While a prolactinoma is indeed consistent with this picture and a difficult fertility history, the most likely reason for amenorrhea, even in a patient with such a long history of infertility. Specific therapy depends on underlying etiology references 1. Secondary amenorrhea is different from primary amenorrhea. Women usually present with amenorrhea and galactorrhea. The aim was to formulate practice guidelines for the diagnosis and treatment of hyperprolactinemia. Galactorrheaamenorrhea due to primary hypothyroidism. Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. Amenorrhoea of pituitary origin serum prl interpretation action prolactinoma, your doctor may recommend. Both women spontaneously ovulated and conceived, and normal pregnancies resulted. The most common cause of amenorrhea in women of childbearing. In women who previously experienced regular menstrual cycles, secondary amenorrhea. The treatment for amenorrhea depends on the underlying cause, as well as the health status and goals of the individual. Pituitary causes of amenorrhea constitute approximately 18% of cases of secondary amenorrhea but only approximately 7% of cases of primary amenorrhea.
Primary amenorrheaoligomenorrhea due to prolactinomas in. From 1972 to 1980,210 patients underwent transsphenoidal operation for removal of a prolactinsecreting tumor. A prolactinoma is almost always benign, meaning it is not a cancer. The primary activity of prolactin is its lactotrophic effect on the epithelium of. Two women who presented with amenorrheagalactorrhea and hyperprolactinemia associated with xray evidence of pituitary enlargement and suprasellar extension were found to have primary hypothyroidism. Mar 11, 2020 once physiological causes such as pregnancy, systemic disorders such as primary hypothyroidism and the use of drugs with dopamine antagonistic actions such as metochlopramide have been ruled out, the most common cause of hyperprolactinemia is a prlsecreting pituitary adenoma or prolactinoma. Hypothalamic amenorrhea weight loss exercise 35% 4. Galactorrhea amenorrhea due to primary hypothyroidism. Two women who presented with amenorrhea galactorrhea and hyperprolactinemia associated with xray evidence of pituitary enlargement and suprasellar extension were found to have primary hypothyroidism. Prolactinoma california center for pituitary disorders.
The tumor causes the pituitary to produce too much prolactin leading to hyperprolactinemia. Primary amenorrhea due to pituitary disease cancer. Primary amenorrhoea usually the result of a genetic or anatomical abnormality all causes of secondary amenorrhoea can present as primary nb sheehans. Giant prolactinoma and primary amenorrhea with an infantile uterus. Magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Up to 50% of competitive runners training 80 miles per week and up to 44% of ballet dancers have amenorrhea. About 1 in 10,000 people will develop a prolactinoma for which a clear cause is not known. If a female of reproductive age fails to menstruate for 6 consecutive months, it is called the secondary amenorrhea. Normal levels are less than 500 miul milliinternational units per litre23. Prolactinoma cause of 20% of secondary amenorrhoea prolactin can be raised by stress, sleep, exerciserepeat if elevated. Discussion the present case of pgaii in a 23yearold patient is rare because of the presence of primary amenorrhea associated with hyperprolactinemia at a level consistent with concentrations found commonly in prolactinomas 365.
Jun 01, 20 amenorrhea can be caused by previous central nervous system infection, trauma, or autoimmune destruction of the pituitary. In human reproduction, pathological hyperprolactinemia most commonly presents as an ovulatory disorder and is often associated with secondary amenorrhea or oligomenorrhea. Primary amenorrhoea is defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics such as breast development, or by years of age in girls with no. Recent reflections david a grainger md, mph february 1, 2017. Prolactinomas represent approximately 40% of all pituitary adenomas, with a female preponderance. Being overweight or severely underweight can affect your menstrual cycle. Pituitary gland introduction the pituitary gland is a crucial structure in the hypothalamic pituitarygonadal axis and plays an integral role in sexual maturation during puberty 1. Difference between amenorrhea and menopause compare the. Prolactinoma high moderate adrenal hyperandrogenism or pcos rule out tumor pelvic ultrasound. In a retrospective study of 104 patients with hyperprolactinemia ages 30 to 44 years, the most commonly reported symptoms were infertility, headache, and. Breast development requires lower levels of estrogens, while uterus and endometrium require higher level of estrogens. We report two cases of adolescents with mullerian agenesis that presented to a tertiary adolescent medicine center with primary amenorrhea and the. Hyperprolactinemia may not be detected until after discontinuation of an oral contraceptive.
Postpartum amenorrhoeagalactorrhoea associated with. A prolactinoma is an abnormal growth, or tumor, on the pituitary gland. Evaluation of primary amenorrhea bmj best practice. Primary amenorrhea and pseudoprolactinoma in a patient with primary hypothyroidism.
Amenorrhoea is the absence or cessation of menstruation. If not pregnant, patients should undergo imaging studies looking for a uterus and gonads. The task force consisted of endocrine societyappointed experts, a methodologist, and a medical writer. The major effect is decreased levels of some sex hormones estrogen in women and testosterone in men. Although overlapping attributes exist between the two groups, the diagnostic approaches vary significantly. Prolactinoma is the commonest adenoma seen in the pituitary gland. Primary hypothyroidism consider eating disorder abnormal tsh. Prolactinoma as a cause of primary amenorrhea in a 16yearold girl. Hyperprolactinemia and pituitary causes of amenorrhea. Pat i e n t i n f o r m at i o n pituitary society. The pathophysiology of amenorrhea in the adolescent neville h. Attention should also be given to features suggesting alternative diagnoses, such as galac torrhea, headache, or visual changes suggesting possible prolactinoma or other pituitary tumor and symptoms of thyroid dysfunction or other chronic medical conditions.
Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age. Primary amenorrhea, which by definition is failure to reach menarche. Blood tests can detect the overproduction of prolactin and whether levels of other hormones controlled by the pituitary are within the normal range. In such patients, it is imperative that primary hypothyroidism be excluded before drug or surgical therapy for presumed prolactinoma is undertaken. A mildly elevated serum prolactin level may be due to a nonfunctioning pituitary adenoma or craniopharyngioma compressing the pituitary stalk, but high prolactin levels are commonly associated with a prolactin secreting prolactinoma. Prolactinomas were diagnosed in four patients with primary amenorrhea and five patients with primary oligomenorrhea. May 12, 2018 prolactinoma is a condition in which a noncancerous tumor adenoma of the pituitary gland in your brain overproduces the hormone prolactin. If primary or secondary amenorrhea is caused by lifestyle factors, your health care provider may suggest changes in the areas below. The primary purpose of this study was to determine the frequency of subtle menstrual disturbances, defined as luteal phase defects lpd or anovulation, in exercising women, with menstrual cycles.
Amenorrhea and amenorrhea resources what is amenorrhea. Prolactinoma as a cause of primary amenorrhea in a 16. Primary amenorrhea and pituitary adenomas fertility and sterility. Giuseppina facciolli, gaetano lombardi, prolactinomas in children and adolescents. The present case of pgaii in a 23yearold patient is rare because of the presence of primary amenorrhea associated with hyperprolactinemia at a level consistent with concentrations found commonly in prolactinomas 365. The index patient with prolactinoma had normal breast development, but small uterus, which suggests that she has been exposed to estrogen, albeit at lower concentrations. Article in polish benskowronek i1, szewczyk l, witkowski d. Hyperprolactinemia 20%, not incl brst feeding breastfeeding hypothyroid prolactinoma.
Primary amenorrhea and pseudo prolactinoma in a patient with primary hypothyroidism. Approximately 15% of these women have abnormal genital examination, with mullerian agenesis being the second most frequent cause. Patients with primary amenorrhea from pituitary dysfunction have a normal uterus. Premenopausal women hyperprolactinemia in premenopausal women causes hypogonadism, with symptoms that include infertility, oligomenorrhea, or amenorrhea and less often galactorrhea.
Marked regression of the invasive prolactinoma after one year of therapy with cabergoline. In premenopausal women, the elevated prolactin causes suppression of lh and fsh, then estrogen and progesterone levels, resulting in irregular or complete cessation of menses amenorrhea. About 1 in 10,000 people will develop a prolactinoma for. Secondary amenorrhea testing indications for testing amenorrhea with negative pregnancy test order. Physical examination o assess sexual development tanner staging o height and weight chart the results o arm span normal within 5 cm of height. Amenorrhea is the transient or permanent absence of menstrual flow and may be subdivided into primary and secondary presentations, relative to menarche. All females presented with primary or secondary amenorrhea. Primary amenorrhea can result from two main causes. Webmd tells you what you need to know about a prolactinoma, a type of pituitary gland tumor that can cause missed periods, low sex drive, vision problems, and more. Prolactinoma kallmann syndrome female athlete triadoverexercise eating disorders.
Although prolactinoma isnt lifethreatening, it can impair your vision, cause infertility and. In amenorrheic women, the levels of female reproductive hormones are not sufficient to stimulate menstruation. Secondary amenorrhea occurs when youve had at least one menstrual period and you stop menstruating for three months or longer. Primary amenorrhea normal secondary sexual development blind ending vagina. The pathophysiology of amenorrhea in the adolescent. Absence of periods during 26 months called oligomenorrhea. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she has previously had oligomenorrhoea. Nov 30, 2015 magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Primary care physicians are frequently faced with the challenge of evaluating primary amenorrhea in adolescent girls. Located at the base of the brain, the pituitary is a peasized gland that controls the production of many hormones. Prolactin levels can increase because of medications, pituitary adenoma, hypothyroidism.
Men may present with sexual dysfunction, hypogonadism, and sometimes gynecomastia, all related to. Amenorrhea is the absence of periods menstrual bleeding for more than 6 months. Women of childbearing age also will have a pregnancy test. A 19yearold girl with primary amenorrhea, galactorrhea, and hyperprolactinemia is described. If a girl fails to menstruate by the age of 16 years, it is called the primary amenorrhea. Amenorrhea, galactorrhea, andor pituitary enlargement may be the principal manifestations of primary hypothyroidism.
Clinical manifestations, evaluation and management of. At a glance approximately 1% of women of reproductive age experience secondary amenorrhea, cessation of menses. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she. Current evaluation of amenorrhea health science center. Primary care clinicians commonly have experience in managing some of the underlying causes of amenorrhoea, such as chronic illness, eating disorders, and exercise or stressassociated amenorrhoea, so cks recommend that these conditions can be safely managed in primary care once other causes have been excluded. Giant prolactinoma and primary amenorrhea with an infantile. Amenorrhea is called primary when a woman has not started to menstruate by the age of 16 years, while secondary amenorrhea refers to the abnormal cessation of menstruation in a woman who previously has had menstrual cycles. This evidencebased guideline was developed using the grading of recommendations, assessment, development, and evaluation grade system to. Prolactinoma robert goldstone, md prolactinsecreting pituitary adenoma, or prolactinoma, is the most common type of secretory pituitary tumor. The most common pituitary cause of amenorrhea is hyperprolactinemia constituting 80% of all pituitary causes of secondary amenorrhea and approximately 15% of cases of secondary amenorrhea due to any cause.
Prolactinoma as a cause of primary amenorrhea in a 16year. They appear to arise independently out of the pituitary gland itself and are not related in. Amenorrhea is the absence of menstruation and it is classified into two categories as primary and secondary amenorrhea. Carlson division of adolescent medicine, stanford university school of medicine, mountain view, california, usa menstrual irregularity is a common occurrence during adolescence, especially within. A prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactin prl is an anterior pituitary hormone which has its principle physiological action in initiation and maintenance of lactation. Hyperprolactinemia without an identified cause requires imaging of the hypothalamicpituitary area. Primary amenorrhea, which by definition is failure to reach menarche failure of menses to occur by age 16, is often the result of chromosomal irregularities leading to primary ovarian insufficiency e. Prolactin signals a womans breasts to produce milk during pregnancy and breastfeeding. Reversal of clinical, biochemical, and radiologic abnormalities with levothyroxine. Turner syndrome, mullerian agenesis, hypothalamic amenorrhea, and primary ovarian insufficiency were excluded by laboratory and radiologic. Jul 25, 2017 amenorrhea is the absence of menstruation and it is classified into two categories as primary and secondary amenorrhea.