A female with primary amenorrhoea with negative progesterone challenge test but positive combined progesterone & estrogen test. Diagnosis may be:

Ans. D Female is having amenorrhoea d/t hypothalamic or pituitary cause, so prolactinoma is only answer among optionsProgesterone Challenge Test# Indications ; Amenorrhea evaluation# Procedure : Administer Progesterone* Assess for Menstrual Bleeding after Progesterone* Anticipate within 7 days of Progesterone completion# Interpretation* Withdrawal bleeding within Progesterone deficiency> See Normogonadotropic Hyprogonadism for causes> Enddometrial Caner risk with unopposed Estrogen- Requires Progesterone replacement* No withdrawal bleeding* Perform Estrogen-Progesterone Challenge Test- No withdrawal bleed suggests outflow obstruction* Obtain Serum FHS and Serum LH> FSH> 20 and LH 40: Hypergonadotropic hypogonadism> FSH and LH< 5: Hypogonadotropic HypogonadismEstrogen-Progesterone Challenge Test# Indications* Secondary Amenorrhea evaluation* No withdrawal bleeding with Progesterone Challenge test# Procedure* Administer Estrogen-Progesterone* Assess for Menstrual Bleeding after stopping medication> Anticipate within 7 days of medication completion# Interpretation* No withdrawal bleeding occurs> Suggests uterine bleeding outflow obstruction* Withdrawal bleeding {but not after Progesterone alone)> Obtain Serum FSH and Serum LH- FSH > 20 and LH 40: Hypergonadotropic hypogonadism- FHS and LH < 5: Hypogonadotropic hypogonadism