Delayed menarche with adequate sexual development 2˚ Congenital abnormalities of the genital tract Androgen insensitivity syndrome Poor feedback of hypothalamo-pituitary-ovarian axis Delayed puberty with inadequate or absent sexual characteristics 2˚ Hypothalamic or pituitary dysfunction (serious) Ovarian failure/dysgenesis Delayed puberty with virilisation Adrenal hyperplasia Androgen producing tumors Heraphroditism Mx: R/F Adolescent with excessive uterine bleeding: Pathogenesis: Immature HPO axis anovulatory cycles irregular cycles, which may be heavy. Other → (≈1-2yr) → symptoms e.g. pain seldomly present Other causes: Bleeding disorder; genital tumor; pregnancy complications Dx: Pregnancy test FBC leukaemia; thrombocytopenia – ESR VWF Hx of bleeding (dental-work/IJ) since birth – Mx: Gynaecological tumors in children: Mx: R/F Ovarian tumors: Types: Older children: Germ-cell tumors Young children/adults: Benign cystic teratoma: Growing cystic abdominal mass ± torsion; ± rupture; ± bleed → All complications will cause much pain & shock Precocious puberty: Granulosa cell tumors Androgen producing tumors Mx: R/F
Delayed menarche with adequate 2˚ sexual development Congenital abnormalities of the genital tract Androgen insensitivity syndrome Poor feedback of hypothalamo-pituitary-ovarian axis Delayed puberty with inadequate or absent 2˚ sexual characteristics Hypothalamic or pituitary dysfunction (serious) Ovarian failure/dysgenesis Delayed puberty with virilisation Adrenal hyperplasia Androgen producing tumors Heraphroditism Mx: R/F Adolescent with excessive uterine bleeding: Pathogenesis: Immature HPO axis → anovulatory cycles (≈1-2yr) → irregular cycles, which may be heavy. Other symptoms e.g. pain seldomly present Other causes: Bleeding disorder; genital tumor; pregnancy complications Dx: Pregnancy test FBC – leukaemia; thrombocytopenia ESR VWF – Hx of bleeding (dental-work/IJ) since birth Mx: Gynaecological tumors in children: Mx: R/F Ovarian tumors: Types: Older children: Germ-cell tumors Young children/adults: Benign cystic teratoma: Growing cystic abdominal mass → ± torsion; ± rupture; ± bleed All complications will cause much pain & shock Precocious puberty: Granulosa cell tumors Androgen producing tumors Mx: R/F
gynaecology_summary.docx