −0.339, p = 0.006, respectively). Serum 25(OH)D levels and AMH levels were the most powerful predictors of depressive severity when using the K-HDRS in SA patients (β = −0.39, p < 0.005; β = −0.42, p < 0.005, respectively). This study showed that low serum 25(OH)D levels were associated with the severity of depressive symptoms in SA patients. This observation suggests that the evaluation of vitamin D deficiency for the risk of depression may be necessary in patients with SA.
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Affiliation(s)
- Gyung-Mee Kim
- Department of Psychiatry, Haeundae Paik Hospital, Inje University School of Medicine, Busan 48108, Korea;
| | - Gyun-Ho Jeon
- Department of Obstetrics and Gynecology, Haeundae Paik Hospital, Inje University School of Medicine, Busan 48108, Korea
- Correspondence: ; Tel.: +82-51-797-2020
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Jensen MJ, Brown KN, Turley JM, Graf MI, Dyckman J, Creer AR, Fullmer S. Nutritional Concerns among Female International Volunteers Based on the Income and Development Status of Their Country of Service. Int J Environ Res Public Health 2022; 19:ijerph19084846. [PMID: 35457713 PMCID: PMC9026757 DOI: 10.3390/ijerph19084846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 12/10/2022]
Abstract
This study aimed to determine the prevalence of female athlete triad risk factors among female international volunteers based on the development and income status of their country of service. A total of 2164 past volunteers completed a retrospective survey. Countries’ income and development statuses were coded using the respective annual United Nations World Economic Situations and Prospects reports. Independent t-tests, ANOVAs, and Pearson’s Chi-Squared tests were used to assess group differences; corresponding odds ratios were calculated. Volunteers in nondeveloped (OR = 2.25, CI = 1.85–2.75) and non-high-income (OR = 2.17, CI = 1.75–2.70) countries had over twice the odds of experiencing secondary amenorrhea. More volunteers who served in nondeveloped countries reported an increase in exercise while serving (p = 0.005). Those who served in a nondeveloped (OR = 1.52, CI = 1.16–1.98) or non-high-income (OR = 1.45, CI = 1.08–1.94) country had higher odds of weight loss. However, volunteers serving in nondeveloped (OR = 0.52, CI = 0.44–0.63) and non-high-income (OR = 0.50, CI = 0.4–0.61) countries were less likely to report food insecurity compared to those in developed and high-income countries. Bone mineral density was within the expected range regardless of income and development status. Female volunteers who served in nondeveloped and non-high-income countries experienced higher odds of secondary amenorrhea, which was likely influenced by an increase in exercise and higher odds of weight loss.
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Affiliation(s)
- Megan J. Jensen
- Department of Nutrition, Dietetics and Food Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA; (M.J.J.); (M.I.G.)
| | - Katie N. Brown
- Department of Nutrition, Dietetics and Food Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA; (M.J.J.); (M.I.G.)
- Correspondence:
| | - Jennifer M. Turley
- Department of Exercise & Nutrition Sciences, Moyes College of Education, Weber State University, Ogden, UT 84408, USA;
| | - Marlene I. Graf
- Department of Nutrition, Dietetics and Food Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA; (M.J.J.); (M.I.G.)
| | - Jenna Dyckman
- Utah State University Extension, Utah State University, Logan, UT 84322, USA;
| | - Andrew R. Creer
- Department of Exercise Science & Outdoor Recreation, College of Science, Utah Valley University, Orem, UT 84058, USA;
| | - Susan Fullmer
- Department of Nutrition, Dietetics and Food Sciences, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA;
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Stuenkel CA, Gompel A, Davis SR, Pinkerton JV, Lumsden MA, Santen RJ. Approach to the Patient With New-Onset Secondary Amenorrhea: Is This Primary Ovarian Insufficiency? J Clin Endocrinol Metab 2022; 107:825-835. [PMID: 34693971 DOI: 10.1210/clinem/dgab766] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Indexed: 11/19/2022]
Abstract
Menstrual cyclicity is a marker of health for reproductively mature women. Absent menses, or amenorrhea, is often the initial sign of pregnancy-an indication that the system is functioning appropriately and capable of generating the intended evolutionary outcome. Perturbations of menstrual regularity in the absence of pregnancy provide a marker for physiological or pathological disruption of this well-orchestrated process. New-onset amenorrhea with duration of 3 to 6 months should be promptly evaluated. Secondary amenorrhea can reflect structural or functional disturbances occurring from higher centers in the hypothalamus to the pituitary, the ovary, and finally, the uterus. Amenorrhea can also be a manifestation of systemic disorders resulting in compensatory inhibition of reproduction. Identifying the point of the breakdown is essential to restoring reproductive homeostasis to maintain future fertility and reestablish reproductive hormonal integrity. Among the most challenging disorders contributing to secondary amenorrhea is primary ovarian insufficiency (POI). This diagnosis stems from a number of possible etiologies, including autoimmune, genetic, metabolic, toxic, iatrogenic, and idiopathic, each with associated conditions and attendant medical concerns. The dual assaults of unanticipated compromised fertility concurrently with depletion of the normal reproductive hormonal milieu yield multiple management challenges. Fertility restoration is an area of active research, while optimal management of estrogen deficiency symptoms and the anticipated preventive benefits of hormone replacement for bone, cardiovascular, and neurocognitive health remain understudied. The state of the evidence for an optimal, individualized, clinical management approach to women with POI is discussed along with priorities for additional research in this population.
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Affiliation(s)
- Cynthia A Stuenkel
- Department of Medicine, University of California, San Diego, School of Medicine, La Jolla, CA 92093, USA
| | - Anne Gompel
- Unite de Gynecologie Medicale, l'Universite de Paris Descartes, 75015 Paris, France
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, 3004 Melbourne, Australia
| | - JoAnn V Pinkerton
- Division Director of Midlife Health, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Mary Ann Lumsden
- University of Glasgow School of Medicine, CEO, International Federation of Obstetrics and Gynecology, Glasgow G31 2ER, UK
| | - Richard J Santen
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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Gong X, Li H, Zhao Y. Successful ovarian stimulation and pregnancy in an infertile woman with Rathke's cleft cyst: a case report. Am J Transl Res 2021; 13:13167-13172. [PMID: 34956537 PMCID: PMC8661215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To report a case of successful ovarian stimulation and pregnancy in an infertile woman with Rathke's cleft cyst (RCC). METHODS This is a case report of a 32-year-old infertile woman with RCC presenting with secondary amenorrhea and hypogonadotropic hypogonadism (HH). Three rounds of ovarian stimulation and ovulation induction by means of HMG and HCG were performed (two before HSG and one after HSG). HSG was performed after two rounds of ovulation induction without pregnancy to assess the fallopian tubes and uterine cavity of the patient. Serum beta-human chorionic gonadotropin (β-HCG) and ultrasound examination were performed after the third round of ovulation induction to confirm successful pregnancy. RESULTS HSG revealed that the uterine cavity was normal and that the bilateral fallopian tubes were unobstructed. Four weeks after the third round of ovulation induction, the β-HCG test was positive (10261 μg/L), and ultrasound examination showed an intrauterine early gestational sac with an embryo (10*7 mm) and a primitive heart tube pulse. CONCLUSIONS Infertility accompanied by RCC is rare in the clinic. Clarifying the cause of infertility and secondary amenorrhea is very important for achieving a successful pregnancy. This case demonstrates that such infertility can be treated effectively with ovarian stimulation and ovulation induction using HMG and HCG. To the best of our knowledge, this is the first case report of infertility accompanied by RCC.
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Affiliation(s)
- Xueqi Gong
- Reproductive Medicine Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology1095 Jiefang Avenue, Wuhan 430030, China
| | - Hemei Li
- Reproductive Medicine Center, Department of Gynecology and Obstetrics, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology26 Shengli Avenue, Wuhan 430014, China
| | - Yiqing Zhao
- Reproductive Medicine Center, Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology1095 Jiefang Avenue, Wuhan 430030, China
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Jiang Q, Wu T, Zhang Y, Wang S, Wang L, Su W, Lin M, Li X. Case Report: A Rare Case of Coexisting of Autoimmune Polyglandular Syndrome Type 3 and Isolated Gonadotropin-Releasing Hormone Deficiency. Front Immunol 2021; 12:734685. [PMID: 34594339 PMCID: PMC8476964 DOI: 10.3389/fimmu.2021.734685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/30/2021] [Indexed: 12/03/2022] Open
Abstract
APS (autoimmune polyglandular syndrome) is defined as the coexistence of at least two kinds of endocrine autoimmune diseases. APS type 3 comprises autoimmune thyroid diseases and other autoimmune diseases but does not involve autoimmune Addison’s disease. So far, APS-3 combined with isolated gonadotropin-releasing hormone (GnRH) reduction caused by the suspected autoimmune hypothalamic disease has not been reported. We recently received a 43-year-old woman with a one-year history of Graves’ disease (GD) and a four-month history of type 1 diabetes presented with hyperthyroidism and hyperglycemia. After the GnRH stimulation test, she was diagnosed with secondary amenorrhea attributed to suspected autoimmune Hypothalamitis and APS type 3 associated with Graves’ disease and Latent Autoimmune Diabetes (LADA). According to this case, the hypothalamus cannot be spared from the general autoimmune process. It is recommended to carry out the GnRH stimulation test when encountering APS patients combined with secondary amenorrhea.
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Affiliation(s)
- Qiuhui Jiang
- The School of Clinical of Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Ting Wu
- The School of Clinical of Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Yuxian Zhang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Shunhua Wang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Liying Wang
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Weijuan Su
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, Xiamen Diabetes Institute, Fujian Key Laboratory of Translational Research for Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
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Rossetti R, Moleri S, Guizzardi F, Gentilini D, Libera L, Marozzi A, Moretti C, Brancati F, Bonomi M, Persani L. Targeted Next-Generation Sequencing Indicates a Frequent Oligogenic Involvement in Primary Ovarian Insufficiency Onset. Front Endocrinol (Lausanne) 2021; 12:664645. [PMID: 34803902 PMCID: PMC8600266 DOI: 10.3389/fendo.2021.664645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/22/2021] [Indexed: 01/12/2023] Open
Abstract
Primary ovarian insufficiency (POI) is one of the major causes of female infertility associated with the premature loss of ovarian function in about 3.7% of women before the age of 40. This disorder is highly heterogeneous and can manifest with a wide range of clinical phenotypes, ranging from ovarian dysgenesis and primary amenorrhea to post-pubertal secondary amenorrhea, with elevated serum gonadotropins and hypoestrogenism. The ovarian defect still remains idiopathic in some cases; however, a strong genetic component has been demonstrated by the next-generation sequencing (NGS) approach of familiar and sporadic POI cases. As recent evidence suggested an oligogenic architecture for POI, we developed a target NGS panel with 295 genes including known candidates and novel genetic determinants potentially involved in POI pathogenesis. Sixty-four patients with early onset POI (range: 10-25 years) of our cohort have been screened with 90% of target coverage at 50×. Here, we report 48 analyzed patients with at least one genetic variant (75%) in the selected candidate genes. In particular, we found the following: 11/64 patients (17%) with two variants, 9/64 (14%) with three variants, 9/64 (14%) with four variants, 3/64 (5%) with five variants, and 2/64 (3%) with six variants. The most severe phenotypes were associated with either the major number of variations or a worse prediction in pathogenicity of variants. Bioinformatic gene ontology analysis identified the following major pathways likely affected by gene variants: 1) cell cycle, meiosis, and DNA repair; 2) extracellular matrix remodeling; 3) reproduction; 4) cell metabolism; 5) cell proliferation; 6) calcium homeostasis; 7) NOTCH signaling; 8) signal transduction; 9) WNT signaling; 10) cell death; and 11) ubiquitin modifications. Consistently, the identified pathways have been described in other studies dissecting the mechanisms of folliculogenesis in animal models of altered fertility. In conclusion, our results contribute to define POI as an oligogenic disease and suggest novel candidates to be investigated in patients with POI.
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Affiliation(s)
- Raffaella Rossetti
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
- *Correspondence: Raffaella Rossetti, ; Luca Persani,
| | - Silvia Moleri
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
| | - Fabiana Guizzardi
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
- Molecular Biology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Davide Gentilini
- Bioinformatics and Statistical Genomics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Libera
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
| | - Anna Marozzi
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Costanzo Moretti
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Francesco Brancati
- Medical Genetics, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Human Functional Genomics, IRCCS San Raffaele Pisana, Rome, Italy
| | - Marco Bonomi
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Luca Persani
- Department of Endocrine and Metabolic Diseases and Lab of Endocrine and Metabolic Research, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
- *Correspondence: Raffaella Rossetti, ; Luca Persani,
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12
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Okawa ER, Gardner R, Feltmate C, Hirsch MS, Craig JW, Chan YM. An Unusual Cause of Secondary Amenorrhea in an Adolescent: Expanding the Differential. J Endocr Soc 2020; 4:bvaa159. [PMID: 33241170 PMCID: PMC7672807 DOI: 10.1210/jendso/bvaa159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
Secondary amenorrhea is not uncommon in the adolescent female population. There are multiple etiologies to consider, and a comprehensive evaluation is often pursued. Sometimes, however, despite a thorough workup, the diagnosis remains unclear. Here, we report an unusual cause of secondary amenorrhea in a 15-year-old girl. Our patient presented with secondary amenorrhea after a 4-year history of regular menstrual cycles. Her evaluation was notable for very low FSH and low estradiol but normal LH; pregnancy, adrenal, thyroid, prolactin studies, and brain magnetic resonance imaging scan did not reveal a cause of her amenorrhea. Her transabdominal ultrasound showed an enlarged right ovary, initially suggestive of a hemorrhagic cyst. Inhibin A and B were measured because of the persistently low FSH; these were found to be very elevated, concerning for an inhibin-producing tumor. The patient had surgical removal of her right ovary; pathology revealed a juvenile granulosa-cell tumor. Postoperatively, the patient had normalization of serum inhibin A and B and resumption of normal menstrual cycles. This report illustrates that careful consideration of laboratory findings and other studies is essential for correctly identifying the underlying cause of secondary amenorrhea, particularly when the results are not consistent with common causes of this condition.
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Affiliation(s)
- Erin R Okawa
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Roxanne Gardner
- Department of Gynecology, Boston Children's Hospital, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Colleen Feltmate
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Gynecologic Oncology, The Dana Farber Cancer Institute, Boston, Massachusetts
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey W Craig
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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13
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Mayama M, Umazume T, Watari H, Nishiguchi S, Moromizato T, Watari T. Frequency of night shift and menstrual cycle characteristics in Japanese nurses working under two or three rotating shifts. J Occup Health 2020; 62:e12180. [PMID: 33211393 PMCID: PMC7676323 DOI: 10.1002/1348-9585.12180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/15/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES In Japan, the prevalence of irregular menstrual cycles and its association with the frequency of night shifts have scarcely assessed. The present study aimed to evaluate the relationship between irregular menstrual cycles and the frequency of night shifts in Japanese female nurses. METHODS We conducted a cross-sectional web-based self-administered questionnaire survey in 2019. An irregular menstrual cycle was defined as a cycle length of ≤21 days or ≥39 days at least a few times over the past year or amenorrhea for at least 3 months. We used Poison regression analysis with a robust error variance to calculate the prevalence ratios adjusted for age, body mass index, hospital size, and the department in which they worked. RESULTS A total of 1249 women were included, and 679 (54.4%) and 195 (15.6%) of them worked under two and three rotating shifts. The prevalence of irregular menstrual cycles was 24.8%, 37.4%, and 35.9% in the no night, two rotating, and three rotating shifts groups, respectively. While the frequency of night shifts had a dose-responsive relationship with irregular menstrual cycles in the two rotating shifts group, it was not observed in the three rotating shifts group. However, the risk of work getting affected by dysmenorrhea or premenstrual symptoms increased in the three rotating shifts group. CONCLUSIONS Over 30% of Japanese female nurses working under night shifts had irregular menstrual cycles. The high frequency of night shifts increased the risk of irregular menstrual cycles and secondary amenorrhea in the two rotating shifts group.
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Affiliation(s)
- Michinori Mayama
- Department of Obstetrics and GynecologyHokkaido University Graduate School of MedicineSapporoJapan
| | - Takeshi Umazume
- Department of Obstetrics and GynecologyHokkaido University Graduate School of MedicineSapporoJapan
| | - Hidemichi Watari
- Department of Obstetrics and GynecologyHokkaido University Graduate School of MedicineSapporoJapan
| | - Sho Nishiguchi
- Department of General Internal MedicineShonan Kamakura General HospitalKamakuraJapan
| | - Takuhiro Moromizato
- Renal & Rheumatology DivisionInternal Medicine DepartmentOkinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaru‐choJapan
| | - Takashi Watari
- Post Clinical Training CenterShimane University HospitalIzumoJapan
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14
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Abstract
The treatment of persistent uterine bleeding in those patients who identify as transmasculine or nonbinary is often straightforward, but can be difficult in a subset of patients. This article reviews the physiology of the normal menstrual cycle and the hormonal influences on the endometrium, and then explores options for the treatment of persistent bleeding for people both already on testosterone and for those who are either not ready for or who do not desire testosterone.
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Affiliation(s)
- Jeremi M. Carswell
- Department of Medicine, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Stephanie A. Roberts
- Department of Medicine, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
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15
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Shelkovnikova NV, Neimark AI, Taranina TS, Pichigina AK, Molodyh OP, Lushnikova EL. Pathogenic Features of Dysuria in Young Women with Secondary Amenorrhea Caused by Body Weight Loss. Bull Exp Biol Med 2016; 162:191-194. [PMID: 27909963 DOI: 10.1007/s10517-016-3573-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Indexed: 10/20/2022]
Abstract
We examined 11 women aged 19-26 years (mean age 22.5±3.5 years) with secondary amenorrhea complaining frequent urination over 1.5 years and repeatedly, but unsuccessful treated for overactive bladder and chronic cystitis. The rare cause of sustained urination disorders in young female patients of reproductive age was established: development of secondary amenorrhea caused by weight loss ("cosmetic" amenorrhea) with subsequent estrogene deficit and urogenital atrophy. Morphological examination of the bladder mucosa, an important clue to the diagnosis, helps to identify the true cause of dysuria, urogenital atrophy of the bladder mucosa, in secondary ("cosmetic") amenorrhea, and determine future course of etiopathogenic treatment of sustained dysuria in young women. The treatment is often effective in case of proper and timely diagnosis and the absence of irreversible changes.
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Affiliation(s)
- N V Shelkovnikova
- Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russia
| | - A I Neimark
- Altay State Medical University, Ministry of Health of Russian Federation, Barnaul, Russia
| | - T S Taranina
- Altay State Medical University, Ministry of Health of Russian Federation, Barnaul, Russia
| | - A K Pichigina
- Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russia
| | - O P Molodyh
- Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russia
| | - E L Lushnikova
- Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russia.
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16
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Dursun F, Mohamoud HSA, Karim N, Naeem M, Jelani M, Kırmızıbekmez H. A Novel Missense Mutation in the CLPP Gene Causing Perrault Syndrome Type 3 in a Turkish Family. J Clin Res Pediatr Endocrinol 2016; 8:472-477. [PMID: 27087618 PMCID: PMC5198008 DOI: 10.4274/jcrpe.2717] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Perrault syndrome (PRLTS) is a heterogeneous group of clinical and genetic disorders characterized by sensory neuronal hearing loss in both sexes and premature ovarian failure or infertility in females. Neurological and hearing loss symptoms appear early in life, but female infertility cannot be detected before puberty. Spastic limbs, muscle weakness, delayed puberty and irregular menstrual cycles have also been observed in PRLTS patients. Mutations in five genes, i.e. HSD17B4, HARS2, CLPP, LARS2, and C10orf2, have been reported in five subtypes of PRLTS. Here, we report a milder phenotype of PRLTS in a Turkish family in which two affected patients had no neurological findings. However, both were characterized by sensory neuronal hearing loss and the female sibling had secondary amenorrhea and gonadal dysgenesis. Genome-wide homozygosity mapping using 300K single-nucleotide polymorphism microarray analysis together with iScan platform (Illumina, USA) followed by candidate gene Sanger sequencing with ABI 3500 Genetic Analyzer (Life Technologies, USA) were used for molecular diagnosis. We found a novel missense alteration c.624C>G; p.Ile208Met in exon 5 of the CLPP at chromosome 19p13.3. This study expands the mutation spectrum of CLPP pathogenicity in PRLTS type 3 phenotype.
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Affiliation(s)
- Fatma Dursun
- Ümraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Hussein Sheikh Ali Mohamoud
- King Abdulaziz University, Princess Al-Jawhara Albrahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia
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St. George’s University of London, Human Genetics Research Centre, Division of Biomedical Sciences, London, United Kingdom
| | - Noreen Karim
- Quaid-I-Azam University Faculty of Biological Sciences, Medical Genetics Research Laboratory, Department of Biotechnology, Islamabad, Pakistan
| | - Muhammad Naeem
- Quaid-I-Azam University Faculty of Biological Sciences, Medical Genetics Research Laboratory, Department of Biotechnology, Islamabad, Pakistan
| | - Musharraf Jelani
- King Abdulaziz University, Princess Al-Jawhara Albrahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia
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Khyber Medical University, Institute of Basic Medical Sciences, Department of Biochemistry, Medical Genetics and Molecular Biology Unit, Peshawar, Pakistan
| | - Heves Kırmızıbekmez
- Ümraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey, Phone: +90 216 632 18 18 E-mail:
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17
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Perdhana R, Sutrisno S, Sugiri YJ, Baktiyani SCW, Wiyasa A. Patients with secondary amenorrhea due to tuberculosis endometritis towards the induced anti-tuberculosis drug category 1. Pan Afr Med J 2016; 24:121. [PMID: 27642459 PMCID: PMC5012722 DOI: 10.11604/pamj.2016.24.121.9709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/12/2016] [Indexed: 11/23/2022] Open
Abstract
Tuberculosis (TB) is a disease which can affect various organs, including human's genital organs such as the endometrium. Tuberculosis endometritis can cause clinical symptoms of secondary amenorrhea and infertility. Infertility in genital TB caused by the involvement of the endometrium. The case presentation is 33-year-old woman from dr. Saiful Anwar Public Hospital to consult that she has not menstruated since 5 years ago (28 years old). The diagnosis was done by performing a clinical examination until the diagnosis of secondary amenorrhea due to tuberculosis endometritis is obtained. A treatment by using category I of anti-tuberculosis drugs was done for 6 months, afterward an Anatomical Pathology observation found no signs of the tuberculosis symptoms. Based on that, patient, who was diagnosed to have secondary amenorrhea due to tuberculosis endometritis, has no signs of tuberculosis process after being treated by using category I of anti-tuberculosis drugs for 6 months.
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Affiliation(s)
- Raditya Perdhana
- Obstetrics and Gynecology Department, Medical Faculty, University of Brawijaya, Malang, Indonesia; Saiful Anwar Public Hospital, Malang
| | - Sutrisno Sutrisno
- Obstetrics and Gynecology Department, Medical Faculty, University of Brawijaya, Malang, Indonesia; Saiful Anwar Public Hospital, Malang
| | - Yani Jane Sugiri
- Saiful Anwar Public Hospital, Malang; Pulmonology Department, Medical Faculty, University of Brawijaya, Malang, Indonesia
| | - Siti Candra Windu Baktiyani
- Obstetrics and Gynecology Department, Medical Faculty, University of Brawijaya, Malang, Indonesia; Saiful Anwar Public Hospital, Malang
| | - Arsana Wiyasa
- Obstetrics and Gynecology Department, Medical Faculty, University of Brawijaya, Malang, Indonesia; Saiful Anwar Public Hospital, Malang
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