![Secondary Amenorrhoea:- I have already written up to secondary amenorrhoea causes 'Ovarian factors'. So today going to start from next point; that's [C]Pituitary factors:- {(1) Adenoma (Prolactinoma), (2) Cushing's disease(3) Acromegaly}:-Micro adenoma usually associated with hyper prolactinaemia. It either inhibits ovarian steroid genesis directly or inhibits pituitary gonadotrophin release. {(4) Sheehan’s syndrome(5) Simmond's disease(unrelated to pregnancy)}:-There is partial or complete destruction of the pituitary by ischemia caused by venous thrombosis following severe postpartum haemorrhage and shock. The principal hormones affected are growth hormone, gonadotrophins, TSH, Adriano corticotrophins and prolactin. [D](1)(Psychogenic shock, stress, anorexia nervosa, strenuous exercise, pseudo cyesis, etc):- Inhibit the release of GnRH or affect dopamine metabolism. There is low level of oestrogen and LH but FSH level remains normal. {(2) Congenital malformation (3)Trauma:-Accidents; surgery or radiotherapy(4)Infection:-Tubercular or sarcoid granulomas, (5)Tumours:-Craniopharyngioma, meningioma}:-Lead to hypogonadotrophic hypogonadism. There may be hyperprolactinaemia due to altered dopamine inhibition. Tumours of the hypothalamus or pituitary need surgical excision or radiotherapy. [E]Adrenal factors:-(1)Adrenal tumour or hyperplasia :- Androgen excess opposes the effect of oestrogen on the endometrium. (2)Cushing syndrome [F] Thyroid factors:-Hypothyroid state:-Raised TSH and hyperprolactinaemia by direct action of TRH on the galactophore cells in the pituitary. [G]General disease:-Malnutrition, tuberculosis, chronic nephritis, diabetes, etc.:-Probably affecting the hypothalamopituitary ovarian axis. [I]Iatrogenic:-(1)Contraceptive pills(post pill amenorrhoea ):-Suppression of GnRH release. (2) Psychotrophic phenothiazine derivative drugs :-Dopamine receptor blocking agents raise the prolactin level. (3) Antihypertensive drugs like reserpine or dopamine antagonists:-Dopamine depleting agents raise the prolactin level. Common Causes of Secondary Amenorrhoea:-(A)Hypothalamus:-Stress, Post pill, Sudden change in weight :-either too much less or too much gain, Psychotrophic & antihypertensive drugs. (B)Pituitary:-Adenoma, Sheahan's (C)Ovary :-PCOS, Premature ovarian failure (D)Uterine:-synechiae. (E)Systemic:- Malnutrition, Hypothyroid state, Diabetes. (Next part will upload at Part 8](https://4.bp.blogspot.com/-XcQkzbNOkjA/W3KHJRBwejI/AAAAAAAACek/osaJ-XU66DcdaYzCILbLxQx7xbwDGKt_gCLcBGAs/s1600/Untitled-13.jpg "web")
Secondary Amenorrhoea:- I have already written up to secondary amenorrhoea causes ‘Ovarian factors’. So today going to start from next point; that’s
[C] Pituitary factors:- {(1) Adenoma (Prolactinoma), (2) Cushing’s disease(3) Acromegaly}:-Micro adenoma usually associated with hyper prolactinaemia. It either inhibits ovarian steroid genesis directly or inhibits pituitary gonadotrophin release. {(4) Sheehan’s syndrome(5) Simmond’s disease(unrelated to pregnancy)}:-There is partial or complete destruction of the pituitary by ischemia caused by venous thrombosis following severe postpartum haemorrhage and shock. The principal hormones affected are growth hormone, gonadotrophins, TSH, Adriano corticotrophins and prolactin.
[D] (1) (Psychogenic shock, stress, anorexia nervosa, strenuous exercise, pseudo cyesis, etc):- Inhibit the release of GnRH or affect dopamine metabolism. There is low level of oestrogen and LH but FSH level remains normal. {(2) Congenital malformation (3)Trauma:-Accidents; surgery or radiotherapy(4)Infection:-Tubercular or sarcoid granulomas, (5)Tumours:-Craniopharyngioma, meningioma}:-Lead to hypogonadotrophic hypogonadism. There may be hyperprolactinaemia due to altered dopamine inhibition. Tumours of the hypothalamus or pituitary need surgical excision or radiotherapy.
[E]Adrenal factors:- (1)Adrenal tumour or hyperplasia :- Androgen excess opposes the effect of oestrogen on the endometrium. (2)Cushing syndrome
[F] Thyroid factors:-Hypothyroid state:-Raised TSH and hyperprolactinaemia by direct action of TRH on the galactophore cells in the pituitary.
[G]General disease:-Malnutrition, tuberculosis, chronic nephritis, diabetes, etc.:-Probably affecting the hypothalamopituitary ovarian axis.
[H] Iatrogenic:-(1)Contraceptive pills (post pill amenorrhoea ):-Suppression of GnRH release. (2) Psychotrophic phenothiazine derivative drugs :-Dopamine receptor blocking agents raise the prolactin level. (3) Antihypertensive drugs like reserpine or dopamine antagonists:-Dopamine depleting agents raise the prolactin level.
Common Causes of Secondary Amenorrhoea:-(A)Hypothalamus:-Stress, Post pill, Sudden change in weight :-either too much less or too much gain, Psychotrophic & antihypertensive drugs. (B)Pituitary:- Adenoma, Sheahan’s (C) Ovary:- PCOS, Premature ovarian failure (D) Uterine:-synechiae. (E) Systemic:- Malnutrition, Hypothyroid state, Diabetes.
(Next part will upload at Part 8
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DR PRIYANKA BAISYA
