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Case of a Girl with Primary Amenorrhea, Delayed Puberty, and High Gonadotropin Levels

Abstract

Primary ovarian insufficiency (POI) is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40. The condition was formerly known as premature menopause or premature ovarian failure. However, ovarian function is often intermittent and unpredictable in affected adolescents and women, and ovarian reserve is decreased rather than depleted. The diagnosis of POI is often delayed in teenagers. These patients may present with primary or secondary amenorrhea. Most cases of POI will not have an identified cause even after a complete evaluation. POI represents an example of primary hypogonadism with estrogen deficiency. One of the major medical complications can be skeletal losses and lack of bone accrual. Hormone replacement therapy is the central component of treatment. However, the optimal dose and delivery system are still under investigation. The diagnosis of POI often has effects on physical, mental, and emotional health. An interdisciplinary approach to management is recommended.

Keywords

Primary ovarian insufficiency Hypergonadotropic hypogonadism Amenorrhea Hypoestrogenism Delayed puberty Premature ovarian failure Pediatrics Adolescent 

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Suggested Educational Reading, References, and Policies

  1. Covington SN, Hillard PJ, Sterling EW, Nelson LM. A family systems approach to primary ovarian insufficiency. J Pediatr Adolesc Gynecol. 2011;24(3):137–41. https://doi.org/10.1016/j.jpag.2010.12.004 CrossRefGoogle Scholar
  2. Gordon CM, Kanaoka T, Nelson LM. Update on primary ovarian insufficiency in adolescents. Curr Opin Pediatr. 2015;27(4):511–9. https://doi.org/10.1097/mop.0000000000000236 CrossRefGoogle Scholar
  3. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015;126.Google Scholar
  4. Nelson LM. Primary ovarian insufficiency. N Engl J Med. 2009;360(6):606–14. https://doi.org/10.1056/NEJMcp0808697 CrossRefGoogle Scholar
  5. Primary ovarian insufficiency in adolescents and young women. Committee Opinion No. 605. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2014;123:193–7.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and GynecologyUniversity of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Division of Adolescent and Transition Medicine, Department of PediatricsUniversity of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical CenterCincinnatiUSA

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