Pediatric emergency medicine trisk 1012 1012
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Adrenal Disorders
Nonclassical congenital adrenal hyperplasia is a rare cause of oligomenorrhea
associated with hyperandrogenism. Though the patient may have signs of
clitoromegaly on physical examination, it is usually indistinguishable clinically
from PCOS and can be excluded by a normal 17-hydroxyprogesterone level in the
morning during the follicular phase of the menstrual cycle. Other rare causes of
oligomenorrhea, including Cushing disease and ovarian and adrenal tumors,
should be suspected in patients with hirsutism accompanied by signs of
glucocorticoid excess, or with rapidly developing, more severe virilization (malepattern baldness, deepening of the voice, clitoromegaly), and in those with
testosterone levels above 200 ng per dL.
HYPOTHALAMIC–PITUITARY AXIS DISORDERS
Caloric Insufficiency
Patients who have insufficient caloric intake to meet energy expenditure have an
“energy drain” and commonly may experience oligomenorrhea or amenorrhea.
There are various reasons why caloric intake may not be adequate: chronic
diseases with increase metabolic rate, intestinal malabsorption problems,
malnutrition and starvation due to unavailable food stores, or purposeful
avoidance of food, such as in patients with eating disorders and in those who
participate in high endurance sports or those where aesthetics, weight restriction
(wrestling), or low body fat are perceived by the athlete coaches or parents
necessary for success such as ballet, figure skating, gymnastics, and long-distance
running or endurance events for example.
Both leptin and ghrelin have been implicated as signals to the hypothalamic–
pituitary system concerning overall energy balance. Regardless of the etiology of
caloric insufficiency, the body’s response is the same, shunting energy
expenditure away from reproductive functions.
Accordingly, in assessing the nonpregnant adolescent with oligomenorrhea,
one should inquire routinely about recent weight loss, chronic illness, behaviors
characteristic of disordered eating, a restrictive eating pattern, and strenuous
exercise . Many amenorrhoeic women who are athletes restrict their food intake;
amenorrhea, disordered eating, and decreased bone mineral density together is a
phenomenon known as “the female athletic triad.”
Hyperprolactinemia
