Outpatient analytic assessment of anorexia nervosa — the importance of venous blood gases / Avaliação laboratorial em ambulatório na anorexia nervosa: a importância da gasometria venosa

ABSTRACT Objective: To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. Methods: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. Results: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). Conclusions: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

RESUMO Objetivo: Avaliar a evolução laboratorial, particularmente da gasometria venosa, na anorexia nervosa (AN), correlacionando os achados com parâmetros clínicos. Métodos: Estudo retrospetivo com adolescentes com AN seguidos em ambulatório, entre janeiro de 2014 e maio de 2017. Foram comparadas três avaliações: (t1) primeira consulta; (t2) consulta com escore Z de índice de massa corpórea (IMC) mais baixo; e (t3) consulta com escore Z de IMC mais elevado. Resultados: Incluídos 24 adolescentes, 87,5% do sexo feminino, idade média de apresentação de 14,9±1,7 anos, início dos sintomas 6,4±3,2 meses antes da primeira consulta. Em t1, escore Z de IMC de -1,91±1,11 kg/m2 e % de peso ideal de 84,3±9,2. Tinham amenorreia 88%. Em t2 as alterações laboratoriais encontradas foram: gasometria venosa alterada em 100%, ferritina alterada (72% elevada), função tiroideia alterada (53% com diminuição da tiroxina), dislipidemia (31% com elevação de lipoproteína de alta densidade, 25% com hipercolesterolemia), elevação da ureia (25%), elevação da alanina aminotransferase (14%), hipoglicemia (14%) e anemia (9%). A acidose respiratória esteve presente em 91% em t1, 100% em t2 e 94% em t3. Verificou-se diminuição significativa entre t2 e t3 da pressão parcial de CO2 (pCO2) média (57,2 versus 53,6 mmHg; p=0,009) e HCO3 médio (30,0 versus 28,8 mEq/L; p=0,023). Conclusões: A acidose respiratória e o aumento da ferritina foram comuns nesse grupo. Acidose respiratória foi a alteração mais frequente, com variação significativa de pCO2 e HCO3 na fase de recuperação. A gasometria venosa deve ser considerada na avaliação laboratorial na AN, pois parece ser importante na avaliação da gravidade e monitorização da doença.

A case of primary amenorrhea with 46+XY genotype from Kashmir Valley.

Primary amenorrhea is one of the common reproductive disorder affecting females. It leads to the absence of menarche in the reproductive age group in females and/or complete absence of reproductive organs. There are many causes which lead to PA, including genetic aberrations which are the leading factors.

Chromosomal abnormalities and hormonal disorders of primary amenorrhea patients in Egypt.

Background: Primary amenorrhea is defined as the absence of menstruation and secondary sexual characteristics in phenotypic women aged 14 years or older. Hormonal disorders are main causes of primary amenorrhea. Common hormonal cause of primary amenorrhea includes pituitary dysfunction and absent ovarian function. The aim of this study was to estimate the incidence and types of chromosomal abnormalities in patients with primary amenorrhea in Egypt. Materials and Methods: Chromosomal analysis and hormonal assay were carried out on 223 patients with primary amenorrhea that were referred from different parts of Egypt to Cytogenetic laboratory of Genetic Unit, Children Hospital Mansoura University, from July 2008 to December 2010. FISH technique was carried out in some of cases to more evaluation. Results: The frequency of chromosomal abnormalities was 46 (20.63%) in primary amenorrhea patients. The chromosomal abnormalities can be classified into four main types. (1) The numerical abnormalities of the X chromosome were detected in 23 (50 %). (2) Structural abnormalities of the X chromosome were detected in 11 (23.91%). (3) Mosaicism of X chromosome was found in 10 (21.74%). (4) Male karyotype 46, XY was presented in 2 (4.35%). Conclusion: The present study showed that karyotype and FISH are necessary to detect the causes of primary amenorrhea. This study also revealed the incidence of chromosomal abnormalities in women with primary amenorrhea in Egypt is similar to that reported in previous literatures.

Prevalência de amenorreia em pacientes submetidas a tratamento quimioterápico / Prevalence of amenorrhea in patients submitted to chemotherapy

JUSTIFICATIVA E OBJETIVOS: A quimioterapia contra o câncer está associada à sequelas importantes em longo prazo, entre elas a falência reprodutiva. O objetivo deste estudo foi avaliar a prevalência de amenorreia e sintomas de climatério em mulheres em idade fértil submetidas a tratamento quimioterápico. MÉTODO: Foi realizado um estudo observacional transversal descritivo que abrangeu duas etapas: levantamento de prontuários e entrevista por telefone com as pacientes. RESULTADOS: Das 50 pacientes, 42 (84%) entraram em amenorreia durante ou após o tratamento. Destas, 24 não retornaram a menstruar após o término do tratamento (p = 0,044). Houve associação significante em relação ao uso de ciclofosfamida e adriamicina e a presença de amenorreia nas pacientes com diversos tipos de câncer (p = 0,007 e p = 0,009). Quanto aos sintomas de climatério, 7 pacientes apresentaram diminuição da libido, 22 ressecamento vaginal, 34 fogachos, 8 dispareunia e 16 ganho de peso durante o tratamento, sendo que em 18 casos não houve regressão dos sintomas. Apenas os sintomas de ressecamento vaginal e presença de fogachos apresentaram-se associados à amenorreia (p < 0,05). CONCLUSÃO: Observou-se elevada porcentagem de pacientes que entraram em falência ovariana após a quimioterapia, com consequente presença de sintomas de climatério. Demonstra-se a necessidade de informar às pacientes que serão submetidas a esse tipo de tratamento sobre a possibilidade de preservação da fertilidade.

BACKGROUND AND OBJECTIVES: Chemotherapy for cancer is associated with significant long-term sequelae, including reproductive failure. The objective of the study was to indentify the prevalence of amenorrhea and menopause symptoms in women after chemotherapy treatment. METHOD: It was performed a descriptive observational study composed by two stages: review of the medical records and interview by phone. RESULTS: From the 50 patients, 42 (84%) presented amenorrhea during or after the treatment. Twenty four patients of these patients do not have periods after the end of treatment (p = 0.044). A significant association regarding the use of cyclophosphamide and adriamycin and the presence of amenorrhea was observed in patients with various types of cancer (p = 0.007 and p = 0.009). As symptoms of menopause, seven patients had decreased libido, 22 had vaginal dryness, 34 flushing, and 8 had dyspareunia and 16 had weight gain during treatment, and in 18 cases there was regression of symptoms. Only the symptoms of vaginal dryness and the presence of hot flushes were associated with the presence of amenorrhea (p < 0.05). CONCLUSION: We observed that there were a high percentage of patients who entered in ovarian failure after chemotherapy, with consequent symptoms of menopause. It reinforces the necessity of inform patients that will undergo such treatment on the possibility of fertility preservation.

Differentials of post-partum amenorrhea: a survival analysis.

Post-partum amenorrhea is an important event for females' reproductive life and their health. It is the time period between the end of pregnancy and the resumption of menstruation after delivery, and it is considered to be the temporary infecundable period of women's reproductive life-span. The main aim of this article is to examine the differentials of post-partum amenorrhea by using current status reporting data according to the characteristics of the mother and her child. The data are utilized from a sample survey of Palpa and Rupandehi districts of western rural Nepal. A life-table based technique of survival analysis has been used. Important summary measures have been computed in order to see the differentials of duration of post-partum amenorrhea. The study revealed that parity of mothers, age of mothers, breast-feeding practices and survival status of the child were found to be the main differentials of the duration of post-partum amenorrhea. Amenorrhea period was found shorter for lower parity and younger mothers. Amenorrheic period was found to be increased with increased birth-interval and duration of breast-feeding practices. A strong positive association was found between the duration of post-partum amenorrhea and breast-feeding. The study also revealed that an inverse association was found between the duration of post-partum amenorrhea and socio-economic status of mothers. The survival status of the child showed a strong effect for the timing of amenorrhea. This study investigated the important differentials of amenorrhea by using current status reporting data according to the characteristics of mother and her child. The estimated values of mean, median and trimean duration of amenorrhea were compared. For instance, trimean of amenorrheic period was found to be 9.6 months while median was 8.4 months and mean was 10.4 months. This finding indicates that the trimean provided the most consistent and best estimates of the duration of amenorrhea than other averages. The trimean is the best measure if the data contain censored and open-ended class interval. Parity, age of mothers, survival status of child, breast-feeding practices and socio-economic status of mothers were found to be the main influencing factors for the timing of amenorrhea among rural Nepalese mothers. Although the coverage of the present study is limited to small areas as well as to a small sample size, it is expected that the findings may help in designing appropriate policies and programs for improving mothers' and children's health as well as for reducing the existing fertility level of a country.

Primary amenorrhea varied etiology

Investigation of primary amenorrhea is usually initiated by the age of 14 years if there is delayed puberty absent secondary sexual characteristics and absent menses, or no menstruation within 4 years of the onset of adrenarche and thelarche. We established diagnosis in our 3 cases on the basis of chromosomal analysis, hormonal analysis, diagnostic laparoscopy, and histopathological examination of the samples biopsied. We identified 3 varied etiologies

Prevalencia de patología endocrinológica: estudio retrospectivo en un centro de atención de adolescentes en Santiago / Prevalence of endocrinologycal pathology: retrospective study in a medical center of adolescents from Santiago

En el presente trabajo se estudia la prevalencia de patología endocrina en un grupo de mujeres adolescentes que acuden espontáneamente en un policlínico de ginecología. Se revisaron las fichas clínicas de todas las pacientes que consultaron durante el período de junio 1997 a agosto 1998 en el policlínico de ginecología infanto juvenil de CEMERA (Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente). Se evaluaron en total 170 jóvenes con edad promedio de 16 años y 6 meses. Se definió un grupo de 58 pacientes (34 por ciento) que tuvo sospecha clínica inicial de enfermedad endocrina, de este grupo hubo 46que hicieron exámenes complementarios (24 ecografía y 22 ecografía más perfil hormonal). Se confirmó el diagnóstico de patología endocrina en 39 pacientes (67 por ciento) destacando los diagnósticos de síndrome de ovario poliquístico (12), poliquistosis ovárica por ecografía (11), amenorrea hipotalámica (4), insulinorresistencia (6), patología tiroidea (3), anorexia/bulimia (2), hiperprolactinemia (1). Analizando la correlación entre presentación clínica y el hallazgo de enfermedad endocrina se encuentra como indicadores de patología la presencia de sobrepeso/obesidad (46 por ciento), ciclos menstruales irregulares (69 por ciento), amenorrea secundaria (25 por ciento), hiturismo/acné (34 por ciento), acantosis nigricans (12 por ciento) y bocio (8 por ciento). Se concluye que existe una alta prevalencia de enfermedades endocrinas en las pacientes adolescentes evaluadas. Los allazgos clínicos permiten la sospecha inicial con alto grado de certeza, lo que ayuda a orientar adecuadamente el estudio diagnóstico

Primary amenorrhoea: a retrospective study at Siriraj Hospital.

To determine the incidence of etiologic factors responsible for primary amenorrhoea in Siriraj Hospital on the basis of clinical examination and laboratory investigations. A retrospective study was performed from the records of patients who attended the Reproductive endocrine Clinic at Siriraj Hospital from 1 September 1992 to 31 August 1995. During the 3 years of the study period, there were 110 cases of primary amenorrhoea. One hundred and one cases were analyzed: nine cases were excluded because the patients lost follow-up before the final diagnosis could be concluded. The two most common etiologic factors were mullerian agenesis (39.65%) and gonadal dysgenesis (32.69%). Mean age of the patients when they first consulted the physicians was 22.45 +/- 6.06 years. Karyotyping was done on 28 of 32 cases of gonadal dysgenesis; 46,XX karyotype was found in 50 per cent and 45,XO in 14.29 per cent of analyzed cases. Clinical examination gave wrong diagnosis of absent uterus in 4 cases who were in the hypoestrogenic stage with hypoplastic uterus; ultrasonography and laparoscopy gave the wrong diagnosis in 1 case each in our report. These patients successfully menstruated after hormonal replacement therapy. The incidence of etiologic causes and cytogenetic study of primary amenorrhoea in our study is different from earlier reports. Racial and environmental differences may play a role in these differences. The facilities of diagnostic tools may also play a part. However, both clinical examination and many laboratory investigations have to be completed before final diagnosis of etiologic causes of primary amenorrhoea are elucidated. Diagnosis based on inadequate data can be misleading.

Amenorreias ovarianas / Ovarian amenorrhea

A amenorreia e um sintoma desafiador para o ginecologista. As de causa ovariana representam 10,5 por cento delas. Para o seu diagnostico deve-se seguir um roteiro basico. Entre as suas causas, as de maior relevancia sao: disgenesia gonadal, sindrome dos ovarios resistentes, iatrogenica, infeccao e tumor funcionante

Falência ovariana precoce: relato de 23 casos / Premature ovarian failure: report of 23 cases

A falência ovariana precoce é caracterizada por uma amenorréia secundária hipergonadotrófica, que ocorre antes dos 40 anos de idade. Neste estudo foram avaliadas retrospectivamente 23 pacientes admitidas no Ambulatório de Menopausa do DTG-CAISM-UNICAMP no período de janeiro de 1986 a julho de 1990. A idade média das pacientes quando se instalou o quadro de amenorréia foi de 31,17 anos (+ 6,20), variando entre 16 e 39 anos, e o tempo médio de amenorréia foi de 32,3 meses (+ 4,33). Quanto aos dados clínicos, 66 por cento das pacientes apresentavam fertilidade prévia e 69,5 por cento apresentavam sintomatologia de ondas de calor. As gonadotrofinas séricas apresentavam-se elevadas em todas as pacientes. Quanto aos hormônios tireoidianos, houve apenas um caso de hipotireoidismo primário. O estudo do cariótipo revelou um caso de síndrome do triplo X (47XX) e uma isocromossomia do braço longo do X (46Xi - Xq). A biópsia ovariana näo evidenciou a presença de folículos em nenhum caso. Os autores comentam alguns dados relevantes de acordo com a revisäo da literatura e enfatizam a importância de se realizar um diagnóstico preciso nesses casos.

Trastornos menstruales en estudiantes universitarias: II Menarquia y dismenorrea / Menstrual upsetting in the female universitary student: II Menarch and Dysmenorrhea

Se analizaron 765 (20,20%) del total de la población femenina de 3.787 estudiantes durante el período comprendido comprendido entre enero y marzo de 1988. Encontramos que la menarquía ocurrió a la edad de 11,97 ñ 1,5 años y en el 98,5% fue de aparición espontánea. El 70% de las estudiantes encuestadas presentaban dismenorrea; el 84% de ellas tenía 25 o menos años. En el 88% de las encuestadas, la dismenorrea les duraba los dos primeros días del período menstrual

Transtornos menstruales en estudiantes universitarias. Amenorrea y oligomenorrea / Menstruation disorders in students university. Amenorrhea and oligomenorrhea

Durante el período comprendido entre enero y marzo de 1988, se encuestaron 801 estudiantes de la Facultad de Medicina de la Universidad del Zulia siguiendo el método del azar. se analizaron 765 (20,20%) del total de la población femenina de 3.787 estudiantes. Se encontró que la frecuencia de la amenorrea fue de 8,35% y de oligimenorrea de 22,41%. La separación del núcleo familiar fue el factor más importante e influyente en la producción de estos trastornos, así como también otros factores relacionados a la vida de la universitaria, como exámenes, estudios, etcetera