[Hypergonadotropic secondary amenorrhea: clinical analysis of 126 cases].
OBJECTIVE
To study the etiology and early diagnosis of hypergonadotropic amenorrhea and to explore the appropriate treatment for preserving their reproductive function.


METHODS
126 cases of secondary amenorrhea with serum follicular stimulating hormone (FSH) levels > or = 40 IU/I, were analysed. Their clinical manifestations, karyotypes, ovarian morphology and histology, reproductive hormone assays, and responses to estrogen therapy and ovulation induction were studied.


RESULTS
6 cases presented with histories of ovarian surgery, radiotherapy or chemotherapy. Among the other 120 cases, 18 manifested amenorrhea before or at 25 years of age, 102 developed amenorrhea after age 25. In the former group, 16 (88.9%) showed unilateral or bilateral gonadal dysgenesis, and the other 2(11.1%) were defined as resistant ovaries. Abnormalities of sex chromosome karyotype occurred in 44.4% (8/ 18). In the latter group, 68 underwent laparotomy or laparoscopy examination. Morphological and histological examinations of both ovaries showed atrophic ovaries in all cases accompanied by 30.9% (21/ 68) unilateral gonadal dysgenesis; sex chromosomal abnormality was found in only one with no sexual immaturation. The efficacy of estrogen treatment was significantly better among cases with amenorrhea less than 1 year as compared with those longer than 1 year. Clomiphene challenge test given to 8 cases during their irregular menstrual stages produced an elevation of FSH levels to > 20 IU/I. without any response of estradiol secretion.


CONCLUSIONS
The earlier estrogen therapy is initiated, the greater possibility of pregnancy will be achieved in cases suffering from hypergonadotropic amenorrhea. The clomiphene challenge test may provide evidence of waning ovarian function for early diagnosis.
Lin
J
J
Obstet and Gynecol Hospital of the Shanghai Medical University.
Yu
C
C
D000328:Adult; D000568:Amenorrhea / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D002996:Clomiphene; D015914:Estrogen Replacement Therapy; D005260:Female; D005300:Fertility Agents, Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D011247:Pregnancy; D012729:Sex Chromosome Aberrations / Q000097:blood; D012730:Sex Chromosomes
D005300:Fertility Agents, Female; D002996:Clomiphene; D005640:Follicle Stimulating Hormone