••• Chapter 53^ Amenorrhea^531
❍ At what age is premature ovarian failure diagnosed?
<40 years old.
❍ What percentage of women are diagnosed with premature ovarian failure?
1%.
❍ What other testing should be considered in a patient with premature ovarian failure?
This is often associated with autoimmune diseases. Check thyroid and adrenal antibodies, TSH, T4, calcium,
phosphorus, and fasting glucose. Also, consider fragile X testing and genetic counseling.
❍ What is the next test that should be performed in a patient with premature ovarian failure whose brother
has a severe learning disability and suffered from recurrent otitis media as a child?
FMr1 gene testing. There is an association between fragile X premutation carriers (characterized by 55 to
200 CGG repeats) and premature ovarian failure. Up to a third of premutation carriers have an early menopause.
❍ What other rare conditions are associated with premature ovarian failure?
Hypoparathyroidism.
Moniliasis.
Myasthenia gravis.
Idiopathic thrombocytopenic purpura.
rheumatoid arthritis.
Vitiligo.
Autoimmune hemolytic anemia.
❍ What is the treatment of hypergonadotropic hypogonadism?
Cyclic estrogen and progestin therapy.
❍ In addition to estrogen and progesterone, individuals with 17a-hydroxylase deficiency need what?
Corticosteroid replacement.
❍ What is the cause of premature ovarian failure?
The cause is probably accelerated follicular atresia. However, the etiology of this accelerated atresia is unknown. In
addition, it can be due to an autoimmune process, infections, or a physical insult such as radiation or chemotherapy.
❍ What infection is a cause of premature ovarian failure?
Mumps oophoritis
❍ Lymphocytic infiltrate surrounding secondary and antral follicles but not primordial follicles is the
hallmark for diagnosis of what cause of premature ovarian failure?
Autoimmune oophoritis.
❍ A positive test for what antibodies is sufficient to establish a diagnosis of autoimmune ovarian failure?
Anti-adrenal antibodies and 21-hydroxylase antibodies.