USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

GYN TRIAD

Imperforate Hymen

The origins of primary amenorrhea can be multiple; the two main categories are
anatomic (e.g., vaginal agenesis/septum, imperforate hymen, or Müllerian
agenesis) and hormonal (e.g., complete androgen insensitivity, gonadal
dysgenesis [Turner syndrome], or hypothalamic-pituitary insufficiency).

Clinical Approach—Preliminary Evaluation

Breasts Present/Uterus  Absent Müllerian    Agenesis(46,XX) Androgen    Insensitivity(46,XY)

Uterus  absent? Idiopathic MIF

Estrogen    from? Ovaries Testes

Pubic   hair? Present Absent

Testosterone    level? Female Male

Primary amenorrhea

(+) breasts and uterus

Normal  height  and weight

Are breasts present or  absent? A   physical    examination will    evaluate

secondary   sexual  characteristics (breast development,    axillary    and pubic   hair,

growth).    Breasts are an  endogenous  assay   of  estrogen.   Presence    of  breasts

indicates   adequate    estrogen    production. Absence of  breasts indicates

inadequate  estrogen    exposure.

Is  a   uterus  present or  absent? An  ultrasound  of  the pelvis  should  be

performed   to  assess  presence    of  a   normal  uterus.