Clinical Pearls

The most common cause of sexually infantile primary amenorrhea is gonadal dysgenesis.

Delayed puberty is defined as no development of secondary sexual characteristics by age 14 years.

The follicle-stimulating hormone level distinguishes ovarian failure from central nervous system dysfunction.

The follicle-stimulating hormone level determines the gonadotropic state, and the ovarian estradiol level dictates the gonadal state.

The most important initial test for primary amenorrhea with normal breast development is a pregnancy test.

REFERENCES

Mishell DR. Primary and secondary amenorrhea. In: Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. eds. Comprehensive gynecology, 4th ed. St. Louis: Mosby-Year Book, 2001:1099-1124.

DeUgarte CM, Buyalos RP. Laufer LR. Puberty and disorders of pubertal development. In: Hacker NF. Moore JG, Gambone JC, eds. Essentials of obstetrics and gynecology, 4th ed. Philadelphia: Saunders. 2004:386-397.

A 20-year-old parous woman complains of right breast pain and fever. She states that she underwent a normal spontaneous vaginal delivery 3 weeks previously. She had been breast-feeding without difficulty until 2 days ago, when she noted progressive pain, induration, and redness to the right breast. On examination, her blood pressure is 100/70, heart rate 110 bpm, and temperature I02°F. Her neck is supple. Her right breast has induration on the upper outer region with redness and tenderness. There is also significant fluctuance noted in the breast tissue. The abdomen is nontender. and there is no costovertebral angle tenderness. Pelvic examination is unremarkable.

♦ What is the most likely diagnosis?

^ What is your next step in therapy?

^ What is the etiology of the condition?

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