It is hard to identify the uterus on imaging studies in a case of gonadal agenesis

CASE REPORT: The 20-year-old female patient presented with primary amenorrhea. She is 175 cm tall and 67kg in weight. No secondary sexual development was noted. Both Tanner classifications of thelarche and pubarche were stage I. The uterus and bilateral adnexa were invisible on a trans-abdominal ultrasound and a pelvic MRI. Phyiscal examination found infantile vulva and normal hymen. The laboratory findings were as follows: follicle-stimulating hormone 89.15 mIU/ml; luteinizing hormone 29.26 mIU/ml; estradiol 23.28 pg/ml; testosterone < 0.2 ng/ml. Genetic investigation revealed a 46,XX karyotype without any mosaicism. Under the impression of gonadal agenesis, hormone replacement therapy began. After regular treatment for 6 months, menarche occurred .An ultrasound arranged and showed normal uterus contour, 53x21x35mm in size. CONCLUSION: In a hypoestrogenic state, the uterus will be atrophic and can not be found on an ultrasound or MRI.