A 28-year-old woman with secondary amenorrhea for 14 months had three dilation and curettage procedures for incomplete miscarriage 2 years ago. Progesterone challenge test shows no withdrawal bleeding. Estrogen-progesterone sequential therapy also fails to induce bleeding. What is the definitive diagnosis?

• A Premature ovarian insufficiency
• B Hypothalamic amenorrhea
• C Pituitary adenoma
• D Asherman syndrome ✓

Explanation

Asherman syndrome (intrauterine adhesions) typically follows uterine curettage and presents with amenorrhea unresponsive to both progesterone alone and combined estrogen-progesterone challenge, confirming the endometrium is non-responsive. Hysteroscopy is diagnostic and therapeutic. Multiple C&Cs are the strongest risk factor. Hormone levels remain normal.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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