ORIGINAL ARTICLE Etiological Evaluation of Adolescents with Primary Amenorrhea Erdal Eren & Halil Saglam & Esra Deniz Papatya Cakir & Omer Tarim Received: 23 May 2013 /Accepted: 27 September 2013 # Dr. K C Chaudhuri Foundation 2013 Abstract Objectives To determine causes of amenorrhea in adolescents with primary amenorrhea and to emphasize general approach to primary amenorrhea. Methods Thirty-nine patients, evaluated between January 2007 and May 2011, were divided into normogonadotropic hypogonadism, hypergonadotropic hypogonadism and hypogonadotropic hypogonadism groups. Means of age, height, weight, body mass index and standard deviation scores, gonadotropin levels, and accompanying diseases were evaluated. Results Mean values of age, height, height standard deviation score, weight and, weight standard deviation score were 15.54 ±1.52 y. 152.0±1.1 cm, -1.37±1.3, 48.2±14.3 kg, 0.96± 1.75, respectively. There were no statistical significances in the auxological parameters. Patients were distributed as 18 cases (46.1 %) with normogonadotropic hypogonadism, 12 cases (30.8 %) with hypergonadotropic hypogonadism, 9 cases (23.1 %) with hypogonadotropic hypogonadism. In the group of normogonadotropic hypogonadism, there were 6 patients with chronic diseases, 5 patients with insulin resis- tance, 4 patients with prolactinomas, 3 patients with müllerian agenesis. Of the hypergonadotropic hypogonadic patients, 3 were idiopathic primary ovarian failure, 3 were 46,XY disor- ders of sex development, 2 were Turner syndrome, 2 were ovarian insufficiency due to drug, one was 17 alpha- hydroxylase deficiency and one was autoimmune oophoritis. The group of hypogonadotropic hypogonadism included 5 patients with normosmic hypogonadism, 2 patients with con- stitutional delay of growth and puberty, 1 patient with panhypopituitarism and 1 patient with anosmic hypogonadism. Conclusions Chronic diseases, prolactinoma, and insulin re- sistance may lead to hypogonadism without altering gonado- tropin levels. Turner syndrome, primary ovarian failure, and autoimmune oophoritis should be investigated in cases with hypergonadotropic hypogonadism. 46, XY disorders of sex development also should be elucidated. Constitutional delay of growth and puberty should be distinguished from isolated hypogonadotropic hypogonadism. Keywords Amenorrhea . Adolescent . Insulin resistance . Hypogonadism . Prolactinoma Introduction Primary amenorrhea (PA) is defined as inability to menstruate until the age of 14 without developing secondary sex charac- teristics or inability to menstruate until 16 y of age regardless of secondary sex characteristics. In adults, the most frequent causes of PA have been reported as gonadal failure, central hypogonadism and müllerian agenesis [1, 2]. Causes of PA in adolescent differ from adults. Furthermore, it can be difficult to differentiate structural delayed puberty seen in adolescents from permanent hypogonadism. Also, PA can be seen in chronic diseases. This paper presents the etiologic data of patients followed up for PA. Material and Methods Thirty-nine cases with PA followed up at Uludağ University Medical Faculty Pediatric Endocrinology clinic between Jan- uary 2007 and May 2011 were evaluated. The patients who E. Eren : H. Saglam : E. D. P. Cakir : O. Tarim Department of Pediatrics, Pediatric Endocrinology Division, Medical School, Uludag University, Bursa, Turkey E. Eren (*) Department of Pediatric Endocrinology, Uludag University, School of Medicine, Gorukle Kampusu, 16059 Bursa, Turkey e-mail: erderen@yahoo.com Indian J Pediatr DOI 10.1007/s12098-013-1266-6