中国医科大学妇产科学英文课件 Amenorrhea & InfertilityPPT资料.pptx

中国医科大学妇产科学英文课件 Amenorrhea & InfertilityPPT资料.pptx

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Nothingspecialnoted.,Case2,Patient:

Womanage30Complaint:

Nomenstruation;

Hotandsweating.Presenthistory:

Normalmenstrualcycle.IUDremoval8monthago.Amountofbleedinginthefollowingmenstruationwasmarkedlyreduced,andtherewasnobleedingforthesecondcycle.Shewasputonasequentialtherapywithestrogensandprogesterone,butnowithdrawalbleedingwasnoted.Twomonthsagoshestartedtofeelhotandsweatinginparticularinthemorningandthesymptomswasgettingworse.Pasthistory:

Marriedatage25.Pregnant2monthsaftermarriage,hadanartificialabortionat46days.AnIUDwasinsertedthen.,Amenorrhea（闭经）,Definitions,Primaryamenorrhea（原发闭经）:

Noperiodsbyage16Noperiodsbyage14withnosecondarysexchangesNoperiodsby2yearsafterthestartofsecondarysexchangesSecondaryamenorrhea（继发闭经）:

Absenceofnormalmenstruationinapatientwithpreviouslyestablishedcycles.Atanyagewhenmenseshaveceasedformorethan6monthsorlongerthanthetotallengthofthreepreviousmenstrualcycles,ProblemsassociatedwithamenorrheaInfertility（duetoanovulation）Osteoporosisandatrophyofthereproductivetract（duetolowlevelofestrogen）Endometrialcancer（duetoprolongedstimulationbyestrogen）Psychologicalproblemsinadolescents,Definitions,Primaryamenorrhea,Differentiationoftheprimitivegonads（原始性腺）startsat6weeks.Ychromosomeencodesthetestisdeterminingfactor（TDF）formationoftestis（睾丸）Mesonephricduct/Wolffianduct（中肾管）malereproductivetract:

vasdeference（输精管）,epididymis（附睾）,ejaculatoryduct（射精管）andseminalvesicle（精囊）Paramesonephricduct/Mullerianduct（副中肾管）fallopiantubes,uterus,vagina（upper1/3）,Primaryamenorrhea,EtiologyGeneticcausesDevelopmentalabnormality1.Presenceofsecondarysexcharacteristics,EtiologyMullerianagenesissyndrome（米勒管发育不全综合征）Mayer-Rokitansky-Kuster-HausersyndromeKaryotype:

46,XXNormalovary,fallopiantubes,absenceofuterusandvaginaNormalFSHNormalsecondarysexcharacteristics,Primaryamenorrhea,Primaryamenorrhea,EtiologyAndrogeninsensitivitysyndrome（雄激素不敏感综合征）Testicularfeminization（睾丸女性化）Karyotype:

46,XYPresenceoftestiswithnormalproductionofEs&

TsNoandrogenreceptorsintargetend-organsPresenceofsecondarysexcharacteristics（incomplete）Novaginaanduterus,Primaryamenorrhea,EtiologySavagesyndrome（对抗性卵巢综合征）Resistantovarysyndrome（卵巢不敏感综合征）Karyotype:

46,XXPresenceofovarywithprimordialandprimaryfolliclesNogonadotropinreceptorsFSHNearnormalsecondarysexcharacteristics,EtiologyCongenitalabnormalitiesinthelowerreproductivetractImperforatehymen（处女膜闭锁）Transversevaginalseptum（阴道横隔）（3）Absenceoflower1/3vagina,Primaryamenorrhea,Etiology2.AbscenceofsecondarysexcharacteristicsHypogonadotropichypogonadism（低促性腺激素性性腺功能减退）1）Kallmannssyndrome（嗅觉缺失综合征）CongenitalabsenceofGnRHsecretionaccompaniedbyanosmia（嗅觉丧失）orhyposmia（嗅觉减退）Karyotype:

46,XXNormaldifferentiationofinternalsexorgansNosecondarysexcharacteristics,Primaryamenorrhea,Etiology2）Hypergonadotropichypogonadism（高促性腺激素性性腺功能减退）

（1）Congenitalgonadaldysgenesis（先天性性腺发育不全综合征）Turnerssyndrome（特纳综合征）Karyotype:

45,XO（60%）;

45,XO/46,XX;

45,XO/47,XXX.FSH&

LHEstrogensManifestations:

Femalephenotypebutpoorlydevelopedsexorgans,shortstature,webbedneck,mentallyretarded,Primaryamenorrhea,Etiology

（2）46,XXpuregonadaldysgenesis（46,XX单纯性腺发育不全）Streakgonad（条索状性腺）,Primaryamenorrhea,46,XYpuregonadaldysgenesis/Swyersyndrome（46,XY单纯性腺发育不全）TestisdevelopmentTestosterone&

MIFTestosteroneDevelopmentofmesonephricductMalereproductivetractMIFDevelopmentofparamesonephricductDevelopmentoffemalereproductivetractManifestations:

Femalephenotype,gonadotropins&

estrogens,notwell-developedsexorgans,streakgonad（条索状性腺）containingLeydigcells,Primaryamenorrhea,1/3chromosomalabnormalitiesKaryotyping（核型分析）46,XY:

testicularfeminizationpuregonadaldysgenesisFor46,XXwithnormalpelvicexaminationProgestinwithdrawaltestandFSHNobleeding,FSH:

Gonadaldysgenesis,ovarianfailureNobleeding,FSH/:

HypogonadotripichypogonadismCentralnervoussystemtumorortraumaBleeding:

CongenitaladrenogenitalsyndromeFeminizingovariantumor,Diagnosisofprimaryamenorrhea,Diagnosisofprimaryamenorrhea,Normalbreast,normaluterus:

SimilartothatofsecondaryamenorrheaNormalbreast,pooruterus:

TestosteroneandKaryotyping46,XX&

femalelevelofT:

Mulleriandysgenesis46,XY&

malelevelofT:

AndrogeninsensitivityPoorbreast,pooruterus:

Karyotyping46,XX:

Congenitalabsenceofuterus46,XY:

PuregonadaldysgenesisPoorbreast,normaluterus:

Karotyping&

FSHFSH:

Gonadaldysgenesis（e.g.Turnerssyndrome）FSH/:

Hypothalamusorpituitarygland,SecondaryAmenorrhea,CentralnervoussystemHypothalamus55%Pituitary20%Ovary20%,Uterus5%OutflowtractMenses,GnRH,FSH,LH,Estrogen,progesterone,Etio