Child with primary amenorrhea with negative progesterone challenge test but positive combined estrogen and progesterone test. Diagnosis may be:: (A) Mullerian agenesis, (B) PCOD, (C) Asherman syndrome, (D) Prolactinoma
Answer is D. Positive combined estrogen and progesterone test means there is no sufficient estrogen for priming the endometrium so the pathology may lies in the hypothalamo-Pituitary-Ovarian axis Causes: Ovarian: Gonadal Dysgenesis, Premature Ovarian Failure, Resistant ovary syndrome , Autoimmune causes and Chemoradiation Pituitary: Pituitary Adenomas, Empty Sella Syndrome, Sheehans Syndrome, Infiltrative Pituitary Lesions Hypothalamic: Eating disorders , Congenital GnRH Deficiency [ Kallmann&;s Syndrome, GnRH Receptor Mutation Reference: Clinical Endocinologic Gynecology and infeility; Eigth Edition, Chapter 11