Diagnosis of Secondary Amenorrhea:

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Diagnosis of Secondary Amenorrhea:

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DrVirgo
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01/06/08 - 07:02 AM

Dx. of Secondary Amenorrhea:

What is the right order:
1. Pregnancy test, then TSH, then Prolactin
OR
2. Pregnancy test, then Prolactin, then TSH

According to Kap it's 1... According to UW its 2.

Please clarify.
Thanks.

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arlete
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01/06/08 - 09:30 AM

I think it's 1, because of the greater incidence (thyroid dysfunction > prolactinoma).

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DrVirgo
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01/06/08 - 10:20 AM

arlete wrote:
I think it's 1, because of the greater incidence (thyroid dysfunction > prolactinoma).

Yes, I agree. smiling face

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sprint123
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01/06/08 - 10:28 AM

However, if we go for prolactin first ----- If it is NOT elevated, can we rule out hypothyroidism?

dec T4 ---> Inc TRH --> Inc Prolactin

arlete
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01/06/08 - 10:30 AM

I don't think so...

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DrVirgo
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01/06/08 - 11:33 AM

sprint123 wrote:
However, if we go for prolactin first ----- If it is NOT elevated, can we rule out hypothyroidism?

dec T4 ---> Inc TRH --> Inc Prolactin

Good question, but I don't think so because ONLY VERY HIGH levels of TSH and TRH can increase prolactin, so sometimes hypothyroidism as you described can lead to Increased prolactin. But an absence of an increase in prolactin can't rule out Hypothyroidism. I hope I'm explaining this right. smiling face

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maoudoody
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01/06/08 - 11:47 AM

sprint123 wrote:
However, if we go for prolactin first ----- If it is NOT elevated, can we rule out hypothyroidism?

dec T4 ---> Inc TRH --> Inc Prolactin

no cause hypothyroidism is not the only cause of hyperprolactinemia

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