Women's Corner
Women's Corner
1) Priorities : Exclude life threathening conditions as malignancy .
2) History :
Confirm Delayed puberty : age
Type of delayed puberty : whether with or without secondary sexual characters
Detect an etiology :
- Family history of consanguinity
- Past history of head trauma or meningitis
- Manifestations of increased intracranial pressure
- History suggestive of hypothyroidism
- Nutritional history, growth and development
3) Examination :
1. General :
- Weight, height and span : normally the span is 5 cm from the height. If the difference is greater this means premature closure of the epiphysis . Upper/lower body segments is 1.7 at birth , 1 on adults and 0.9 in negros .
Tall or normal Short
Hypogonado- GnRh deficiency / Kallman syndrome Laurance Moon Biedl syndrome
tropic Weight loss and excercise Levi lorain syndrome
Hyperprolactinemia Hypothyroidism
CNS tumors
Hypergonado- Gonadal agensis (XX or XY [Swyer]) Turner syndrome
tropic Mixed gonadal dysgenesis True hermaphroditism
Ovarian failure (radio or chemotherapy or Galactose defeciency)
Eugonadotropic Imperforate hymen, AIS, MRKH synd.
- Ocular : fundus and field examination for increased intracranial tension
- Neck : Webbing neck and thyroid for goiter
- Breast : for galactorrhea , shield breast and widely spaced nipples and Tanner staging
- Skin : Axillary hair , skin pigmentation (extrapigmented nevi in gonadal dygenesis or acanthosis nigricans in PCO) and manifestations of virilization
- Bony : Increased muscle mass in virilization and increased carrying angle in Turner .
- Nose for sense of smell
2. Abdominal :
- Abdominal masses
- Pubic hair for Tanner staging .
3. Pelvic :
- Inguinal or labial masses : ectopic testis or hernias
- Abnormality of the external genitalia
· Inadequate estrogenic stimulation i.e infantile in Turner, Levi Lorain
· Labioscrotal fusion
· Clitromegaly
· Vaginal
- Bimanual abdominorectal examination for adenxal masses, uterus and hematocolpos
4) Investigations :
1. Confirm delayed puberty and its type :
a. Hormonal assays : Basal gonadotropin is the first step :
- High levels points out to Hypergonadotropism (FSH > 40 mU/ml) .
- Low gonadotropin indicates Hypogondotropism (LH and FSH < 6 mU/ml)
b. Imaging X-ray for estimation of the bone age :
- Retarded : ovarian failure
- Normal : normal or tall
N.B. bone age may be retarded in hypothyroidism
2. To reach an etiology :
a. Hormonal studies :
1. Estradiol levels : if increased suggests an estrogen secreting ovarian neoplasm
2. Androgen levels :
- Testosterone : points to a a virilizing ovarian tumor
- DHAS : points to an adrenal cause
- 17 hydroxylase : high in CAH
3. Thyroid functions
4. Serum prolactin
b. Imaging :
- Head CT or MRI and
- US on the abdomen and the uterus .
- IVP to detect urinary anomalies with MRKH syndrome
c. karyotyping .
dr. Hisham Al-Inany Lecturer in Obstetrics and Gynecology Department, Cairo University, Egypt Dr. Amr Hussein Lecturer in Obstetrics and Gynecology Department, Cairo University, Egypt