Amenorrhoea (secondary)

Population Covered By The Guidance

This pathway provides guidance on investigating adult female patients with unexplained secondary amenorrhoea.

Date reviewed: February 2013

Date Published: April 2013

Image 1a (T1 weighted), 1b and 1c (T2 weighted) (Magnetic Resonance Imaging): There is a lesion seen within the pituitary gland centred to the right of the midline which is of high signal intensity on the T2 weighted imaging and shows slightly reduced signal intensity compared with adjacent pituitary on the T1 weighted imaging. Overall, the lesion measures up to 6mm. The lateral aspect of the lesion is abutting the medial aspect of the cavernous segment of the right internal carotid artery. The superior aspect of the pituitary is directly adjacent to the inferior aspect of the optic chiasm. The appearances are consistent with a pituitary microadenoma.

Pituitary Microadenoma

Image 1a (T1 weighted), 1b and 1c (T2 weighted) (Magnetic Resonance Imaging): There is a lesion seen within the pituitary gland centred to the right of the midline which is of high signal intensity on the T2 weighted imaging and shows slightly reduced signal intensity compared with adjacent pituitary on the T1 weighted imaging. Overall, the lesion measures up to 6mm. The lateral aspect of the lesion is abutting the medial aspect of the cavernous segment of the right internal carotid artery. The superior aspect of the pituitary is directly adjacent to the inferior aspect of the optic chiasm. The appearances are consistent with a pituitary microadenoma.

Pituitary Microadenoma

Image 1a (T1 weighted), 1b and 1c (T2 weighted) (Magnetic Resonance Imaging): There is a lesion seen within the pituitary gland centred to the right of the midline which is of high signal intensity on the T2 weighted imaging and shows slightly reduced signal intensity compared with adjacent pituitary on the T1 weighted imaging. Overall, the lesion measures up to 6mm. The lateral aspect of the lesion is abutting the medial aspect of the cavernous segment of the right internal carotid artery. The superior aspect of the pituitary is directly adjacent to the inferior aspect of the optic chiasm. The appearances are consistent with a pituitary microadenoma.

Pituitary Microadenoma

Image 2a and 2b: Post-mortem specimens showing a circumcribed nodular tumour arising from the anterior pituitary consistent with a macroadenoma.

Pituitary Macroadenoma

Image 2a and 2b: Post-mortem specimens showing a circumcribed nodular tumour arising from the anterior pituitary consistent with a macroadenoma.

Pituitary Macroadenoma

Image 2c (H&E, x2.5) and 2d (H&E, x20): Histological sections demonstrating a circumscribed lesion composed of sheets of uniform polygonal cells with centrally placed nuclei and amphophilic cytoplasm. The features are consistent with a pituitary adenoma.

Pituitary Macroadenoma

Image 2c (H&E, x2.5) and 2d (H&E, x20): Histological sections demonstrating a circumscribed lesion composed of sheets of uniform polygonal cells with centrally placed nuclei and amphophilic cytoplasm. The features are consistent with a pituitary adenoma.

Pituitary Macroadenoma

  • Diagnostic Imaging may reveal a cause of secondary amenorrhoea in the following cases
    • Central hypogonandism where a functioning or non-functioning pituitary adenoma is present
    • Ultrasonography of the ovaries in suspected polycystic ovarian syndrome or primary ovarian failure

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SYMBOL RRL EFFECTIVE DOSE RANGE
No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv

Disclaimer

Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.

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Obstetric & Gynaecological