【GYN】無月經症Amenorrhea－小節的醫學筆記

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1.POI.png

2.Eugonadotropic.png

3.Hypogonadotropic.png

GnRH	LH/FSH	Estrogen	Primary defect
Hypergonadotropic (POI) 佔40%	High (FSH>20, LH>40 IU/L)	Low	Ovary (Turner’s disease, Swyer, 17a-reductase deficiency(男假性雌雄同體), 化療放療導致的卵巢衰竭)
Eugonadotropic	Normal (FSH, LH 5~20 IU/L)	Normal	Uterus, fallopian tube, obstruction or abnormality (Mullerian agenesis, PCOS, 厭食症, Asherman, Cervical stenosis, AIS, CAH, Hyperprolactinemia, Hyperthyroidism, hypothyroidism)
Hypogonadotropic	Low (FSH, LH<5 IU/L)	Low	Hypothalamus/pituitary (先天性分泌不良IHH, 厭食症, Sheehan syndrome, Kallmann syndrome) ***使用hMG治療Hypogonadotropic hypogonadism效果最好，約91.2%在6個cycle後可以排卵。

*** 備註：POI=Primary ovary insufficiency卵巢衰竭, CAH=Congenital adrenal hyperplasia(46, XX), AIS=Androgen insensitivity(46, XY)

*** hMG = Human Menopausal Gonadotropins (hMG, 人類停經期促性腺激素)，是直接作用於濾泡的FSH。有腦下垂體或下視丘疾病的病人﹙譬如在腦下垂體壞死(Sheehan’s syndrome)或Kallman’s syndrome﹚HMG是誘導排卵的主要用藥。這些情況下，Clomid無法刺激下視丘及腦下垂體產生自體的FSH及LH，必須靠外加的HMG直接供應FSH及LH誘導排卵。另外在Clomid治療失敗，或引起黃體功能不良、子宮頸黏液明顯減少的病人，也可以改用HMG治療。