Endokrinologische diagnostik der sekundaren amenorrho und oligomenorrho unter besonderer berucksichtigung des polyzystischen ovar-syndroms

Secondary oligo/amenorrhoea is a common symptom leading to the referral of patients to a gynecological endocrinologist. The many possible causes of secondary amenorrhoea demand a stepwise diagnostic programme in which the determination of serum concentrations of steroid and proteo hormones, either in terms of basal concentrations or as function tests, plays a significant role. This review presents a synopsis of the various data found in the literature concerning the relative frequencies of the different forms of oligo/amenorrhoea and describes a rationalised two-step laboratory diagnostic programme that takes the aetiological situation, as well as practical and economical considerations, into account. Serum concentrations of the parameters estradiol, prolactin, luteinising and follicle-stimulating hormone, testosterone, sex hormone-binding globulin and thyroid-stimulating hormone make up the first diagnostic level, their results leading to further diagnostic steps if 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 recombinant 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 ovarial hyperandrogenemia resulting from PCOS, has been significantly improved upon by the introduction of the Nafarelin test.