Primary Amenorrhea with Pubertal Development.

A 16-year-old Guatemalan adolescent presented for routine immunizations. She was still amenorrheic and appeared significantly younger than her stated age. Her evaluation revealed pubertal development and primary amenorrhea due to primary ovarian failure of unknown etiology, characterized by hypergonadotrophic hypogonadism with an infantile uterus and no visible adnexa. At the time of evaluation, her diagnosis was thought to be 46XX gonadal dysgenesis. Due to the problems related to the patient's lack of medical insurance, uncompliance with medications and follow-ups, and family objections and attitudes, her evaluation was still incomplete 26 months later on high school graduation.