Prognosis in primary amenorrhea.

A retrospective review of 62 patients with primary amenorrhea indicates that thoughtful clinical evaluation combined with dynamic hypothalamic-pituitary testing can usually determine the etiology and prognosis. A careful history, consideration of chronologic age/bone age/height relationships, and assay of serum gonadotropins distinguished all patients with medical diseases, ovarian failure, hypogonadotropic hypogonadism, and polycystic ovaries. Luteinizing hormone-releasing hormone (LH-RH) stimulation, sometimes combined with clomiphene therapy and estrogen provocation tests, assisted with prognostic and pathophysiologic evaluation, although patient management rarely changed. An age-inappropriate LH-RH test result was helpful in identifying patients with abnormal maturational patterns.