Amenorrea Primaria

Descripción General

Definición

• No hay menstruación a los LOS Neisseria 15 años a pesar de la presencia de crecimiento normal y características sexuales secundarias.
• A los LOS Neisseria 13 años no se desarrollan caracteres sexuales secundarios.
• Las características sexuales secundarias incluyen:
  • Desarrollo mamario
  • Vello axilar
  • Vello púbico

Fisiología normal

Las hormonas del eje hipotálamo-hipófisis-ovario y toda la anatomía pertinente deben estar presentes y funcionar para que una niña tenga su primera menstruación.

• Revisión de la fisiología normal:
  • El hipotálamo libera la hormona liberadora de gonadotropina (GnRH) → estimula a la hipófisis para que libere la hormona foliculoestimulante ( FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle) y la hormona luteinizante ( LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle) → el ovario libera estrógeno y progesterona.
  • Estrógeno y progesterona:
    • Producidos por los LOS Neisseria folículos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum desarrollo dentro del ovario
    • El estrógeno estimula el crecimiento del endometrio.
    • La progesterona madura y estabiliza el endometrio (producido solo después de la ovulación).
    • Ambos ↓ al final del ciclo → la pérdida de hormonas “estabilizadoras” ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum particular la progesterona) desencadena el fluido menstrual.
• Orígenes estructurales:
  • Cresta genital → gónadas primordiales → testículos u ovarios
  • Conductos müllerianos (conductos paramesonéfricos) → trompas de Falopio, útero, cuello uterino y 1/3 proximal de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy
  • Seno urogenital → 2/3 distales de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy
  • Conductos de Wolff (conductos mesonéfricos) → epidídimo, conductos deferentes y vesículas seminales
• Proceso de diferenciación del sexo:
  • Presencia de la región determinante del sexo del gen del cromosoma Y (SRY) → gónadas primordiales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum testículos, que secretan:
    • Hormona antimülleriana ( AMH AMH A glycoprotein that causes regression of mullerian ducts. It is produced by sertoli cells of the testes. In the absence of this hormone, the mullerian ducts develop into structures of the female reproductive tract. In males, defects of this hormone result in persistent mullerian duct, a form of male pseudohermaphroditism. Primary Amenorrhea, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés), también llamada sustancia inhibidora de la mülleriana → estimula la regresión de los LOS Neisseria conductos müllerianos.
    • Testosterona → estimula la virilización de los LOS Neisseria conductos de Wolff en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el epidídimo, los LOS Neisseria conductos deferentes y las vesículas seminales.
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ausencia del gen SRY, las gónadas primordiales se convierten en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ovarios.
    • Sin testículos que produzcan altas cantidades de AMH AMH A glycoprotein that causes regression of mullerian ducts. It is produced by sertoli cells of the testes. In the absence of this hormone, the mullerian ducts develop into structures of the female reproductive tract. In males, defects of this hormone result in persistent mullerian duct, a form of male pseudohermaphroditism. Primary Amenorrhea, los LOS Neisseria conductos müllerianos persisten → se desarrollan las trompas de Falopio, el útero, el cuello uterino y la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy proximal.
    • Las pacientes con anomalías müllerianas suelen tener un eje hipotálamo-hipófisis-ovario normal, ovarios normales y genitales femeninos externos normales.

Etiología y Fisiopatología

Etiologías hipotalámicas e hipofisarias

• Fisiopatología:
  • Si la GnRH no se libera o la liberación es disfuncional:
    • No se libera FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle ni LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle de la hipófisis.
    • No hay estimulación ovárica.
    • No hay producción de estrógenos.
    • No hay proliferación endometrial.
    • Esto hace HACE Altitude Sickness que no haya menstruación.
• Amenorrea hipotalámica funcional:
  • Estrés
  • Falta de nutrición:
    • Trastornos de la conducta alimentaria
    • Hambre
  • Exceso de ejercicio (común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las atletas)
• Hipogonadismo hipogonadotrópico idiopático:
  • Una familia de trastornos genéticos que provocan la deficiencia o los LOS Neisseria defectos de la GnRH
  • Síndrome de Kallmann: hipogonadismo hipogonadotrópico idiopático con anosmia Anosmia Complete or severe loss of the subjective sense of smell. Loss of smell may be caused by many factors such as a cold, allergy, olfactory nerve diseases, viral respiratory tract infections (e.g., COVID-19), aging and various neurological disorders (e.g., Alzheimer disease). Cranial Nerve Palsies
• Retraso constitucional de la pubertad:
  • Retraso global de la pubertad
  • Poco frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las niñas (diagnóstico de exclusión)
  • Difícil de distinguir de hipogonadismo hipogonadotrópico idiopático
• Hiperprolactinemia:
  • El ↑ de prolactina puede suprimir la liberación de GnRH.
  • Generalmente se presenta como amenorrea secundaria, pero puede presentarse como primaria.
  • Medicamentos implicados:
    • Antipsicóticos
    • Antidepresivos tricíclicos
    • Metoclopramida
  • A menudo causada por adenomas hipofisarios
  • Un mecanismo similar puede resultar del hipotiroidismo primario y central: ↑ hormona liberadora de tiroides (TSH) → ↑ liberación de prolactina.
• Enfermedad sistémica:
  • Las enfermedades graves pueden ↓ GnRH.
  • Ejemplos:
    • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus de tipo 1
    • Enfermedad celíaca
    • Enfermedad inflamatoria intestinal
• Enfermedades infiltrativas:
  • Sarcoidosis Sarcoidosis Sarcoidosis is a multisystem inflammatory disease that causes noncaseating granulomas. The exact etiology is unknown. Sarcoidosis usually affects the lungs and thoracic lymph nodes, but it can also affect almost every system in the body, including the skin, heart, and eyes, most commonly. Sarcoidosis
  • Hemocromatosis
• Neoplasia/masa selar:
  • Craneofaringioma
  • Germinoma
  • Histiocitosis de células de Langerhans

Etiologías ováricas/gonadales

• Fisiopatología:
  • Los LOS Neisseria ovarios, los LOS Neisseria ovocitos o los LOS Neisseria folículos son anormales.
  • No hay ovocitos/folículos sanos → no hay estrógenos ni progesterona → no hay estimulación endometrial → no hay menstruación.
• Disgenesia gonadal:
  • Cuando las gónadas no se forman correctamente y no segregan hormonas sexuales
  • Síndrome de Turner (45,X o formas de mosaico): Los LOS Neisseria ovarios son sustituidos por tejido fibrótico.
  • Disgenesia gonadal 46,XX: Resulta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cintillas ováricas no funcionales.
  • Síndrome de Swyer (46,XY), fallo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el desarrollo testicular que provoca la ausencia de:
    • Testosterona → No se desarrollan las estructuras de Wolff.
    • AMH AMH A glycoprotein that causes regression of mullerian ducts. It is produced by sertoli cells of the testes. In the absence of this hormone, the mullerian ducts develop into structures of the female reproductive tract. In males, defects of this hormone result in persistent mullerian duct, a form of male pseudohermaphroditism. Primary Amenorrhea → Persisten las estructuras müllerianas.
• Insuficiencia ovárica prematura:
  • Menopausia clínica a < 40 años
  • A menudo se presenta como amenorrea secundaria, pero puede presentarse como primaria
  • Causas:
    • Premutación de FMR1 (gen que causa el síndrome X frágil)
    • Quimioterapia
    • Radioterapia
    • Ooforitis autoinmune

Etiologías uterinas y vaginales

• Fisiopatología: ausencia u obstrucción del útero y/o de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy
• Agenesia mülleriana (síndrome de Mayer-Rokitansky-Küster-Hauser):
  • Resulta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ausencia completa de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy con un desarrollo uterino variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables.
  • El útero puede estar ausente o ser rudimentario con algo de endometrio funcional
  • Los LOS Neisseria ovarios suelen estar presentes y ser funcionales:
    • El eje hipotálamo-hipófisis-ovario está intacto → se produce estrógeno.
    • Las mamas se desarrollan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pubertad.
  • Los LOS Neisseria genitales externos femeninos son normales.
• Obstrucción del flujo vaginal:
  • Tabique vaginal transversal
  • Himen imperforado

Otras etiologías hormonales

• Fisiopatología: interferencia hormonal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el eje hipotálamo-hipófisis-ovario
• Síndrome de ovario poliquístico (SOP):
  • Amenorrea más ↑ niveles de andrógenos
  • La foliculogénesis es anormal → los LOS Neisseria ovocitos no son ovulatorios → no se produce progesterona → no hay menstruación.
  • Generalmente se presenta como amenorrea secundaria, pero raramente puede presentarse como primaria.
• Síndrome de insensibilidad completa a los LOS Neisseria andrógenos:
  • Trastorno recesivo ligado al AL Amyloidosis X que se observa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos 46,XY
  • Los LOS Neisseria testículos, que fabrican la sustancia inhibidora mülleriana, están presentes → provoca la regresión de las trompas de Falopio, el útero y la parte superior de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy.
  • La mutación da lugar a receptores de andrógenos defectuosos → los LOS Neisseria pacientes son resistentes a la testosterona (que tiende a estar ↑↑).
  • La testosterona es incapaz de virilizar las estructuras wolffianas o los LOS Neisseria genitales externos → fenotipo femenino.
  • ↑ Testosterona se convierte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum estrógeno → las mamas se desarrollan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pubertad.
• Hiperplasia suprarrenal congénita:
  • Las mutaciones genéticas provocan deficiencias en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las enzimas necesarias para la biogénesis de los LOS Neisseria esteroides.
  • Resulta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niveles ↑ de andrógenos → afecta a la ovulación.

Presentación Clínica y Diagnóstico

Presentación

• Ausencia de menstruación a los LOS Neisseria 15 años a pesar de un desarrollo puberal normal.
• Debe realizarse una evaluación si no hay menstruación a los LOS Neisseria 13 años en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ausencia de características sexuales secundarias.
• Otras manifestaciones dependen de la etiología subyacente.

Examen físico

• Evaluar los LOS Neisseria signos de los LOS Neisseria caracteres sexuales secundarios:
  • Desarrollo de las mamas → indica la exposición a los LOS Neisseria estrógenos.
  • Vello axilar y vello púbico (vello sexual) → indican exposición a la testosterona.
  • Hirsutismo → exceso de andrógenos
• Examen pélvico:
  • Búsqueda de una obstrucción del flujo de salida
  • Presencia o ausencia de útero y vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy
  • Los LOS Neisseria genitales ambiguos sugieren un trastorno de la diferenciación sexual.

Consideraciones diagnósticas

• Para recordar el diagnóstico diferencial de la amenorrea primaria, piense en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Qué puede fallar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cada nivel del eje hipotálamo-hipófisis-ovario.
  • Qué puede fallar anatómicamente.
• El desarrollo de las mamas y el vello sexual significa la exposición a los LOS Neisseria estrógenos y la testosterona, lo que indica que:
  • El eje hipotálamo-hipófisis-ovario está intacto.
  • Las gónadas son funcionales.
• No hay mamas ni vello sexual → indica que no hay exposición a hormonas sexuales:
  • El defecto se encuentra a nivel del ovario o por encima de él.
  • Excepción: presencia de mamas, pero sin vello sexual → sospecha de síndrome de insensibilidad completa a los LOS Neisseria andrógenos

Evaluación

Empiece evaluando 4 puntos:

1. ¡Descarte el embarazo! (Prueba de embarazo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum orina)
2. Niveles de prolactina, hormona estimulante del tiroides (TSH) y tiroxina ( _{T4 T4 The major hormone derived from the thyroid gland. Thyroxine is synthesized via the iodination of tyrosines (monoiodotyrosine) and the coupling of iodotyrosines (diiodotyrosine) in the thyroglobulin. Thyroxine is released from thyroglobulin by proteolysis and secreted into the blood. Thyroxine is peripherally deiodinated to form triiodothyronine which exerts a broad spectrum of stimulatory effects on cell metabolism. Thyroid Hormones}):
   • ↑ Prolactina → hiperprolactinemia
   • ↓ O nivel normal de TSH con ↓ _{T4 T4 The major hormone derived from the thyroid gland. Thyroxine is synthesized via the iodination of tyrosines (monoiodotyrosine) and the coupling of iodotyrosines (diiodotyrosine) in the thyroglobulin. Thyroxine is released from thyroglobulin by proteolysis and secreted into the blood. Thyroxine is peripherally deiodinated to form triiodothyronine which exerts a broad spectrum of stimulatory effects on cell metabolism. Thyroid Hormones} → hipotiroidismo central
   • ↑ TSH con ↓ T₄ → hipotiroidismo primario
3. Presencia de un útero y una vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy:
   • Examen pélvico y ultrasonido
   • RM para casos más complejos
   • Si la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy es anormal → examinar bajo anestesia; manejo quirúrgico:
     • Tabique transversal
     • Himen imperforado
   • Si el útero está ausente → pedir cariotipo y medición de testosterona para buscar:
     • 46,XX: agenesia mülleriana → testosterona normal
     • 46,XY: síndrome de insensibilidad completa a los LOS Neisseria andrógenos → ↑ testosterona
4. Nivel de FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle (con presenica de útero):
   • ↑ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle = el problema está en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria ovarios, los LOS Neisseria cuales no responden a la FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle (pero el hipotálamo y la hipófisis son probablemente normales).
     • Insuficiencia ovárica primaria
     • Síndrome de Turner → confirmar con cariotipo
   • ↓ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle = el problema está en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cerebro:
     • Amenorrea hipotalámica funcional (estrés, desnutrición, exceso de ejercicio)
     • Enfermedad sistémica (celíaca, diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus tipo 1, enfermedad inflamatoria intestinal)
     • Síndrome de Kallmann
     • Deficiencia congénita de GnRH
     • Considere la posibilidad de hacer una resonancia magnética para descartar una masa selar.

Tratamiento

El tratamiento depende de la etiología y suele estar dirigido a corregir el problema hormonal o anatómico subyacente.

• Medidas generales:
  • Resolver problemas médicos o de estrés
  • Aumento de peso o ↓ intensidad del ejercicio (amenorrea hipotalámica funcional)
• Terapia médica:
  • Terapia de reemplazo hormonal: Garantiza una exposición adecuada a los LOS Neisseria estrógenos para mantener la salud cardiovascular y ósea.
  • Terapia antiandrogénica (espironolactona)
• Cirugía:
  • Corrección de lesiones anatómicas congénitas
  • Extirpación de gónadas anormales: Las pacientes tienen riesgo de neoplasia (e.g., tumores de células germinales, gonadoblastomas)
• Considere las implicaciones de la fertilidad:
  • GnRH pulsátil
  • Fecundación in vitro
• Consejería:
  • Fertilidad
  • Problemas de diferenciación sexual
  • Trastornos de la conducta alimentaria