trogen deficiency isless common. Though some cases trogen andes- in womenwithhypergonadotropism Pregnancy levels(2). and ovulate,despitemenopausal hormone intermittently estrogen Somewomenproduce norrhea. ame- bleeding, after a periodof secondary menstrual ovarianfunctionand with POFexperienceintermittent 50%ofwomen condition,approximately an irreversible (1). few weeksapart above 40IU/L),detectedonatleasttwooccasionsa (FSH)inmenopausalrange(usually mulating hormone the age of 40 years. cycles before cessation ofmenstrual ovarianinsufficiency,premature isusuallydefinedasthe (POF), or ovarian failure the age of 60 years. Premature beyond ofwomen continuingtomenstruate percent erage, menopauseoccursat51yearsofage,withone Arq Bras Metab. Endocrinol 2011;55/4 T INTRODUCTION reção dohipotireoidismo. espontaneamente onze anosapósodesenvolvimento dafalênciaovariana prematuraedacor de idadequeapresentoufalênciaovariana prematuraehipotireoidismoprimário e concebeu pontânea emmulheresafetadasnãoécomum.Relatamos umcasodeumamulher34anos consiste de terapia reposição hormonal com estrógeno e doação de oócitos. A gravidez es- ção emgeral.Noscasosqueexistepreocupaçãocomafertilidade, otratamentogeralmente A falênciaovariana prematuratemumaprevalênciaglobalvariandode0,3%a0,9% napopula- Sumário and correction ofhypothyroidism. after spontaneouslyelevenyears thedevelopmentofprematureovarianand conceived failure case ofa34-yearoldwoman,whohadprematureovarian failureandprimaryhypothyroidism, and oocytedonation.Spontaneouspregnancyinaffected womenisuncommon. We report a fertility isaconcern,treatmentusuallyconsistsofestrogentherapyashormonereplacement Premature ovarian failure has an overall prevalence of 0.3% to 0.9% in generalpopulation.If SUMMARY Laway Bashir Ahmad combinação defalência ovariana edisfunçãotireoidiana Gravidez espontânea emumapaciente apresentando uma ovarian andthyroid failure patient withacombinationof Spontaneous pregnancy ina Mohd Ashraf Ganie Mohd Ashraf Diagnosis isbasedonelevatedlevelsoffolliclesti- and also affected by environmental factors.Inav- byenvironmental and alsoaffected he ageofnaturalmenopauseiscloselyinherited 1 , Abdul HamidZargar Although normal menopauseis Although normal 1 ,Syed Tufail Arq BrasEndocrinolMetab. 2011;55(4):291-3 Arq BrasEndocrinolMetab. 2011;55(4):291-3 1 , MirIftikharBashir 1 1 , primary . hypothyroidism. primary of andsubsequent correction tation ofovarianfailure who conceivedspontaneously10yearsafterdocumen- (3-5).Wegen replacement acaseofwoman report - ofestro some form involved womenwhohadreceived withoutanytherapy, occurred apparently most ofthem ried out four months apart (FSHwas36.73IU/L and ried outfour months apart car the basisofpostmenopausal levelsofgonadotropins by cessationofmenstruation. with hot flushes,followed developed oligomenorrhea years. Thesubjectfailedto conceiveandsubsequently afteraperiodoftwo wasremoved months postpartum ge. Anintrauterinecontraceptivedeviceimplantedatsix - section 14yearsback,withinthefirstyearofhermarria herfirstchildbycesarean A 34-yearwomandelivered CASE REPORT A diagnosis of premature menopausewasmadeon A diagnosisofpremature clinical casereport - 1 Accepted onFeb/9/2011 Received onOct/1/2010 [email protected] Srinagar, Kashmir, India Sciences, Sher-i-Kashmir Institute ofMedical Department ofEndocrinology, Abdul HamidZargar Correspondence to: Sciences, Srinagar, Kashmir, India Sher-i-Kashmir Institute ofMedical DepartmentofEndocrinology 291 -

Copyright© ABE&M todos os direitos reservados. Copyright© ABE&M todos os direitos reservados. Pregnancy inawoman 10years after premature ovarian failure 292 havefailedtodemonstrate any ds. Theseinterventions - andcorticosteroi agonists,sexsteroids asing hormone tempt toinducefertility,- rele includinggonadotrophin 15% (3-5).Various therapieshavebeenusedinanat- 10to Chance ofspontaneousconception rangesfrom levels. ofhighgonadotrophin despite thepresence andevenovulation, production function withestrogen ovarian event, POFischaracterizedbyintermittent menopause is generally an irreversible While normal DISCUSSION of8/10. score malebabyof3.2kgandApgar anormal she delivered Atgestationalage of38weeks, on 50µgofthyroxine. value0.7-2).Patientcontinued 1.11 ng/dL(normal T4was value0.5-5),andfree was 2.7µU/mL(normal TSH glucosetolerance.Herserum 9-11) andnormal valueof calciumof9.35mg/dL (normal dL, serum hemoglobin of11gm/ ths, andinvestigationsrevealed care. cian forherprenatal gestational ageof9weeks.Thepatientsawanobstetri- byultrasoundexamination,with ted andconfirmed wasdetec- check-up,pregnancy Onaroutine norrhea. cycles,followed againbyame- spontaneous menstrual skin pigmentation.AfterstoppingEP, shehadthree wasdiscontinuedbecauseofweight gainand treatment the followingfouryearsuntilJanuary, 2009,whenEP P.O. wasadded.Shecontinuedthesemedicationsfor factor wasnegative. tion; testingforantinuclearantibodyandrheumatoid of was noevidence There normal. ney functiontests, were tion rateandbloodchemistry, includingliverandkid- sedimenta- Complete bloodcount(CBC),erythrocyte orotherautoimmunedisorders. polyglandular failure evaluatedforanyevidenceof The patientwasfurther value5.5-13.5). (T4)of6.34µg/dL(normal thyroxine value0.5-5)and ne (TSH)of25.48µU/mL(normal - stimulatinghormo also detected,withserum was (non-goitrous) hypothyroidism Besides, primary and wasconsistentwithPOF(FSH51.48U/L). of POF, wasrepeated ofgonadotrophins measurement tinued forsixyears.Sixyearsaftertheinitialdiagnosis 0.15mg),whichshecon- 0.03 mgandlevonorgestrel (EP)(ethinylestradiol nation ofestrogen-progesterone 41.93 IU/L).Thepatientwasputonacycliccombi- , adrenal or parathyroid hypofunc- orparathyroid mellitus,adrenal She wasagainseenatthegestationalageof7mon- Patient continuedoncyclicalEP, 50µg andthyroxine may occur after regression ofautoimmunestateand may occurafterregression ofovarianfunction the mostcommonone.Recovery as 10%-30% of women with POF; with hypothyroidism & 51.48IU/L). timeswasbelow40IU/L(FSH–41.93;36.73 three atoneofthe patient, inwhomoneFSHmeasurement below40IU/L,asitwasthecaseofour asurements commoninwomenwithoneortwoFSHme- more It has been seen that ovulation and conceptionare appeartoworkbetter(13). higher dosesofestrogen inthesepatients; onpregnancies of publishedreports is a paucity there replacement, withestrogen treated ofPOFpatientsbeing FSH. Despitehighpercentage ofactuallyloweringserum theimportance support eggandsubsequentpregnancy.fertilized suitablefortheimplantation ofthe py makestheuterus thera- inovulation(12).Hormone actions wouldresult ofFSH.Both sensitivity ofgranulosacellstotheeffect the increasing follicles,orbydirectly of theremaining thesensitivity FSHandrestoring act byloweringserum ment inthesepatients. - replace explanations fortheusefulnessofhormone several are thelikelihoodofovulation.There increase may treatment ,estrogen gonadotropic of POFandspontaneousconception.Despitehyper betweentheonset reported one ofthelongestintervals accuracy.with great represents Thecasedescribed here event thisrare isabletopredict feature no particular in womenwithanestablisheddiagnosisofPOF, and healthybabies(11). normal, delivered conceivedand 11%ovulated;andthree ovarian failure, analysisof86womenwith of onset.Inaretrospective dependingontheage in womenwithovarianfailure, outcomes maybedifferences ly (3).There contraceptive pills, and twoconceivedspontaneous- oncombinedoral whilepatientswere two occurred onconjugatedestrogen; whileonpatientswere curred oc- conceived afterPOFdiagnosis.Two pregnancies sixwomenwho (4,5,7-10). Alperandcols.reported with estrogen in womenwithPOFtreated pregnancy fertilization. oocyte withinvitro dation fortheseindividualswouldbetoconsiderdonor - recommen rates (6). In general, the most appropriate in ovulation and pregnancy significant improvement A concurrent autoimmune disorder is present in ispresent autoimmunedisorder A concurrent that some anecdotal published reports are There could Itwashypothesizedthatexogenousestrogen ofovarianfunctioncanoccur Spontaneous return severalisolatedcasesofspontaneous are There Arq Bras Metab. Endocrinol 2011;55/4 - Arq Bras Metab. Endocrinol 2011;55/4 4. 3. 2. 1. REFERENCES was reported. relevant tothisarticle nopotentialconflictofinterest Disclosure: conception. canhelpspontaneous failure, cies, especiallythyroid ofotherendocrinedeficien- Simultaneous correction ofthediagnosis. taneously longafterconfirmation helped inovulationandconception. whichalsomayhave withthyroxine, and wastreated wasalsodiagnosedwithhypothyroidism described here of coexisting endocrine disease (6).Thepatient control

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