A patient had a spontaneous abortion, then she came with amenorrhea and FSH 6 IU/mL. What the most probably diagnosis?
Ans. is b, i.e. Uterine SynechiaeRef: Leon speroff 7th/ed, p415-425, 8th/ed, p443 for FSH significance and 459 for asherman syndromeExplanation:Normal FSH values range from 5to20mIU/mL. In the question, FSH levels are 6mIU/mL, that means this is a case of secondary amenorrhea with normal FSH values.* In case of pituitary failure - as is evident from the flow diagram - values of FSH should be lower than the normal values. So Option'd' is ruled out* Incase of ovarian failure - estrogen is deficient so negative feedback on FSH will be absent, thus values of FSH will be more than normal. In case of ovarian failure/ menopause, FSH is above 40mIU/mL so option a is also ruled out.* Normal FSH and amenorrhea point towards uterine pathology. The patient had a spontaneous abortion following which a curettage is generally required which would be responsible for intrauterine synechiae (Asherman's Syndrome). Thus, the most probable diagnosis is uterine synechiae.KEY POINTSRememberHyperprolactinemia leads to decreased levels of FSH.
Ovarian failure
Uterine Synechiae
Pregnancy
Pituitary failure
Disorders in Menstruation