Pediatric emergency medicine trisk 1013 1013
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Hyperprolactinemia occurs in approximately 25% of adult women with
secondary amenorrhea but is a much less common cause of oligomenorrhea in
adolescents. Nevertheless, the possibility of hyperprolactinemia must be
considered in all adolescents with oligomenorrhea because only 40% to 50% of
hyperprolactinemic patients have spontaneous or expressible galactorrhea.
Hyperprolactinemia can be a side effect of several commonly used medications
(see Table 51.3 ). A pituitary adenoma is a rare, but important cause of
hyperprolactinemia. In one retrospective review of teenagers with pituitary
adenomas, over 50% of the females presented with either oligomenorrhea or
secondary amenorrhea. Other central nervous system tumors should also be
considered as a potential cause for hyperprolactinemia. The occasional patient
with galactorrhea but with a normal prolactin level should be reevaluated
periodically in an effort to identify a treatable cause of the problem.
Ovarian Disorders
Ovarian failure in adolescents may be caused by primary or acquired etiologies.
Primary ovarian failure most commonly is due to gonadal dysgenesis from
genetic causes, most commonly Turner syndrome. Secondary causes of premature
ovarian failure include sequelae of chemotherapy, pelvic irradiation, or
autoimmune disease. Ovarian tumors or other hormone-secreting tumors may
result in ovarian failure. Endometrial destruction that results from overly
vigorous curettage or pelvic tuberculosis is an exceedingly rare cause of
oligomenorrhea.
Thyroid Disorders
Hypothyroidism and hyperthyroidism can both produce menstrual irregularities.
The provider who sees a female patient presenting with either infrequent bleeding
or excessive bleeding should have hypothyroidism and hyperthyroidism on the
differential diagnosis. It can be beneficial to send thyroid studies (TSH) from the
emergency department.
Miscellaneous
Among adolescents who do not have overt signs of PCOS, hyperprolactinemia, or
malnutrition, suppression of the hypothalamic–pituitary axis is the most common
cause of oligomenorrhea that occurs more or persists for at least 2 years after
menarche. Although oligomenorrhea in otherwise normal-appearing adolescents
has historically been ascribed to psychosocial stressors (family disruption,
moving, depression), many patients with apparently psychogenic menstrual
irregularity prove on careful evaluation to have disordered eating patterns or
