<prompt> Primary amenorrhoea is seen in all except: RepeatKali man syndromeRokitansky syndromeAshermann syndromeTurners syndrome  <response>: Ans: C Ashermann syndrome Ref: Duttas Gynecology pg 433Explanation:See Table 17 and Figure BelowAshermans syndrome or Fritsch syndromeIt is characterized by adhesions and fibrosis of the endometrium.Most often associated with dilation and curettage of the intrauterine cavity.Patients present with secondary amenorrhea. Table 17 : Causes of Primary AmenorrheaOutflow tractAnomaliesobstructionGonadalend-organ disordersPituitary and hypothalamicUterine Mullerian agenesis 2nd MC cause Gonadal dysgenesis, including Turner syndrome, is the most common cause Androgen insensitivity syndrome Testicular feminization syndrome Receptor abnormalities for hormones FSH and LH Specific forms of congenital adrenal hyperplasiaHypothalamic: Kallmann syndromeVaginal: Vaginal atresia, Cryptomenontioea Imperforate hymen. Swyer syndrome Galactosaemia Aromatase deficiency Prader-Willi syndrome Male pseudo-hermaphroditism Approach to Primary Amenorrhea History and Physical Exam Uterus Present Uterus absent or uncertain FSH -20 IUL and LH 40 IULFSH -20 IUL and LH 40 IUL KaryotypePatient Hypogonadotropic HypogonadismEating disordersBrain injury or irradiationKallman SyndromePituitary defectHyperprolactinemiaHemochromatosisHypergonadotropicHypogonadism KaryotypePatient 46. XX46. XY45. XO46. XXMullenanAgenesisMayerRokitansktKusterHauserSyndromeAndrogenInsensitivitySyndrome.Vanishing TestesSyndrome.5 alpha reductase deficiency TurnerSyndromePremature OvarianFailureConsider MRI 