1.A case of functional hypothalamic amenorrhea presenting with polycystic ovary syndrome
Utulo Marijay M. ; Esguerra Rosiebel C.
Philippine Journal of Reproductive Endocrinology and Infertility 2012;9(1):4-9
Secondary amenorrhea occurs in about 0.7% of women and may be more common among the less than 25 years of age. Any disturbance in the established norm of the cyclinical pattern of menstrual bleeding can have social and emotional impact on the patient. Thu, a thorough investigation to discount any life threatening cause for a timely intervention should be done. A case of a 24 year old, nulligravid, with secondary amenorrhea for 12 years came in for evaluation. No other associated signs were seen. Diagnostic evaluation revealed she has a polycystic ovary with normal serum prolactin, follic;e stimulating hormone and estradiol. The progesterone challenge test was negative. Pending the result of the respone to the estrogen/progesterone challenge test, a diagnosis of functional hypothalamic amenorrhea, with concomitant polycystic ovarian morphology is likely. Therapy will include exogenous GnRH secretion is deficient and gonadotropin secretion and ovarian function can be normalized with physiologic replacemnt of exogenous, pulsatile GnRH. Monitoring the patients' glucose tolerance secondary to the polycystic ovary syndrome should also be done to prevent the long term sequelae of this disease. Despite the presentation of anovulation with polycystic ovary in this patients, the likehood of a hypothalamic dysfunction cannot be discounted, and has to be confirmed since exogenous GnRH will be needed to resume a pulsatile pattern of release, and return the patient's ovarian function.
Human
;
Female
;
Young Adult
;
AMENORRHEA
;
POLYCYSTIC OVARY SYNDROME
2.Turner Syndrome associated with Mayer-Rokitansky-KusterHauser Syndrome: A case report and review of related literature
Glaiza S. de Guzman ; Rosiebel C. Esguerra
Philippine Journal of Reproductive Endocrinology and Infertility 2023;20(2):39-44
Turner syndrome and Mayer-Rokitansky-Kuster-Hauser syndrome are the most common causes
of primary amenorrhea. However, mullerian agenesis in patients with Turner syndrome is rare,
with only 15 reported cases worldwide. Described in this report is an 18-year-old female who
presented with primary amenorrhea, absent secondary sexual characteristics, short stature,
webbed neck, and shield chest. Work up revealed hypergonadotropic hypogonadism, absence of
normal ovaries and uterus, and hypothyroidism. She had a 45,X karyotype and was diagnosed
with a very rare case of Turner syndrome with associated Mayer-Rokitansky-Kuster-Hauser
syndrome. Early detection of the etiology of amenorrhea is critical for prompt management
and initiation of hormonal replacement. She was counseled on the possible systemic problems
associated with her condition. The importance of regular follow-up and continuous care were
also emphasized. With the coexistence of these two conditions, adoption is the only option
for having children in the Philippines, where oocyte donation and uterine transplantation are
currently unavailable.
Turner Syndrome
;
Mullerian aplasia
3.A cross-sectional descriptive study on the quality of life, anxiety and depression among Filipino patients with pelvic endometriosis
Ma. Sheryll R. de Jesus ; Rosiebel C. Esguerra
Philippine Journal of Reproductive Endocrinology and Infertility 2023;20(2):55-65
Objective:
To determine the impact of endometriosis on the quality of life, risk of anxiety and depression among Filipino women in a tertiary hospital.
Methods:
A cross-sectional study was conducted among 210 patients aged 18-50 diagnosed
clinically and sonographically with pelvic endometriosis. Verbal and written consent were
secured. Descriptive statistical analysis was used to describe the baseline characteristics of the
population. Short Form McGill Pain Questionnaire (SF-MPQ) was used to assess the degree of
pain symptoms of the patients. WHO Quality of Life Tool (WHOQOL-BREF), Hamilton Anxiety
Scale (HAM-A) and Hamilton Depression Scale (HAM-D) in Filipino version were used to
evaluate the quality of life, anxiety and depression of the respondents. Series of paired t-tests
were performed to determine the differences in the average outcomes (i.e. level of depression,
anxiety, quality of life and subscales, pain scores and types of pain). McNemar’s chi-square
test was utilized to determine the differences in the frequency of mild to severe anxiety and
depression before and after treatment. Spearman’s rho rank correlation was performed to
determine the relationship of the level of pain to the outcome measures. One-way analysis of
variance was performed to determine differences in the current mean levels of depression,
anxiety, quality of life and its subscales across disease conditions (i.e. endometriosis alone,
myoma uteri, adenomyosis, other gynecologic conditions, infertility). The level of significance
was set at a p-value < 0.05 using two-tailed comparison.
Results:
The most common symptoms reported were the presence of dysmenorrhea (90.95%)
and pelvic pain (88.57%), which were both rated at pain scale 8/10. Majority (73.8%) of
patients have some form of depression (mild-28.57%, moderate-27.13%, severe-13.33%,
very severe-4.76%) with an average level of depression at 12.39 ± 6.5. Majority (54.76%) of
patients likewise have some form of anxiety (mild-15.24%, moderate-20.95%, severe-18.57%)
with an average level of anxiety at 15.44 ± 10.38. Depression and anxiety scores significantly
decreased after medical treatment. In terms of overall quality of life and perceived level of health,
respondents demonstrated an average score of 3.25 ± 0.91 and 2.86 ± 0.96, respectively. These
post-treatment scores showed significant improvement from baseline. The sub-domains (i.e.
physical, psychological, social and environmental) also have relatively high scores ranging
from 13.44 ± 2.39 to 15.60 ± 2.63. These are indicative of very satisfactory quality of life.Other
gynecologic conditions, such as infertility, myoma uteri, and adenomyosis, do not contribute
significantly to the outcomes measured.
Conclusion
Pelvic endometriosis is a chronic, life-long, inflammatory disease that presents
mainly as pelvic pain. This debilitating pain can significantly affect patients’ psychological
well-being and mental health, which is manifested by the very high incidence of anxiety and
depression among Filipino women with endometriosis. Management of endometriosis is complex,
hence a multi-disciplinary approach that includes psychiatric counseling may be necessary.
Anxiety
;
Depression
;
Pelvic Pain
;
Quality of Life