Pituitary amenorrhea

1- Sheehan syndrome;
– Ischemic necrosis of anterior pituitary after spasm in its arterioles.
– Caused by severe hemorrhage and shock (usually postpartum).
– Manifestations:
* Impaired pituitary functions;
– Lactogenic → Failure of lactation (1st presentation),
– Gonadotrophic → amenorrhea, genital atrophy,
– Thyrotrophic, corticotrophic and somatotrophic.
* Hypothyroidism → bradycardia, intolerance to cold, constipation.
* Adrenocortical failure → No axillary sweating,
Loss of axillary and pubic hair,
Decrease skin pigmentation.
Hypotension and loss of weight.
♦ Simmond’s disease:
– Loss of all anterior pituitary function,
– Due to any cause (Not only postpartum haemorrhage),
– In either sex (Not only in female).
– Treatment: HRT:
* Cortisone and thyroxin for life (ACTH and TSH may be tried).
* HMG (Contain FSH and LH) for induction of ovulation.

2- Frohlich’s syndrome:
* It is hypothalamo- pituitary disorder, so discussed with both.
3- Empty sella syndrome;
– Defect in Diaphragm sella → cerebrospinal fluid and pia herniates into the pituitary fossa
producing → compression atrophy of the pituitary gland.
– The result is hypopituitarism with amenorrhea (↓↓ gonadotropins) and galactorrhea?!! (↓PIF)
– This is documented by CT scan and air encephalogram.
– Treatment: Hormone replacement therapy.
4- Pituitary infantilism “Levi-Lorain syndrome”:
– 1ry amenorrhea.
– Low level of growth hormone and gonadotropins,
– Arrest of growth and hypogonadism (infantilism).
5- Lawrence Moon Biedle syndrome:
– As Frohlich’s syndrome, plus
– Limb anomalies e.g. Polydactyly or syndactyly,
– Mental retardation, &
– Blindness (retinitis pigmentosa).
6- Pituitary adenomas;
* Prolactin producing adenoma;
– Tumor arising from PRL secreting cells.
– One of amenorrhea- galactorrhea syndromes.
– Micro-adenoma is < 10 mm diagnosed only by MRI or CT.
– Macro-adenoma is > 10 mm may cause optic atrophy.
* Chromophobe adenoma;
– Tumor arising from Chromophobe cells.
– Pressure atrophy of hormone producing cells.
– Amenorrhea, optic atrophy and distorted sella turcica on X-ray,
*Forbes syndrome: (rare);
– Prolactin producing chromophobe adenoma.
– Amenorrhea- galactorrhea manifested.
– A small sized uterus without history of pregnancy.
* Acidophil adenoma;
– Tumor arising from GH secreting cells.
– Excessive growth hormone manifestations (gigantism or acromegaly).
– Amenorrhea results from destructed gonadotrophes.
* Basophil adenoma;
– Tumor arising from ACTH secreting cells.
– Excessive ACTH production (Cushing syndrome);
– Trunkal obesity, mild hirsutism,
– Tendency to diabetes and hypertension.
– Amenorrhea results from destructed gonadotrophes.
* Treatment of pituitary adenomas:
– Prolactin secreting adenoma:
a- Medical treatment e.g. Bromocriptine.
b- Surgical removal if drug resistant or causing field changes.
– Other pituitary adenomas are treated by hypophysectomy.

Pituitary amenorrhea videos

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Amenorrhea and Pituitary amenorrhea , a simple, handwritten explanation and full lecture of causes and treatment of amenorrhea and Pituitary amenorrhea for medical students taking USMLE. Discussing Amenorrhea and Pituitary amenorrhea signs and symptoms as well as treatment for amenorrhea and Pituitary amenorrhea.

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In this video I discuss the basic physiology of the menstrual cycle and the mechanism behind the most common causes of amenorrhea like pregnancy, PCOS, premature ovarian failure, Asherman syndrome, stress, prolactinoma, hypothyroidism, Turner syndrome, Kallmann syndrome, Pituitary amenorrhea and others. I targeted this presentation toward fellow medical students, nursing students, health care professionals, and curious laymen. In part 2, I discuss the diagnostic approach to patients with amenorrhea. I hope you find this helpful.

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Undergraduate course lectures in Obstetrics&Gynecology .Prepared by Dr Manal Behery .Professor of OB&Gyne Faculty of medicine ,Zagazig University

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