Child with primary amenorrhea with negative progesterone challenge test but positive combined estrogen and progesterone test. Diagnosis may be:
Positive combined estrogen and progesterone test means there is no sufficient estrogen for priming the endometrium so the pathology may lies in the hypothalamo-Pituitary-Ovarian axis Causes: Ovarian: Gonadal Dysgenesis, Premature Ovarian Failure, Resistant ovary syndrome , Autoimmune causes and Chemoradiation Pituitary: Pituitary Adenomas, Empty Sella Syndrome, Sheehans Syndrome, Infiltrative Pituitary Lesions Hypothalamic: Eating disorders , Congenital GnRH Deficiency [ Kallmann&;s Syndrome, GnRH Receptor Mutation Reference: Clinical Endocinologic Gynecology and infeility; Eigth Edition, Chapter 11
Mullerian agenesis
PCOD
Asherman syndrome
Prolactinoma
Disorders of menstruation