Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 36 year old woman was admitted to the hospital in November 1983 because of her inability to walk. For 3 months prior to admission, she took oral contraceptives (OCs) as a treatment for amenorrhea. 2 months prior to admission, she had general malaise, anorexia, and unsteady gait. 1 month before her admission, tingling and numbness began in the fingertips and spread up to the forearms, a tight feeling around the waist developed, and walking became ataxic. On admission to the hospital, she was thin and pale with greying hair. Her mind was clear and there were no abnormalities of the cranial nerves. Her extremities were hypotonic but not wasted. Slight muscle weakness of the hands and feet was noted. There was myokymia in both legs. Deep tendon reflexes of the extremities were absent. The plantar responses were extensor and lack of coordination in the extremities was noted. There was a definite glove and stocking type of hypesthesia to pinprick and cotton wool. Vibration sense was decreased below T11 and lost in both legs. There was a marked loss of position sense to passive movement in the legs and some impairment in the hands. Laboratory examination revealed mild magaloblastic anemia, elevated LDH, borderline low concentration of vitamin B12 in the serum, increased excretion of methylmalonate in the urine, achylia, positive antiparietal cell antibody and positive anti-intrinsic factor antibody. Cyanocobalamin absorption by the Schilling test was 5.6% after intrinsic factor, 11.3%. The diagnosis of pernicious anemia was made. Upper gastrointestinal studies showed typical carcinoid tumors of the stomach. Cerebrospinal fluid was normal. Peripheral nerve conduction studies demonstrated normal or slightly decreased motor conduction velocities and absent sensory action potential. Sural nerve biopsy was performed. Myelinated fibers were moderately decreased in number to 5554/mm squared and pronounced loss of large myelinated fibers was demonstrated in fiber histogram. Teased method of the single fiber showed mainly axonal degeneration. Anemia and neurologic function improved rapidly with parenteral hydroxocobalamin therapy and 1 month after treatment commenced, she was able to walk without assistance. The clinical significance of peripheral nerve involvement of subacute combined degeneration of the spinal cord was discussed, as the peripheral nerve affection is only poorly understood in contrast to the myelopathy. This was followed by discussion of the possible effect of the OCs and gastric carcinoid to neurological manifestation of pernicious anemia. (author's modified)
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PMID:[Subacute combined degeneration of spinal cord. Significance of peripheral nerve involvement]. 401 64

The classical cause of postpartum hypopituitarism is Sheehan's syndrome, in which an obstetric catastrophe is associated with hypotension. However, with improvements in obstetric care, the most common cause now may be lymphocytic hypophysitis. Five women with postpartum hypopituitarism, whose symptoms occurred during or immediately after pregnancy, had detailed endocrine and pituitary imaging for the duration of follow-up. Two presented with visual symptoms, and three with non-specific illnesses related to varying deficiencies of anterior pituitary hormones. Four were unable to lactate, and four were initially amenorrhoeic. Initially, four of the five women had enlarged pituitary glands on magnetic resonance imaging. Four have to some extent recovered pituitary function. One patient had associated thyroiditis: in two cases antinuclear antibodies became positive during follow-up, and in one of these dsDNA antibody was also detected. In no case were pituitary antibodies detected. None had complicated pregnancies or deliveries, and the two who had caesarean sections had no episodes of hypotension. The presentation of secondary hypothyroidism combined with ACTH deficiency in four of the five women strongly suggests lymphocytic hypophysitis. This diagnosis should be considered in postpartum women with general malaise and persistent amenorrhoea, as well as in women who develop visual impairment in the last trimester of pregnancy without antecedent pituitary disease. A conservative policy of management of the pituitary enlargement should be pursued as this resolves.
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PMID:Peripartum hypopituitarism and lymphocytic hypophysitis. 764 44

The authors report the case of a 28 year old woman admitted as an emergency at 15 weeks' amenorrhea for malaise with transient aphasia and orthopnoea due to massive thrombosis of a St Jude aortic valve prosthesis implanted two years previously. This complication occurred after relay of oral anticoagulants with subcutaneous heparin therapy. After a medico-surgical and obstetrical discussion, the indication for thrombolytic therapy with 50 mg of rt-PA over two hours was decided with an excellent clinical and echocardiographic, immediate and lasting result, without any maternal or foetal complication. This enabled pregnancy to be continued to term under oral anti-coagulant therapy. Caesarean section was performed at 8 months leading to the birth of a healthy child. Echocardiographic and radioscopic parameters in the post-partum period showed good prosthetic valve function with no indication for reoperation. This case is original by the absence of neurological and obstetrical complications of thrombolysis, the continuation of pregnancy to term and complete lysis of the thrombus without replacement of the valvular prosthesis.
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PMID:[Successful thrombolysis on an aortic valve prosthesis by plasminogen tissue activator during pregnancy]. 1032 51

Reactions to oral contraceptive therapy tend to be maximal during the first few months of use. They include nausea or epigastric discomfort, malaise, dizziness, nervousness, fatigue, weakness, leg cramps, headache, and depression. The estrogenic component is thought to be the cause. There may also be a psychogenic basis reflecting apprehension. Breast tenderness is an occasional complaint and intermenstrual spotting or breakthrough bleeding is often reported. Increasing dosage has reduced this symptom. Dysmenorrhea prior to treatment may be improved but occasionally it is aggravated. Drug-induced amenorrhea presents a double problem in that failure to resume medication 7 days after completion of a cycle results in a risk of conception. Episodes of severe uterine bleeding in patients discontinuing use after several months or years have been reported. Other side effects include a skin reaction resembling acne, pruritus, hirsutism, thinning of scalp hair, increased skin pigmentation, and weight gain or loss. Serious vascular complications and hepatic dysfunction have been shown and deviation of thyroid function may be shown by increase of serum protein-bound iodine (PBI). Clinical signs of hyperthyroidism have not been described. Oral contraception is associated with elevated plasma cortisol (hydrocortisone) levels and decreased urinary levels of 17-hydroxycorticosteroids (17-OCHS). Suppression of ovarian activity by oral contraceptives is rapidly reversible. Fear of carcinogenesis has caused much alarm but no proof as of the present time. Safety of long term use will require additional years of experience.
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PMID:Side-effects and possible complications of oral contraceptive drugs. 1225 41

Symptomatic granular cell tumors of the neurohypophysis or infundibulum are very rare neoplasms which are difficult to diagnose before operation. We report a case of symptomatic granular cell tumor of the neurohypophysis in a 36-year-old woman who had suffered from amenorrhea and general malaise for more than 1 year. No definite visual or neurological deficit was found. Laboratory examination revealed hyperprolactinemia and decrease of other pituitary hormones. T1-weighted magnetic resonance imaging (MRI) revealed an isointense sellar mass with suprasellar extension. Transsphenoidal subtotal tumor removal was performed and pathological examination revealed a granular cell tumor of the neurohypophysis composed of densely packed polygonal cells with abundant eosinophilic, granular cytoplasm. The granules were periodic acid-Schiff-positive and diastase-resistant. Immunohistochemical study showed positive reaction for S-100 protein and antitrypsin antibodies. Electron microscopic examination showed numerous lysosomes in the cytoplasm of tumor cells. The postoperative MRI showed the residual tumor to be just behind the pituitary stalk and that the tumor should arise from the posterior lobe of the pituitary gland. The postoperative course was smooth and there were no sequelae during 30 months of regular follow-up. We believe surgery remains the treatment of choice and even partial removal of the tumor may benefit the patient.
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PMID:Symptomatic granular cell tumor of the neurohypophysis. 1502 60

Lymphocytic hypophysitis is divided into three forms according to the involved tissues, lymphocytic adenohypophysitis, lymphocytic infundibulo-neurohypophysitis, and lymphocytic panhypophysitis (LPH). The term LPH was first proposed by us in 1995, although its entity and pathogenesis still remain controversial. Here we report five cases of LPH, who visited our clinics during 1994 to 2009. All cases were female of 20 to 77 years of age, and one case was associated with pregnancy. They presented with polyuria (n = 4), headache (n = 3), general malaise, polydipsia (n = 2), blunted vision, diplopia, amenorrhea or appetite loss (n = 1). Magnetic resonance imaging showed the pituitary swelling, the thickened stalk, the loss of the T1 hyperintense neurohypophysis (n = 4), or the atrophic pituitary (n = 1). Endocrinological examinations revealed deficiencies of TSH, ADH in all cases, GH, ACTH in three cases, LH, PRL in two cases, and FSH in one case, respectively. The severity of ADH deficiency varied among the cases. Anti-pituitary antibody was not detected in the cases examined. The biopsy of the pituitary lesions was performed except for one case, all of which revealed the diffuse lymphocytic infiltration. These results suggest that LPH is characterized by the female predominance, the atypical patterns of anterior pituitary hormone deficiencies and the variable degrees of diabetes insipidus in Japanese.
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PMID:Lymphocytic panhypophysitis: its clinical features in Japanese cases. 2388 85

A 54 year old lady presented to our institute with a history of low grade fever for one week associated with occasional loose stools, vomiting and severe malaise. Initial evaluation revealed low serum sodium. An initial diagnosis of acute gastroenteritis with secondary hyponatremia was made. Work up for infective causes of gastroenteritis was however negative. ENT evaluation and review of drug history did not contribute towards a diagnosis. The patient's symptoms persisted and did not respond to symptomatic treatment. Ultrasound of abdomen revealed cholelithiasis with no evidence of cholecystitis. Further evaluation revealed hypotonic hyponatremia with normal levels of urinary sodium excretion. With other causes of hyponatremia ruled out, an endocrinopathy was suspected as the likely culprit. Follow up hormonal studies revealed hypopituitarism and MRI of brain revealed a partially empty sella. On reviewing the case, a past history of amenorrhea immediately after the birth of her third child (almost 20 years ago!) was elicited. Intractable vomiting is quite an unusual presentation for Sheehan's syndrome, but a thorough case history coupled with a high index of suspicion can contribute towards identifying the cause among a series of confounding clinical and radiological findings, as in our case.
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PMID:An Unusual Case of Intractable Vomiting: Unravelling the Present, Through the Past! 3133 Nov 46