​Symptoms and Signs – Differential Diagnosis of Ovulatory Dysfunction
HYPERANDROGENIC ANOVULATION
• Polycystic ovary syndrome
• Late-onset congenital adrenal hyperplasias
• Ovarian hyperthecosis
• Androgen-producing ovarian tumors
• Androgen-producing adrenal tumors
• Cushing’s syndrome
HYPOESTROGENIC ANOVULATION (HYPOTHALAMIC OR
PITUITARY ETIOLOGY)
Hypogonadotropic Hypoestrogenic States
• Reversible
• Functional hypothalamic amenorrhea: eating disorders (anorexia nervosa, excessive weight loss), excessive athletic training
• Neoplastic: craniopharyngioma, pituitary stalk compression
• Infiltrative diseases: histiocytosis X, sarcoidosis
• Hypophysitis
• Pituitary adenomas: hyperprolactinemia, euprolactinemic galactorrhea
• Endocrinopathies: hypothyroidism/hyperthyroidism, Cushing’s disease
• Irreversible
• Kallmann’s syndrome
• Isolated gonadotropin deficiency (hypothalamic or pituitary origin)
• Panhypopituitarism/pituitary insufficiency: Sheehan’s syndrome, pituitary apoplexy, pituitary irradiation or ablation
Hypergonadotropic Hypoestrogenic States
• Physiologic states: menopause, perimenopause
• Premature ovarian failure
• Immune related: radiation therapy/chemotherapy induced
• Ovarian dysgenesis
• Turner’s syndrome
• 46XX with mutations of X
• Androgen insensitivity syndrome
MISCELLANEOUS
• Endometriosis
• Luteal phase defect
* Spontaneous, multivector, chaotic eye movement.