528 obstetrics and Gynecology Board review •••
❍ A 32-year-old patient develops amenorrhea status post a D & E for a septic abortion. Her transvaginal
ultrasound revealed the findings as below. What is the diagnosis?
Asherman syndrome (thick intrauterine adhesions and calcifications)
❍ The absence of secondary sexual characteristics indicates that a woman has never been exposed to what?
Estrogen stimulation.
❍ What laboratory tests should you consider in a patient with primary amenorrhea who does not have a uterus?
Karyotype and serum testosterone (Müllerian abnormality with 46XX karyotype with normal testosterone versus
androgen insensitivity syndrome (AIS) with 46XY karyotype and male serum testosterone levels).
❍ What laboratory tests should you consider in a patient with primary amenorrhea who DOES have a uterus?
Human chorionic gonadotropin (hCG), thyroid-stimulating hormone (TSH), prolactin (PrL), progestin
challenge, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).
❍ When should an MRI be ordered in cases of primary amenorrhea?
For symptoms of visual changes, headache, or hypogonadotropic hypogonadism.
❍ What is the differential diagnosis of vaginal agenesis?
Congenital absence of the vagina (with or without uterine structures)
Androgen insensitivity
Transverse septum
Imperforate hymen
17 a-hydroxylase deficiency (46XY with complete male pseudohermaphroditism).
❍ In primary amenorrhea, if FSH is elevated and no breast development is present, what is the diagnosis?
Gonadal dysgenesis (50% of primary amenorrhea cases). Check karyotype next.
❍ What is the first test that should be ordered in a patient with 2∞ amenorrhea?
Pregnancy test.