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==[[Differentiating menopause from other diseases]]==
 
==[[Differentiating menopause from other diseases]]==
 
[[Menopause]] should be differentiated from other [[diseases]] presenting with [[menstrual irregularities]] ([[oligomenorrhea]]/[[amenorrhea]]).<ref name="pmid9541295">{{cite journal |vauthors=Sato N, Sze G, Endo K |title=Hypophysitis: endocrinologic and dynamic MR findings |journal=AJNR Am J Neuroradiol |volume=19 |issue=3 |pages=439–44 |year=1998 |pmid=9541295 |doi= |url=}}</ref><ref name="pmid7758238">{{cite journal |vauthors=Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH |title=Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature |journal=Clin. Endocrinol. (Oxf) |volume=42 |issue=3 |pages=315–22 |year=1995 |pmid=7758238 |doi= |url=}}</ref><ref name="pmid26262437">{{cite journal |vauthors=Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S |title=Diagnosis of Primary Hypophysitis in Germany |journal=J. Clin. Endocrinol. Metab. |volume=100 |issue=10 |pages=3841–9 |year=2015 |pmid=26262437 |doi=10.1210/jc.2015-2152 |url=}}</ref><ref name="pmid7629223">{{cite journal |vauthors=Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S |title=Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings |journal=J. Clin. Endocrinol. Metab. |volume=80 |issue=8 |pages=2302–11 |year=1995 |pmid=7629223 |doi=10.1210/jcem.80.8.7629223 |url=}}</ref><ref name="pmid8345854">{{cite journal |vauthors=Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H |title=Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus |journal=N. Engl. J. Med. |volume=329 |issue=10 |pages=683–9 |year=1993 |pmid=8345854 |doi=10.1056/NEJM199309023291002 |url=}}</ref><ref name="pmid21668725">{{cite journal |vauthors=Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS |title=Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman |journal=Emerg Med Australas |volume=23 |issue=3 |pages=372–5 |year=2011 |pmid=21668725 |doi=10.1111/j.1742-6723.2011.01425.x |url=}}</ref><ref name="pmid9747750">{{cite journal |vauthors=Dejager S, Gerber S, Foubert L, Turpin G |title=Sheehan's syndrome: differential diagnosis in the acute phase |journal=J. Intern. Med. |volume=244 |issue=3 |pages=261–6 |year=1998 |pmid=9747750 |doi= |url=}}</ref>
 
[[Menopause]] should be differentiated from other [[diseases]] presenting with [[menstrual irregularities]] ([[oligomenorrhea]]/[[amenorrhea]]).<ref name="pmid9541295">{{cite journal |vauthors=Sato N, Sze G, Endo K |title=Hypophysitis: endocrinologic and dynamic MR findings |journal=AJNR Am J Neuroradiol |volume=19 |issue=3 |pages=439–44 |year=1998 |pmid=9541295 |doi= |url=}}</ref><ref name="pmid7758238">{{cite journal |vauthors=Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH |title=Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature |journal=Clin. Endocrinol. (Oxf) |volume=42 |issue=3 |pages=315–22 |year=1995 |pmid=7758238 |doi= |url=}}</ref><ref name="pmid26262437">{{cite journal |vauthors=Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S |title=Diagnosis of Primary Hypophysitis in Germany |journal=J. Clin. Endocrinol. Metab. |volume=100 |issue=10 |pages=3841–9 |year=2015 |pmid=26262437 |doi=10.1210/jc.2015-2152 |url=}}</ref><ref name="pmid7629223">{{cite journal |vauthors=Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S |title=Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings |journal=J. Clin. Endocrinol. Metab. |volume=80 |issue=8 |pages=2302–11 |year=1995 |pmid=7629223 |doi=10.1210/jcem.80.8.7629223 |url=}}</ref><ref name="pmid8345854">{{cite journal |vauthors=Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H |title=Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus |journal=N. Engl. J. Med. |volume=329 |issue=10 |pages=683–9 |year=1993 |pmid=8345854 |doi=10.1056/NEJM199309023291002 |url=}}</ref><ref name="pmid21668725">{{cite journal |vauthors=Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS |title=Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman |journal=Emerg Med Australas |volume=23 |issue=3 |pages=372–5 |year=2011 |pmid=21668725 |doi=10.1111/j.1742-6723.2011.01425.x |url=}}</ref><ref name="pmid9747750">{{cite journal |vauthors=Dejager S, Gerber S, Foubert L, Turpin G |title=Sheehan's syndrome: differential diagnosis in the acute phase |journal=J. Intern. Med. |volume=244 |issue=3 |pages=261–6 |year=1998 |pmid=9747750 |doi= |url=}}</ref>
 
{| class="wikitable"
 
! rowspan="3" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Diseases}}
 
! rowspan="3" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Onset}}
 
! colspan="5" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Manifestations}}
 
! colspan="4" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Diagnosis}}
 
|-
 
! colspan="4" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|History and Symptoms}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Physical examination}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Laboratory findings}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Gold standard}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Imaging}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Other investigation findings}}
 
|-
 
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Trumatic delivery}}
 
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Lactation failure}}
 
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Menstrual irregularities}}
 
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Other features}}
 
|-
 
![[Sheehan's syndrome]]
 
|Acute
 
|<nowiki>++</nowiki>
 
| ++
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|Symptoms of:
 
* [[Adrenal insufficiency]]
 
 
* [[Hypothyroidism]]
 
|
 
* [[Breast tissue]] [[atrophy]]
 
 
* Decreased [[axillary]] and [[pubic]] hair growth
 
|
 
* [[Pancytopenia]]
 
 
* [[Eosinophilia]]
 
 
* [[Hyponatremia]]
 
 
* Low [[fasting plasma glucose]]
 
 
* Decreased levels of [[anterior pituitary]] [[hormones]] in blood
 
 
|
 
* Clinical diagnosis 
 
 
* Most senitive test: Low baseline [[prolactin]] levels w/o response to [[Thyrotropin-releasing hormone|TRH]]
 
|CT/MRI:
 
* Sequential changes of pituitary enlargement followed by:
 
* Shrinkage and [[necrosis]] leading to decreased sellar volume or [[empty sella]]
 
|
 
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
 
|-
 
![[Lymphocytic hypophysitis]]
 
|Acute
 
|<nowiki>+/-</nowiki>
 
|<nowiki>+</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
* Associated with [[autoimmune]] conditions
 
 
* Generalized [[headache]]
 
 
* Retro-orbital or Bitemporal [[pain]]
 
 
* Mass lesion effect such as [[Visual field defect|visual field defects]]
 
|
 
* [[Diabetes insipidus|DI]]
 
 
* [[Autoimmune]] [[thyroiditis]]
 
|
 
* Decreased pituitary hormones([[Gonadotropins]] most common)
 
 
* [[Hyperprolactinemia]](40%)
 
 
* [[Growth hormone|GH]] excess
 
|
 
* [[Pituitary gland|Pituitary]] [[biopsy]]: [[lymphocytic]] [[Infiltration (medical)|infiltration]]
 
|
 
* [[CT]] & [[MRI]]: Features of a [[Pituitary gland|pituitary]] [[mass]]
 
 
* Diffuse and homogeneous contrast enhancement
 
|[[Assay|Assays]] for:
 
* Anti-TPO 
 
* Anti-Tg Ab
 
|-
 
![[Pituitary apoplexy]]
 
|Acute
 
|<nowiki>+/-</nowiki>
 
|<nowiki>++</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|Severe [[headache]]
 
* [[Nausea and vomiting]]
 
* Paralysis of eye muscles ([[diplopia]])
 
* Changes in vision
 
|
 
* [[Visual acuity]] defects
 
 
* [[Cranial nerve palsies|CN palsies]] (nerves III, IV, V , and VI)
 
 
|
 
* Decreased levels of [[anterior]] pituitary hormones in blood.
 
|
 
* [[Magnetic resonance imaging|MRI]]
 
|
 
* [[CT]] scan without [[Contrast medium|contrast]]: Hemorrhag<nowiki/>e on [[CT]] presents as a hyperdense lesion
 
 
* [[MRI]]: If inconclusive [[CT]]
 
|
 
[[Blood tests]] may be done to check:
 
* [[PT]]/[[INR]] and [[aPTT]]
 
 
* [[Pituitary gland|Pituitary]] [[hormonal]] assay
 
|-
 
![[Empty sella syndrome]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
* [[Erectile dysfunction]]
 
 
* [[Headache]]
 
 
* Low [[libido]]
 
 
|
 
* Signs of raised [[intracranial pressure]] may be present
 
 
* [[Nipple discharge|Nipple]] discharge
 
|
 
* Decreased levels of pituitary hormones in the blood.
 
|
 
* [[MRI]]
 
|
 
* [[Empty sella]] containing [[Cerebrospinal fluid|CSF]]
 
|
 
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
 
|-
 
![[Simmond's Disease|Simmonds' disease]]/[[Pituitary]] [[cachexia]]
 
|Chronic
 
|<nowiki>+/-</nowiki>
 
| +
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
* [[Cachexia]]
 
* [[Premature aging|Premature]] aging
 
|
 
* Progressive [[emaciation]]
 
 
* Loss of body hair
 
|
 
* Decreased levels of anterior pituitary hormones in the blood.
 
|
 
* [[Magnetic resonance imaging|MRI]]
 
|
 
* Done to rule out any pituitary cause
 
|
 
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
 
|-
 
! [[Primary hypothyroidism|Hypothyroidism]]
 
|Chronic
 
|<nowiki>+/-</nowiki>
 
|<nowiki>-</nowiki>
 
|[[Oligomenorrhea]]/[[menorrhagia]]
 
|
 
* Cold intolerance
 
* [[Constipation]]
 
|
 
* Dry skin
 
 
* [[Bradycardia]]
 
 
* Hair loss
 
 
* [[Myxedema]]
 
 
* Delayed relaxation phase of deep [[Tendon reflex|tendon reflexes]]
 
|
 
* Low [[T3]],[[T4]]
 
 
* Normal/ low [[Thyroid-stimulating hormone|TSH]]
 
 
* Rest of pituitary hormone levels WNL
 
|
 
* [[TSH]] levels
 
|
 
* Done to rule out any pituitary cause
 
|
 
*Assays for anti-TPO and anti-Tg Ab
 
*FNA biopsy
 
|-
 
![[Hypogonadotropic hypogonadism]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>-</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
* [[Hot flushes]]
 
 
* Energy and mood changes
 
 
* Decreased [[libido]]
 
|
 
* [[Breast tissue]] [[atrophy]]
 
* Decreased [[maturation]] of [[vaginal]] [[mucosa]]
 
|
 
* Low [[estrogen]], [[testosterone]]
 
 
* High [[FSH]]/[[Luteinizing hormone|LH]]
 
|
 
* [[FSH]]
 
* [[Luteinizing hormone|LH]]
 
|
 
* Done to rule out any pituitary cause
 
|
 
* Genetic tests  ([[karyotype]])
 
* Measurement of total and free [[testosterone]] and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] concentrations
 
|-
 
!Hypoprolactinemia
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
 
|<nowiki>-</nowiki>
 
|
 
* [[Infertility]]
 
* Subfertility
 
|
 
* Puerperal agalactogenesis
 
|
 
* No workup is necessary
 
|
 
* Decreased prolactin levels
 
|
 
* Done to rule out any pituitary cause
 
|
 
* [[Prolactin]] assay in [[3rd trimester]]
 
 
* [[Luteinizing hormone|LH]], [[Follicle-stimulating hormone|FSH]]
 
 
* [[Thyrotropin]] and free [[thyroxine]]
 
|-
 
![[Panhypopituitarism]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
* [[Polyuria]]
 
 
* [[Polydipsia]]
 
* Features of [[hypothyroidism]] and [[hypoadrenalism]]
 
|
 
* [[Growth failure]]
 
 
* B/L [[hemianopsia]]
 
 
* [[Papilledema]]
 
|
 
* All pituitary hormones decreased
 
|
 
* [[Magnetic resonance imaging|MRI]]
 
|
 
* Done to rule out any pituitary cause
 
|
 
* Left hand and wrist [[radiograph]] for [[bone age]]
 
|-
 
![[Primary adrenal insufficiency]]/[[Addison's disease]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
| -
 
|<nowiki>-</nowiki>
 
|
 
* [[Hypoglycemia]]
 
 
* [[Hypotension]]
 
|
 
* [[Dehydration]]
 
 
* [[Hyperpigmentation]]
 
 
* loss of [[pubic]] and [[axillary]] hair
 
 
|
 
* [[Hyponatremia]] with/without [[hyperkalemia]]
 
 
* [[Plasma renin activity]] to [[Aldosterone|aldosterone ratio]]
 
|
 
* Abdominal [[Computed tomography|CT]]
 
|
 
* Abdominal [[Computed tomography|CT]]
 
|
 
* Serum [[cortisol]] testing
 
 
* Serum [[ACTH]] testing
 
 
* Anti-adrenal [[Antibody|Ab]] testing
 
|-
 
![[Menopause]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>+/-</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
* [[Hot flashes]]
 
* [[Insomnia]]
 
* [[Weight gain]] and [[bloating]]
 
* Mood changes
 
|
 
* [[Vaginal atrophy]]
 
* Loss of pelvic [[muscle tone]]
 
|
 
* ↑ [[FSH]]
 
* ↓ [[Estradiol]] and [[inhibin]]
 
|
 
* [[FSH]] > [[LH]]
 
|Normal
 
|
 
* [[Endometrial biopsy]]
 
|}
 
{| class="wikitable"
 
! rowspan="3" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Diseases}}
 
! rowspan="3" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Onset}}
 
! colspan="5" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Manifestations}}
 
! colspan="4" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Diagnosis}}
 
|-
 
! colspan="4" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|History and Symptoms}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Physical examination}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Laboratory findings}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Gold standard}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Imaging}}
 
! rowspan="2" style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Other investigation findings}}
 
|-
 
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Trumatic delivery}}
 
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Lactation failure}}
 
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Menstrual irregularities}}
 
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF| Other features}}
 
|-
 
![[Sheehan's syndrome]]
 
|Acute
 
|<nowiki>++</nowiki>
 
|  ++
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|Symptoms of:
 
 
*[[Adrenal insufficiency]]
 
 
*[[Hypothyroidism]]
 
|
 
*[[Breast tissue]] [[atrophy]]
 
 
* Decreased [[axillary]] and [[pubic]] hair growth
 
|
 
*[[Pancytopenia]]
 
 
*[[Eosinophilia]]
 
 
*[[Hyponatremia]]
 
 
* Low [[fasting plasma glucose]]
 
 
* Decreased levels of [[anterior pituitary]] [[hormones]] in blood
 
 
|
 
* Clinical diagnosis
 
 
* Most senitive test: Low baseline [[prolactin]] levels w/o response to [[Thyrotropin-releasing hormone|TRH]]
 
|CT/MRI:
 
 
* Sequential changes of pituitary enlargement followed by:
 
* Shrinkage and [[necrosis]] leading to decreased sellar volume or [[empty sella]]
 
|
 
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
 
|-
 
![[Lymphocytic hypophysitis]]
 
|Acute
 
|<nowiki>+/-</nowiki>
 
|<nowiki>+</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
* Associated with [[autoimmune]] conditions
 
 
* Generalized [[headache]]
 
 
* Retro-orbital or Bitemporal [[pain]]
 
 
* Mass lesion effect such as [[Visual field defect|visual field defects]]
 
|
 
*[[Diabetes insipidus|DI]]
 
 
*[[Autoimmune]] [[thyroiditis]]
 
|
 
* Decreased pituitary hormones([[Gonadotropins]] most common)
 
 
*[[Hyperprolactinemia]](40%)
 
 
*[[Growth hormone|GH]] excess
 
|
 
*[[Pituitary gland|Pituitary]] [[biopsy]]: [[lymphocytic]] [[Infiltration (medical)|infiltration]]
 
|
 
*[[CT]] & [[MRI]]: Features of a [[Pituitary gland|pituitary]] [[mass]]
 
 
* Diffuse and homogeneous contrast enhancement
 
|[[Assay|Assays]] for:
 
 
* Anti-TPO
 
* Anti-Tg Ab
 
|-
 
![[Pituitary apoplexy]]
 
|Acute
 
|<nowiki>+/-</nowiki>
 
|<nowiki>++</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|Severe [[headache]]
 
*[[Nausea and vomiting]]
 
* Paralysis of eye muscles ([[diplopia]])
 
* Changes in vision
 
|
 
*[[Visual acuity]] defects
 
 
*[[Cranial nerve palsies|CN palsies]] (nerves III, IV, V , and VI)
 
 
|
 
* Decreased levels of [[anterior]] pituitary hormones in blood.
 
|
 
*[[Magnetic resonance imaging|MRI]]
 
|
 
*[[CT]] scan without [[Contrast medium|contrast]]: Hemorrhag<nowiki/>e on [[CT]] presents as a hyperdense lesion
 
 
*[[MRI]]: If inconclusive [[CT]]
 
|
 
[[Blood tests]] may be done to check:
 
 
*[[PT]]/[[INR]] and [[aPTT]]
 
 
*[[Pituitary gland|Pituitary]] [[hormonal]] assay
 
|-
 
![[Empty sella syndrome]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
*[[Erectile dysfunction]]
 
 
*[[Headache]]
 
 
* Low [[libido]]
 
 
|
 
* Signs of raised [[intracranial pressure]] may be present
 
 
*[[Nipple discharge|Nipple]] discharge
 
|
 
* Decreased levels of pituitary hormones in the blood.
 
|
 
*[[MRI]]
 
|
 
*[[Empty sella]] containing [[Cerebrospinal fluid|CSF]]
 
|
 
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
 
|-
 
![[Simmond's Disease|Simmonds' disease]]/[[Pituitary]] [[cachexia]]
 
|Chronic
 
|<nowiki>+/-</nowiki>
 
|  +
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
*[[Cachexia]]
 
*[[Premature aging|Premature]] aging
 
|
 
* Progressive [[emaciation]]
 
 
* Loss of body hair
 
|
 
* Decreased levels of anterior pituitary hormones in the blood.
 
|
 
*[[Magnetic resonance imaging|MRI]]
 
|
 
* Done to rule out any pituitary cause
 
|
 
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests)
 
|-
 
![[Primary hypothyroidism|Hypothyroidism]]
 
|Chronic
 
|<nowiki>+/-</nowiki>
 
|<nowiki>-</nowiki>
 
|[[Oligomenorrhea]]/[[menorrhagia]]
 
|
 
* Cold intolerance
 
*[[Constipation]]
 
|
 
* Dry skin
 
 
*[[Bradycardia]]
 
 
* Hair loss
 
 
*[[Myxedema]]
 
 
* Delayed relaxation phase of deep [[Tendon reflex|tendon reflexes]]
 
|
 
* Low [[T3]],[[T4]]
 
 
* Normal/ low [[Thyroid-stimulating hormone|TSH]]
 
 
* Rest of pituitary hormone levels WNL
 
|
 
*[[TSH]] levels
 
|
 
* Done to rule out any pituitary cause
 
|
 
*Assays for anti-TPO and anti-Tg Ab
 
*FNA biopsy
 
|-
 
![[Hypogonadotropic hypogonadism]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>-</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
*[[Hot flushes]]
 
 
* Energy and mood changes
 
 
* Decreased [[libido]]
 
|
 
*[[Breast tissue]] [[atrophy]]
 
* Decreased [[maturation]] of [[vaginal]] [[mucosa]]
 
|
 
* Low [[estrogen]], [[testosterone]]
 
 
* High [[FSH]]/[[Luteinizing hormone|LH]]
 
|
 
*[[FSH]]
 
*[[Luteinizing hormone|LH]]
 
|
 
* Done to rule out any pituitary cause
 
|
 
* Genetic tests  ([[karyotype]])
 
* Measurement of total and free [[testosterone]] and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] concentrations
 
|-
 
!Hypoprolactinemia
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
 
|<nowiki>-</nowiki>
 
|
 
*[[Infertility]]
 
* Subfertility
 
|
 
* Puerperal agalactogenesis
 
|
 
* No workup is necessary
 
|
 
* Decreased prolactin levels
 
|
 
* Done to rule out any pituitary cause
 
|
 
*[[Prolactin]] assay in [[3rd trimester]]
 
 
*[[Luteinizing hormone|LH]], [[Follicle-stimulating hormone|FSH]]
 
 
*[[Thyrotropin]] and free [[thyroxine]]
 
|-
 
![[Panhypopituitarism]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>+</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
*[[Polyuria]]
 
 
*[[Polydipsia]]
 
* Features of [[hypothyroidism]] and [[hypoadrenalism]]
 
|
 
*[[Growth failure]]
 
 
* B/L [[hemianopsia]]
 
 
*[[Papilledema]]
 
|
 
* All pituitary hormones decreased
 
|
 
*[[Magnetic resonance imaging|MRI]]
 
|
 
* Done to rule out any pituitary cause
 
|
 
* Left hand and wrist [[radiograph]] for [[bone age]]
 
|-
 
![[Primary adrenal insufficiency]]/[[Addison's disease]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|  -
 
|<nowiki>-</nowiki>
 
|
 
*[[Hypoglycemia]]
 
 
*[[Hypotension]]
 
|
 
*[[Dehydration]]
 
 
*[[Hyperpigmentation]]
 
 
* loss of [[pubic]] and [[axillary]] hair
 
 
|
 
*[[Hyponatremia]] with/without [[hyperkalemia]]
 
 
*[[Plasma renin activity]] to [[Aldosterone|aldosterone ratio]]
 
|
 
* Abdominal [[Computed tomography|CT]]
 
|
 
* Abdominal [[Computed tomography|CT]]
 
|
 
* Serum [[cortisol]] testing
 
 
* Serum [[ACTH]] testing
 
 
* Anti-adrenal [[Antibody|Ab]] testing
 
|-
 
![[Menopause]]
 
|Chronic
 
|<nowiki>-</nowiki>
 
|<nowiki>+/-</nowiki>
 
|[[Oligomenorrhea|Oligo]]/[[amenorrhea]]
 
|
 
*[[Hot flashes]]
 
*[[Insomnia]]
 
*[[Weight gain]] and [[bloating]]
 
* Mood changes
 
|
 
*[[Vaginal atrophy]]
 
* Loss of pelvic [[muscle tone]]
 
|
 
* ↑ [[FSH]]
 
* ↓ [[Estradiol]] and [[inhibin]]
 
|
 
*[[FSH]] > [[LH]]
 
|Normal
 
|
 
*[[Endometrial biopsy]]
 
|}
 
  
 
==[[Menopause epidemiology and demographics|Epidemiology and Demographics]]==
 
==[[Menopause epidemiology and demographics|Epidemiology and Demographics]]==
Line 668: Line 25:
 
==[[Diagnosis]]==
 
==[[Diagnosis]]==
 
[[Menopause history and symptoms|History and Symptoms]] | [[Menopause physical examination|Physical Examination]] | [[Menopause laboratory findings|Laboratory Findings]]
 
[[Menopause history and symptoms|History and Symptoms]] | [[Menopause physical examination|Physical Examination]] | [[Menopause laboratory findings|Laboratory Findings]]
 +
 
==[[Treatment]]==
 
==[[Treatment]]==
[[Menopause medical therapy|Medical Therapy]] | | [[Menopause cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Menopause future or investigational therapies|Future or Investigational Therapies]]
+
[[Menopause medical therapy|Medical Therapy]] | [[Menopause cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Menopause future or investigational therapies|Future or Investigational Therapies]]
  
 
==Related Chapters==  
 
==Related Chapters==  

Revision as of 19:26, 2 August 2020

Menopause Microchapters

Home

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Overview

Historical Perspective

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Pathophysiology

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Epidemiology and Demographics

Natural History, Complications and Prognosis

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Other Imaging Findings

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Medical Therapy

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Case #1

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For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Editor-In-Chief: Rahmah Al-Edresi, M.D.

Synonyms and Keywords: Climacteric, Midlife crisis, Perimenopause, Postmenopause, Premenopause, Change of life.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating menopause from other diseases

Menopause should be differentiated from other diseases presenting with menstrual irregularities (oligomenorrhea/amenorrhea).[1][2][3][4][5][6][7]

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings

Treatment

Medical Therapy | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Related Chapters

References

  1. Sato N, Sze G, Endo K (1998). "Hypophysitis: endocrinologic and dynamic MR findings". AJNR Am J Neuroradiol. 19 (3): 439–44. PMID 9541295.
  2. Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH (1995). "Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature". Clin. Endocrinol. (Oxf). 42 (3): 315–22. PMID 7758238.
  3. Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S (2015). "Diagnosis of Primary Hypophysitis in Germany". J. Clin. Endocrinol. Metab. 100 (10): 3841–9. doi:10.1210/jc.2015-2152. PMID 26262437.
  4. Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S (1995). "Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings". J. Clin. Endocrinol. Metab. 80 (8): 2302–11. doi:10.1210/jcem.80.8.7629223. PMID 7629223.
  5. Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H (1993). "Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus". N. Engl. J. Med. 329 (10): 683–9. doi:10.1056/NEJM199309023291002. PMID 8345854.
  6. Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS (2011). "Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman". Emerg Med Australas. 23 (3): 372–5. doi:10.1111/j.1742-6723.2011.01425.x. PMID 21668725.
  7. Dejager S, Gerber S, Foubert L, Turpin G (1998). "Sheehan's syndrome: differential diagnosis in the acute phase". J. Intern. Med. 244 (3): 261–6. PMID 9747750.

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