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+--- Thread: Secondary Amennorrhea - sachin007 (/showthread.php?tid=587925)
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Secondary Amennorrhea - sachin007 - ArchivalUser - 05-24-2011
33, f, 6 month history of amenorrhea. BMI - 31.5, Pregnancy test negative.
What is the best next step in management?
1. Estrogen levels
2. Progestin challenge
3. FSH & LH
4. TSH
5. Testesterone & DHEAS
0 - ArchivalUser - 05-24-2011
2..
0 - ArchivalUser - 05-24-2011
why not 4. As far as i remember MTB has a table where they check TSH first and go on to do the others. Please explain
0 - ArchivalUser - 05-24-2011
4 ... i suspect hypothyroidism BMI 31.5 hhmmmm
0 - ArchivalUser - 05-24-2011
this question is in u world... i was confused as well... after bhcg negative next step is progesterone challenge test....
Q 102 . U World
sec amenorrhea work up...
1.pregnancy test
2.progesterone challenge test
3.tsh
4.prolactin
0 - ArchivalUser - 05-24-2011
Yes. This is Uworld question.
Check page 440 of MTB.
I personally think TSH is a better answer. Any other suggestions?
0 - ArchivalUser - 05-24-2011
this is a case of secondary amenorrhea:
according to fisher, the steps in the w/u:
1. pregnancy test
2. TSH
3.Prolactin
4. progestgerone challenge test
5. estrogen-progesterone challenge test
0 - ArchivalUser - 05-24-2011
Yes, Sachin even I think prolactin and TSH should be done first
0 - ArchivalUser - 05-24-2011
Tsh can't show the direct cause of amoenorrhoea,it is likely association.
Q is asking the best next test....that should be the progesterone challenge test that can give direct clue for amoenorrhoea.
0 - ArchivalUser - 05-24-2011
But don't we test for the most common cause first?