Analysis of management efficacy in patients with heavy menstrual bleeding associated with antithrombotic therapy / 中华妇产科杂志

Objective: To evaluate different methods' efficacy of controlling acute bleeding and managing long-term menstruation in patients with heavy menstrual bleeding (HMB) associated with antithrombotic therapy. Methods: The clinical data of 22 cases with HMB associated with antithrombotic therapy admitted to Peking University People's Hospital from January 2010 to August 2022 were analyzed, aged 39 years old (26-46 years). Changes in menstrual volume, hemoglobin (Hb), and quality of life were collected after control of acute bleeding and long-term menstrual management. Menstrual volume was assessed by pictorial blood assessment chart (PBAC), and quality of life was assessed by menorrhagia multi-attribute scale (MMAS). Results: (1) Treatment of acute bleeding: of the 22 cases with HMB associated with antithrombotic therapy, 16 cases were treated in our hospital and 6 in other hospital for emergency bleeding; of the 16 cases treated in our hospital, 3 underwent emergency intrauterine Foley catheter balloon compression due to severe bleeding (Hb decreased by 20 to 40 g/L within 12 hours). Of the 22 cases with antithrombotic therapy-related HMB, 15 (including 2 cases with severe bleeding) underwent emergency aspiration or endometrial resection, and intraoperative placement of levonorgestrel-releasing intrauterine system (LNG-IUS) followed by a significant reduction in bleeding volume; 3 cases had controlled acute bleeding after rivaroxaban dose reduction and continued observation; 2 cases were given gonadotropin-releasing hormone agonists to control acute bleeding in other hospital, of which 1 case was temporarily treated with periodic blood transfusion, and the other one patient underwent total hysterectomy; and 2 cases had temporary amenorrhea with oral mifepristone after intrauterine balloon compression or oral norethindrone. (2) Long-term menstrual management: of the 22 cases with antithrombotic therapy-related HMB, 15 had LNG-IUS placement and 12 had LNG-IUS placement for 6 months, and menstrual volume was significantly reduced [PBAC scores were 365.0 (272.5-460.0) vs 25.0 (12.5-37.5), respectively; Z=4.593, P<0.001], Hb was significantly increased [91.5 g/L (71.8-108.2 g/L) vs 128.5 g/L (121.2-142.5 g/L); Z=4.695, P<0.001], and quality of life was significantly improved [MMAS scores were 415.0 (327.5-472.5) vs 580.0 (570.0-580.0), respectively; Z=-3.062, P=0.002] before placement compared with 6 months after placement. Three rivaroxaban dose reduction patients' PBAC scores decreased by 20 to 35 but remained >100, and perceived quality of life did not change significantly. Two cases with temporary amenorrhea treated with oral mifepristone felt significantly improved quality of life, and the MMAS scores increased by 220 and 180, respectively. Conclusion: Intrauterine Foley catheter balloon compression, aspiration or endometrial ablation could be used to control acute bleeding in patients with antithrombotic therapy-related HMB, and LNG-IUS for long-term management could reduce menstrual volume, increase hemoglobin, and improve the quality of life of patients.

Five-year Contraceptive Use of 52-mg Levonorgestrel Releasing Intrauterine System in Young Women, Menstrual Patterns, and New Contraceptive Choice / Cinco anos de uso contraceptivo do sistema intrauterino liberador de levonorgestrel 52 mg em mulheres jovens, padrões menstruais e nova escolha contraceptiva

Abstract Objective To evaluate the continuation rates of the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) during the first 5 years of use, reasons for its discontinuation, bleeding patterns, and new contraceptive choice after the 5th year, in adolescents and young women. Methods The present study was a 5-year prospective cohort conducted in a Family Planning Service of a tertiary hospital in Brazil. We selected 100 healthy women between 15 and 24 years old who used 52-mg LNG-IUS for contraception. The clinical follow-up of these women took place from June 2017 to December 2022. The study evaluated the continuation rates of the method, reasons for its discontinuation, bleeding patterns, and new contraceptive choice after the 5th year. Continuous data were reported as mean ± standard deviation (SD) and range (minimum-maximum). Categorical variables were described as percentages. Results The continuation rates of LNG-IUS were 89.1% (82/92), 82.9% (72/87), 75.3% (64/85), 70.5% (60/85), and 64.2% (54/84) in the 1st, 2nd, 3rd, 4th, and 5th years of use, respectively. The main reason for discontinuation was acne (11/30). Amenorrhea rates were 50, 54.1, 39, 35.7, and 51.8% at 12, 24, 36, 48, and 60 months, respectively. All patients who completed the study and needed contraception after the 5th year opted for long-acting contraceptive methods (LARC). Conclusion The LNG-IUS showed high continuation rates in adolescents and young women in the first 5 years of use. Most patients who completed the study chose a LARC method after the 5th year.

Resumo Objetivo Avaliar as taxas de continuação do sistema intrauterino liberador de levonorgestrel (SIU-LNG) 52 mg durante os primeiros 5 anos de uso, razões de sua descontinuação, padrões de sangramento e nova escolha contraceptiva após o 5° ano, em adolescentes e mulheres jovens. Métodos O estudo foi uma coorte prospectiva de 5 anos realizada em um Serviço de Planejamento Familiar de um hospital terciário no Brasil. Selecionamos 100 mulheres saudáveis entre 15 e 24 anos que usaram o SIU-LNG 52 mg para contracepção. O acompanhamento clínico dessas mulheres ocorreu de junho de 2017 a dezembro de 2022. O estudo avaliou as taxas de continuação do método, razões de sua descontinuação, padrões de sangramento e nova escolha contraceptiva após o 5° ano. Os dados contínuos foram relatados como média ± DP e intervalo (mínimo-máximo). As variáveis categóricas foram descritas como porcentagens. Resultados As taxas de continuação do SIU-LNG foram 89,1% (82/92), 82,9% (72/87), 75,3% (64/85), 70,5% (60/85) e 64,2% (54/84) no 1°, 2°, 3°, 4° e 5° anos de uso, respectivamente. O principal motivo de descontinuação foi a acne (11/30). As taxas de amenorreia foram de 50, 54,1, 39, 35,7 e 51,8% aos 12, 24, 36, 48 e 60 meses, respectivamente. Todas as pacientes que completaram o estudo e necessitaram de contracepção após o 5° ano optaram por métodos contraceptivos de longa duração (LARC). Conclusão O SIU-LNG apresentou altas taxas de continuação em adolescentes e mulheres jovens nos primeiros 5 anos de uso. A maioria das pacientes que completou o estudo escolheu um método LARC após o 5° ano.

Estudio Descriptivo: Cumplimiento del estándar de estimación de la edad gestacional en la atención prenatal en un hospital general en Ecuador / Descriptive Study: Compliance of the standards for estimating gestational age during prenatal care in a general hospital in Ecuador.

INTRODUCCIÓN: La datación gestacional es un requisito crítico en la toma de decisiones durante el embarazo; la Organización Mundial de Salud recomienda realizar el primer estudio ecográfico antes de la semana 24 de gestación. La edad gestacional también se puede estimar en función de la historia menstrual. El objetivo del presente estudio fue describir la taza de cumplimiento del estándar de estimación de la edad gestacional en un hospital general en la ciudad de Machala, Ecuador. MATERIALES Y MÉTODOS: El presente es un estudio observacional, descriptivo, trasversal, cuyo universo fueron las pacientes embarazadas que acudieron a consulta prenatal al Hospital General de Machala, El Oro-Ecuador, entre abril del 2017 y marzo del 2020. Se estudió a la totalidad del universo. Se recopilaron datos de las variables: edad, paridad, FUM, edad menstrual, ecografía temprana, datación gestacional confiable. RESULTADOS: El 47.9% de la muestra tuvo entre 18 y 29 años de edad. El 83.33% (195/234) pacientes cumplieron con el registro de semanas de amenorrea. El 75.21% (176/234), de pacientes cumplieron con la recomendación de una ecografía temprana, a las 24 semanas o menos. El 1.28% no tuvo ningún de los métodos de datación gestacional. El 64%(n=149) de la muestra se le realizó la primera ecografía hasta la semana 20 de gestación. De las 140 pacientes que cumplen con tener tanto datación gestacional por FUM confiable y ecografía, en 31/140 pacientes (22.1%) no se pudo confirmar la edad gestacional dada por el tiempo de amenorrea, con la ecografía temprana. CONCLUSIÓN: Concluimos que la datación gestacional obtenida por semanas de amenorrea, se registró en el 83.33% de las pacientes, que califica como un cumplimiento regular. Se realizó ecografía temprana, a las ≤ 24 semanas, como recomienda la OMS en el 75% de las pacientes, que califica como un cumplimiento pobre.(au)

BACKGROUND: Gestational dating is an important requirement for decision-making during pregnancy; the World Health Organization recommends making the first ultrasound before week 24. Gestational age can also be estimated based on menstrual history. The aim of this study was to describe the rate of compliance of the standards for estimating gestational age in a general hospital in Machala, Ecuador. METHODS: This is an observational, descriptive, cross-sectional study; the universe was the total of pregnant women who attended for prenatal care to Hospital General Machala, El Oro- Ecuador, between April 2017 and March 2020. The entire universe was studied. We collected data for the variables: age, parity, last menstrual period( LMP), menstrual age, early ultrasound, reliable gestational dating. RESULTS: 47.9% of the sample was 18 to 29 years old. 83.33% (195/234) patients complied with the weeks of amenorrhea registry. 75.21% (176/234) of patients complied with the recommendation of an early ultrasound, at 24 weeks or less. 1.28% did not have any method of gestational dating. 64% (n=149) of the sample underwent the first ultrasound until week 20. Of 140 patients who complied with having both gestational dating by reliable LMP and ultrasound, in 31/140 (22.1%) the gestational age given by LMP could not be confirmed with early ultrasound. CONCLUSION: We concluded that gestational dating obtained by weeks of amenorrhea was registered n 83.33% of the patients, this rate qualifies as regular compliance. An early ultrasound was performed, at ≤ 24 weeks, as recommended by WHO, in 75% of the patients, this rate qualifies as poor compliance.(au)

The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S) / A tríade da atleta feminina/déficit energético relativo no esporte (RED-S)

Abstract In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, andmenstrual cycle.Onthe other hand, an imbalance causedby low energy availability dueto a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of themost recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote theacquisition ofmore consolidated knowledgeon an undervaluedtheme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.

Resumo Emumaatleta saudável, oaporte calórico é suficientepara anecessidade energética esportiva e para as funções fisiológicas corporais, permitindo um equilíbrio entre disponibilidade energética (DE), metabolismo ósseo e função menstrual. Por outro lado, um desequilíbrio devido à baixa disponibilidade energética (BDE) por dieta restritiva, perturbações alimentares ou grandes períodos de gasto energético conduz a uma desregulação multissistêmica priorizando as funções essenciais do corpo. Este fenômeno, descrito inicialmente como tríade da mulher atleta e, atualmente, comodéfice energético relativo no esporte (RED-S, nasigla eminglês) tem como pilares a BDE, disfunção menstrual e alterações na densidade mineral óssea (DMO), estando presente em uma percentagem considerável de atletas de alta competição, com consequências nefastas para o seu futuro a curto, médio e longo prazo. A presente revisão foi realizada a partir da análise crítica das publicações mais recentes disponíveis e pretende proporcionar uma percepção global do tema RED-S. O objetivo é promover a aquisição de um conhecimento mais consolidado sobre uma temática subvalorizada, possibilitando a aquisição de estratégias preventivas, diagnóstico precoce e/ou tratamento adequado.

Insuficiencia ovárica primaria en adolescentes: revisión de la literatura a propósito de un caso clínico / Primary ovarian insufficiency in adolescents: review of the literature regarding a clinical case

El objetivo de este manuscrito es realizar una revisión y actualización de la literatura de la insuficiencia ovárica primaria (IOP) en población adolescente, a partir del diagnóstico, manejo y seguimiento de un caso clínico. La insuficiencia ovárica primaria se define como la menopausia en una mujer antes de los 40 años, acompañada de amenorrea, hipogonadismo hipergonadotrópico e infertilidad. Su prevalencia varía entre 1 a 2%, y en mujeres menores de 20 años su prevalencia es un caso de cada 10,000. Aunque se sabe que muchas afecciones pueden llevar a una IOP, la más común es la causa idiopática. La presentación clínica es diversa, y varios trastornos diferentes pueden también, llevar a esta condición. CASO CLÍNICO: Se presenta el caso de una adolescente de 17 años, previamente sana, con historia de amenorrea secundaria, no embarazada, con examen físico general y ginecológico normal. Se solicita estudio analítico complementario resultando con niveles de hormona folículo estimulante (FHS), estradiol (E2) y hormona antimülleriana (AMH) compatibles con una insuficiencia ovárica como la observada en la posmenopausia. Se inicia terapia hormonal (TH) clásica con estradiol y progesterona, siendo posteriormente reemplazada por anticoncepción hormonal combinada (AHC) oral, coincidente con el inicio de vida sexual, con respuesta favorable y sangrados regulares. La IOP tiene graves consecuencias para la salud incluyendo trastornos psicológicos como angustia, síntomas depresivos o depresión, infertilidad, osteoporosis, trastornos autoinmunes, cardiopatía isquémica, y un mayor riesgo de mortalidad. La enfermedad de Hashimoto es el trastorno autoinmune más frecuente asociado a la IOP. Su tratamiento y diagnóstico deben establecerse de forma precoz para evitar consecuencias a largo plazo. La terapia con estrógenos es la base del tratamiento para eliminar los síntomas de la deficiencia de estrógenos, además de evitar las consecuencias futuras del hipogonadismo no tratado. También el manejo debe incluir los siguientes dominios: fertilidad y anticoncepción, salud ósea, problemas cardiovasculares, función psicosexual, psicológica y neurológica, informando a los familiares y a la paciente sobre la dimensión real de la IOP y la necesidad de tratamiento multidisciplinario en muchos casos. CONCLUSIÓN: El caso presentado, pese a ser infrecuente, permite abordar de manera sistematizada el diagnostico de IOP y evaluar alternativas de manejo plausibles para evitar graves consecuencias en la salud, así como conocer respuesta clínica y de satisfacción de la adolescente.

The objective of this manuscript is to review and update the literature on primary ovarian insufficiency (POI) in an adolescent population, based on the diagnosis, management and follow-up of a clinical case. Primary ovarian insufficiency is defined as menopause in a woman before the age of 40, accompanied by amenorrhea, hypergonadotropic hypogonadism, and infertility. Its prevalence varies between 1 to 2%, and in women under 20 years of age its prevalence is one case in every 10,000. Although it is known that many conditions can lead to POI, the most common is the idiopathic cause. The clinical presentation is diverse, and several different disorders can also lead to this condition. CLINICAL CASE: The case of a 17-year-old adolescent, previously healthy, with a history of secondary amenorrhea, not pregnant, with a normal general physical and gynecological examination is presented. A complementary analytical study is requested, resulting in levels of follicle stimulating hormone (FHS), estradiol (E2) and anti-müllerian hormone (AMH) compatible with ovarian insufficiency such as that observed in postmenopause. Classic hormonal therapy (HT) with estradiol and progesterone was started, later being replaced by combined hormonal contraception (CHC), coinciding with the beginning of sexual life, with a favorable response and regular bleeding. POI has serious health consequences including psychological disorders such as distress, depressive symptoms or depression, infertility, osteoporosis, autoimmune disorders, ischemic heart disease, and an increased risk of mortality. Hashimoto's disease is the most common autoimmune disorder associated with POI. Its treatment and diagnosis must be established early to avoid long-term consequences. Estrogen therapy is the mainstay of treatment to eliminate the symptoms of estrogen deficiency, in addition to avoiding the future consequences of untreated hypogonadism. Management should also include the following domains: fertility and contraception, bone health, cardiovascular problems, psychosexual, psychological and neurological function, informing family members and the patient about the real dimension of POI and the need for multidisciplinary treatment in many cases. CONCLUSION: The case, although infrequent, allows a systematic approach to the diagnosis of POI and evaluate plausible management alternatives to avoid serious health consequences, as well as to know the clinical response and satisfaction of the adolescent.

Actualización sobre deficiencias nutricionales en la mujer deportista a partir de la literatura científica / Update on nutritional deficiencies in women athletes from the scientific literature

Los déficits nutricionales en la mujer deportista causan numerosos problemas de salud, así como un empeoramiento en el rendimiento deportivo, como consecuencia de estas deficiencias nutricionales. El conocimiento de estos déficits y su prevención deben ser un aspecto principal para cualquier responsable deportivo. Establecer la importancia del estudio de los déficits de energía, proteínas, minerales (Fe, Ca y Mg) y vitaminas (Vitamina D, ácido fólico y vitamina B12) que pueden desarrollar las mujeres deportistas y su relación con la prevalencia de la tríada femenina y constatar la importancia del conocimiento por parte de los responsables deportivos de los problemas derivados de los déficits nutricionales. Se realizó una búsqueda bibliográfica de artículos, entre 2013-2020, relevantes para el objetivo de estudio. Se usaron bases de datos científicas como PubMed y Pennutrition, siguiendo los criterios de exclusión e inclusión elegidos para este estudio. 51 artículos fueron encontrados. Los resultados mostraron la prevalencia de energía, Fe, vitamina D y Ca, así como un suficiente aporte proteico, faltan estudios para determinar los niveles de vitamina B12 y ácido fólico. Se observó, además la prevalencia de mujeres que cumplen con uno o varios factores de riesgo para el desarrollo de la tríada de la deportistas femenina. Es imprescindible la prevención o, el tratamiento, de los déficits nutricionales en las mujeres deportistas para asegurar un correcto estado de salud y un rendimiento deportivo óptimo(AU)

Nutritional deficiencies in women athletes cause numerous health problems, as well as a worsening of sports performance, as a result of these nutritional deficiencies. Awareness of these deficiencies and their prevention should be a major aspect for any sports manager. The aim of the study was to establish the importance of studying the deficits of energy, protein, minerals (Fe, Ca and Mg) and vitamins (Vitamin D, folic acid and vitamin B12) that can be developed by female athletes and their relationship with the prevalence of the female triad and to establish the importance of knowledge by sports managers of the problems arising from nutritional deficiencies. 51 papers were found. A bibliographic search of relevant articles for the study objective was carried out (2013-2020). Scientific databases such as PubMed and Pennutrition were used, following the exclusion and inclusion criteria chosen for this study. The results showed the prevalence of energy, Fe, vitamin D and Ca, as well as sufficient protein intake and a lack of studies to determine the levels of vitamin B12 and folic acid. In addition, the prevalence of women meeting one or more risk factors for the development of the female sports triad was observed. It is essential the prevention or, treatment, of nutritional deficits in female athletes to ensure proper health status and optimal sports performance(AU)

Ovarian dysgerminoma with Müllerian anomaly: a case report

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.

Amenorrea primaria asociada a paciente con cariotipo 45 XX, ROB (13; 14) (q 10; q 10): presentación de un caso / Primary amenorrhea associated with a patient with karyotype 45 XX, ROB (13; 14) (q 10; q 10): case presentation

La función ovárica depende de la expresión de múltiples genes, por lo que las anomalías del cromosoma X y los autosomas revisten gran importancia en la etiología de la insuficiencia ovárica primaria (IOP). Las translocaciones de autosomas en mujeres con IOP son muy raras y solo se han detectado tres casos: dos translocaciones entre los cromosomas 2 y 15 en dos mujeres con cariotipo 46, XX, t (2, 15) (q32.3, q13.3)2; una translocación entre los cromosomas 13 y 14 en una mujer con cariotipo 45, XX, t (13; 14)3; por lo que nuestro caso sería el cuarto reporte de mujeres con translocaciones de autosomas e IOP.

Ovarian function depends on the expression of multiple genes, so Xchromosome abnormalities and autosomes are of great importance in the etiology of primary ovarian insufficiency (IOP). Autosomal translocations in women with IOP are very rare and only three cases have been detected: two translocations between chromosomes 2 and 15 in two women with karyotype 46, XX, t (2, 15) (q32.3, q13.3)2; a translocation between chromosomes 13 and 14 in a woman with karyotype 45, XX, t (13; 14)3 , so our case would be the fourth report of women with autosomal translocations and IOP.

Quiste de bolsa de Rathke e hiperprolactinemia, una causa infrecuente de amenorrea primaria / Rathke cleft cysts and hyperprolactinemia, an uncommon cause of primary amenorrhea

El quiste de la bolsa de Rathke es una lesión epitelial benigna de la región selar, formada a partir de remanentes embrionarios. La mayoría de los casos son asintomáticos, aunque pudiera presentarse con cefalea, disfunción hipofisaria y trastornos visuales, muy infrecuentemente como apoplejía hipofisaria. Se presenta el caso de una paciente que, habiendo presentado amenorrea primaria, se le realiza el diagnóstico de quiste de la bolsa de Rathke con hiperprolactinemia, logrando menarquia luego del tratamiento con cabergolina.

Rathke's cyst is a benign epithelial lesion of the sellar region, formed from embryonic remnants. Most cases are asymptomatic although it could present with headache, pituitary dysfunction and visual disorders, very infrequently as pituitary stroke. We present the case of a patient who, having presented primary amenorrhea, is diagnosed with Rathke's cyst with hyperprolactinemia, achieving menarche after treatment with cabergoline.

Disgenesia gonadal pura 46 XX, una causa infrecuente de hipogonadismo: presentación de un caso / Pure gonadal dysgenesis 46 XX, an ucommon cause of hypogonadism: case presentation

El término disgenesia gonadal pura hace referencia a mujeres fenotípicas con infantilismo sexual, amenorrea primaria, hábito eunucoide y un cariotipo 46, XX o 46, XY sin anomalías cromosómicas. Puede asociarse a complicaciones como osteoporosis y síndrome metabólico, elevando el riesgo cardiovascular. Se presenta una paciente femenina de 16 años y 8 meses de edad que acude a consulta de endocrinología por presentar amenorrea primaria.

The term pure gonadal dysgenesis refers to phenotypic women with sexual infantilism, primary amenorrhea an d the eunucoid habit and a 46, XX or 46, XY karyotype without chromosomal abnormalities. It can be associated with complications such as osteoporosis and metabolic syndrome, increasing cardiovascular risk. We present a female patient of 16 years and 8 months of age who attended endocrinology clinic for presenting primary amenorrea.

Hormonas sexuales en la enfermedad crítica / Sexual hormones in critical disease

INTRODUCCIÓN. En el paciente crítico ha existido un conglomerado de situaciones dadas por alteración de las hormonas acorde al comportamiento del eje hipotalámi-co-hipofisario- gonadal, entender su rol es fundamental. OBJETIVO. Describir las alteraciones de las hormonas sexuales en el paciente críticamente enfermo desde un enfoque fisiológico y clínico. MATERIALES Y MÉTODOS. Estudio observacional, de revisión bibliográfica y análisis sistemático de 84 artículos científicos y selección de muestra de 27 en MedLine, The Cochrane Library Plus, LILACS y Web of Science; en español e inglés y variables: hormonas esteroides gonadales, enfermedad crítica, endocrinología, estrés, gónadas y disfunción, periodo 1998-2017. CONCLUSIÓN. Las alteraciones detectadas fueron un mecanismo para la producción de hormonas esteroideas hacia la síntesis predominante de cortisol y soportar el alto estrés meta-bólico de los pacientes. Las citocinas pro inflamatorias fueron importantes en éstos cambios. La polifarmacia fue un factor adicional poco ponderado de la alteración endocrina sexual.

INTRODUCTION. In the critical patient there has been a conglomerate of situations given by alteration of the hormones according to the behavior of the hypothalamic-pi-tuitary-gonadal axis, understanding their role is fundamental. OBJECTIVE. Describe the alterations of sex hormones in the critically ill patient from a physiological and clinical approach.MATERIALS AND METHODS.Observational, literature review and systematic analysis of 84 scientific articles and sample selection of 27 in MedLine, The Cochrane Library Plus, LILACS and Web of Science; in Spanish and English and variables: gonadal steroid hormones, critical illness, endocrinology, stress, gonads and dysfunction, period 1998-2017. CONCLUSION. The alterations detected were a mechanism for the production of steroid hormones towards the predominant syn-thesis of cortisol and withstand the high metabolic stress of the patients. Pro inflam-matory cytokines were important in these changes. Polypharmacy was an additional unweighted factor of sexual endocrine disruption.

Gonadoblastoma bilateral em paciente com mosaicismo de síndrome de Turner: relato de caso e revisão de literatura / Bilateral gonadoblastoma in patient with Turner syndrome mosaicism: case report and literature review

A síndrome de Turner decorre de uma anomalia dos cromossomos sexuais, afetando cerca de 1:2.500 nascidos vivos. A síndrome caracteriza-se principalmente por atraso do e denvolvimento dos caracteres sexuais e/ou amenorreia e baixa estatura. Entretanto, uma diversidade de estigmas também pode estar presente. O diagnóstico pode ser realizado com base nos estigmas da síndrome associados a um quadro de hipogonadismo hipergonadotrófico e confirmado por meio do cariótipo ­ sendo esse classicamente 45,X (monossomia do cromossomo X). Entretanto, os mosaicos (45,X/46,XY ou 45,X/46,XX) podem representar 34% a 75% dos casos, dependendo do método de análise utilizado. Trata-se de uma condição rara correspondendo a 5% das disgenesia gonadais e apresenta um amplo espectro fenotípico. A importância da identificação de mosaicos, especialmente a presença do cromossomo Y, reside no manejo adequado da gônada disgenética para a prevenção da ocorrência de tumor gonadal, principalmente o gonadoblastoma, com considerável potencial maligno.(AU)

Turner's syndrome results from a sex chromosomes anomaly, affecting about 1:2,500 live births. The syndrome is characterized mainly by delayed development of sexual characteristics and/or amenorrhea and short stature. However, a variety of stigmas may also be presented. The diagnosis can be made based on the stigmas of the syndrome associated with a hypergonadotrophic hypogonadism and confirmed by the karyotype ­ this being classically 45, X (monosomy of the X chromosome). However, mosaics (45,X/46,XY or 45,X/46, XX) may represent 34% to 75% of cases depending on the method of analysis used. It is a rare condition, corresponding to 5% of gonadal dysgenesis and presents a broad phenotypic spectrum. The importance of mosaic identification, especially the presence of the Y chromosome, lies in the proper management of the dysgenetic gonad for the prevention of the occurrence of gonadal tumor, especially gonadoblastoma, with considerable malignant potential.(AU)

Amenorrhea as a Side Effect of Low Dose Aripiprazole: An Adolescent Case

No abstract available.

Foeniculum vulgare as Valuable Plant in Management of Women's Health

This review paper evaluates use of Foeniculum vulgare extracts as a popular female plant in management of different ailments of women. Information in this paper was gathered from accessible sources (PubMed, Science Direct, Springer, Wiley, and Google), and traditional books (Persian or English modern traditional books), unpublished data (R&D reports, thesis and dissertation) by keywords based on the words F. vulgare or fennel and women. Efficacy of oral fennel oil in management of dysmenorrhea, premenstrual syndrome, amenorrhea, menopause, lactation, and polycystic ovary syndrome were confirmed according to results of clinical studies. Results of clinical efficacy of fennel oil on menstrual bleeding is complicated, but results of one meta-analysis study revealed that fennel oil significantly increased means of bleeding in the first menstrual periodic cycle (P = 0.001), while fennel oil had no significant effect on bleeding in the second menstrual cycle (P = 0.67). Topical and vaginal fennel extract (5%) exhibited good efficacy in treatment of sexual function, vaginal atrophy, and hirsutism. Fennel had no effect on bone density, or body mass index of menopause women. Results of clinical studies introduce fennel as a valuable medicinal plant in management of women's ailments, but understanding the mechanism of action could be the subject of future studies.

Clinicopathological features of premature ovarian insufficiency associated with chromosome abnormalities

PURPOSE: The aim of this study was to investigate the clinicopathological features of premature ovarian insufficiency (POI) associated with chromosomal abnormalities. MATERIALS AND METHODS: This was a retrospective study of POI patients with chromosomal abnormalities diagnosed between January 2009 and December 2017. The definition of POI is based on hypergonadotropinism of 40 or greater in follicle stimulating hormone (FSH) measurements at age 40 years or less. FSH was measured twice at least 4 weeks apart. Karyotyping using peripheral blood for chromosomal testing was conducted in all patients diagnosed with POI. We analyzed the clinical characteristics and genetic causes of patients who were diagnosed with POI. RESULTS: Forty patients were diagnosed with POI including 9 (22.5%) with identified chromosomal abnormalities. The mean age at diagnosis was 23.1±7.8 years (ranging between 14 and 39). Three patients did not experience menarche. The presenting complaints were short stature in one case, one case of amenorrhea with ambiguous external genitals, one case of infertility, and six related to menstruation such as oligomenorrhea or irregular rhythm. Turner syndrome was diagnosed in four cases, Xq deletion in one case, trisomy X in two cases, and 46,XY disorder of sexual development in two other patients. CONCLUSION: Patients diagnosed with POI carrying the same type of chromosomal abnormality manifest different phenotypes. The management protocol also needs to be changed depending on the diagnosis. A karyotype is indicated for accurate diagnosis and proper management of POI in patients, with or without stigmata of chromosomal abnormalities.

Pituitary magnetic resonance imaging abnormalities in young female patients with hypogonadotropic hypogonadism

OBJECTIVE: To elucidate the association between clinical and laboratory characteristics and pituitary magnetic resonance imaging (MRI) abnormalities in young female patients with hypogonadotropic hypogonadism (HH). METHODS: We retrospectively investigated a series of 74 female patients (age range, 14–42 years) with normoprolactinemic HH who underwent pituitary MRI. Pubertal milestones and hormonal features of patients with small pituitary glands (PGs) and space-occupying lesions were compared with those of patients with normal PGs. RESULTS: The overall frequency of abnormal PGs was 35.1%, with space-occupying lesions observed in 8 patients (10.8%), and small PG observed in 18 patients (24.3%). The mean serum gonadotropin level was not different between patients with and without pituitary MRI abnormalities (P>0.05). Space-occupying lesions were not associated with low gonadotropin levels, type of amenorrhea, or presence of secondary sex characteristics. The frequency of space-occupying lesions was higher in patients with interrupted puberty (25.0%) than in patients who did not go through puberty (4.8%) or had a normal puberty (9.8%), but were not statistically significant (P>0.05). Small PG was associated with low gonadotropin levels and type of amenorrhea (P<0.05). CONCLUSION: Clinically significant space-occupying lesions were not associated with low gonadotropin levels, type of amenorrhea, or presence of secondary sex characteristics. However, the frequency of space-occupying lesions was higher in patients with interrupted puberty than in patients who did not go through puberty or who with normal puberty.

A rare case of ovarian vein thrombosis in a gestational trophoblastic neoplasia patient

Ovarian vein thrombosis (OVT) is a rare disease with complications that can be life-threatening. An ovarian vein thrombus in a gestational trophoblastic neoplasia (GTN) is an extremely rare condition that has not been previously reported in the literature. We report the case of a 23-year-old woman who presented with symptoms of amenorrhea for 15 weeks and 6 days along with intermittent lower abdominal pain. She was diagnosed with a hydatidiform mole, and a metastatic workup was scheduled. Abdominal computed tomography showed a right ovarian vein thrombus. She received methotrexate chemotherapy combined with oral anticoagulants. Complete radiological remission was obtained. During the 12-month follow-up period, no disease progression or recurrence was noted. Early recognition and detection of the condition are of the utmost importance. The differential diagnosis of OVT must be considered when there is unexplained abdominal pain, fever, and leukocytosis during the diagnosis and treatment of GTN. A high level of suspicion is required for prompt diagnosis of OVT.

Evaluation and management of amenorrhea related to congenital sex hormonal disorders

Primary amenorrhea is a symptom with a substantial list of underlying etiologies which presents in adolescence, although some conditions are diagnosed in childhood. Primary amenorrhea is defined as not having menarche until 15 years of age (or 13 years with secondary sex characteristics). Various etiologies of primary amenorrhea include outflow tract obstructions, gonadal dysgenesis, abnormalities of the central nervous system, various endocrine diseases, chronic illnesses, psychologic problems, and constitutional delay of puberty. The management of primary amenorrhea may vary considerably depending on the patient and the specific diagnosis. In this article, the various causes, evaluation, and management of primary amenorrhea are reviewed with special emphasis on congenital sex hormonal disorders.