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.

Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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