Child with primary amenorrhea with negative progesterone challenge test but positive combined progesterone and estrogen test. Diagnosis may be:
This child is presenting with primary amenorrhea with:
• Negative progesterone challenge test - which rules out PCOD (which may sometimes manifest as primary amenorrhea)
• When next step was done i.e., estrogen, progesterone combined test - It comes out to be positive i.e., compartment I system (uterus, endometrium and outflow tract) is normal if properly stimulated by estrogen which rules out mullerian agenesis and Ashermann’s syndrome.
• Positive estrogen progesterone combined test means the defect is in the production of estrogen i.e., either ovaries, pituitary, or hypothalamus.
So from the given options we have to look for a cause which involves either of the above sites, which in this case is prolactinoma.
Mullerian agenesis
PCOD
Asherman syndrome
Prolactinoma