ENDOCRINOLOGIC ASSESSMENT OF SECONDARY AM ENORRHEA AND OLIGOMENORRHEAWITH PARTICULAR FOCUS ON THE POLYCYSTIC-OVARY-SYNDROME (PCOS)

Secondary oligo/amenorrhoea is a common symptom leading to the referra l of patients to a gynecological endocrinologist. The many possible ca uses of secondary amenorrhoea demand a stepwise diagnostic programme i n which the determination of serum concentrations of steroid and prote o hormones, either in terms of basal concentrations or as function tes ts, prays a significant role. This review presents a synopsis of the V arious data found in the literature concerning the relative frequencie s of the different forms of oligo/amenorrhoea and describes a rational ised two-step laboratory diagnostic programme that takes the aetiologi cal situation, as well as practical and economical considerations, int o account. Serum concentrations of the parameters estradiol, prolactin , luteinising and follicle-stimulating hormone, testosterone, sex horm one-binding globulin and thyroid-stimulating hormone make up the first diagnostic level, their results leading to further diagnostic steps i f needed. By aetiology, secondary oligo/amenorrhoea may be classified as hypothalamic, hperprolactinemic, or hyperandrogenemic in origin, as well as caused by ovarial insufficiency or other metabolic conditions , including thyroid dysfunctions. With the help of newly developed rec ombinant gonadotropin releasing factors and analogues, it has recently been possible to study the endocrinological feedback interactions in much greater detail. In particular, the laboratory diagnosis of one of the most common causes of secondary oligo/amenorrhoea, functional ova rial hyperandrogenemia resulting from PCOS, has been significantly imp roved upon by the introduction of the Nafarelin test.