Absence of secondary sexual characteristics

In this particular situation, it is extremely important to make an assessment of the patient's height. If the patient is of normal height for age, measurement of gonadotrophin will reveal levels that are either low or high. Low levels of gonadotrophins confirm the diagnosis of hypogo-nadotrophin hypogonadism, and elevated levels should provoke the clinician to perform a karyotype. The 46XX patient will have premature ovarian failure, the resistant ovary syndrome or gonadal agenesis while the XY female will have 46XY gonadal agenesis or testicular enzymatic failure. If stature is short gonadotrophin levels will either be low, as associated with an intracranial lesion or high which, following a karyotype, will almost certainly indicate Turner syndrome or a Turner mosaic.

MANAGEMENT

In patients with hypogonadotrophic hypogonadism treat-mentshould be towards managing any avoidable problem or in the isolated GnRH deficiency hormone replacement therapy will need to be instituted to induce secondary sexual characteristic development. These patients can be informed that they are infertile and that ovulation induction in the future can be invoked using various fertility regimes. Hormone replacement therapy is essential and regimes exist for the induction of secondary sexual characteristics over 3-5 years. Oestrogen should be used alone for about 2 years, and then 2-3 years of gradual introduction of progestogens thereby establishing normal breast growth over a time frame that is equivalent to normal. Any attempt to accelerate breast growth by using higher doses of oestrogen will result in abnormal breast growth and this should be avoided at all costs. Patients with an XY dysgenesis or enzymatic failure should have gonadectomies performed to avoid malignancy.

It must always be remembered that any chronic medical illness which prevents normal growth will result in delayed onset of puberty and these causes must be considered in any patient presenting in this way.

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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