const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Puberty and Primary Amenorrhea";
pres.author = "Medical Education";

// ─── COLOR PALETTE ────────────────────────────────────────────────────────────
const C = {
  deepPurple: "3D1A78",   // dominant dark
  midPurple:  "6B35A8",   // supporting
  lilac:      "B08FD9",   // accent light
  teal:       "1A7B78",   // second accent
  tealLight:  "4DBDB9",
  coral:      "E05A4E",   // alert / highlight
  amber:      "F0A500",   // warm accent
  offWhite:   "F5F0FF",   // light bg
  white:      "FFFFFF",
  darkText:   "1C1035",
  grayText:   "5A5472",
};

// ─── HELPER: dark slide background ───────────────────────────────────────────
function darkBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.deepPurple }, line: { color: C.deepPurple } });
}

function lightBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.offWhite }, line: { color: C.offWhite } });
}

// ─── HELPER: left accent bar ──────────────────────────────────────────────────
function leftBar(slide, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625,
    fill: { color: color || C.teal }, line: { color: color || C.teal } });
}

// ─── HELPER: section header band ─────────────────────────────────────────────
function headerBand(slide, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.1,
    fill: { color: color || C.midPurple }, line: { color: color || C.midPurple } });
}

// ─── HELPER: slide number ────────────────────────────────────────────────────
function slideNum(slide, n, total) {
  slide.addText(`${n} / ${total}`, {
    x: 8.8, y: 5.3, w: 1, h: 0.25,
    fontSize: 9, color: C.grayText, align: "right"
  });
}

// ─── HELPER: source tag ──────────────────────────────────────────────────────
function source(slide, text) {
  slide.addText(text, {
    x: 0.15, y: 5.3, w: 8.5, h: 0.25,
    fontSize: 8, color: C.grayText, italic: true
  });
}

// ─── HELPER: bullet list ─────────────────────────────────────────────────────
function bullets(slide, items, opts) {
  const defaults = { x: 0.35, y: 1.2, w: 9.3, h: 4.2, fontSize: 16,
    color: C.darkText, bullet: { type: "bullet" }, paraSpaceBefore: 6 };
  const merged = Object.assign({}, defaults, opts);
  slide.addText(
    items.map((item, i) => ({
      text: item,
      options: { bullet: true, breakLine: i < items.length - 1, paraSpaceBefore: 5 }
    })),
    merged
  );
}

// ─── HELPER: two-column layout ───────────────────────────────────────────────
function twoCol(slide, leftItems, rightItems, opts = {}) {
  const base = { fontSize: 15, color: C.darkText, paraSpaceBefore: 5 };
  slide.addText(
    leftItems.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < leftItems.length - 1, paraSpaceBefore: 5 } })),
    Object.assign({}, base, { x: 0.2, y: opts.y || 1.25, w: 4.7, h: opts.h || 4.0 }, opts.left || {})
  );
  slide.addText(
    rightItems.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < rightItems.length - 1, paraSpaceBefore: 5 } })),
    Object.assign({}, base, { x: 5.1, y: opts.y || 1.25, w: 4.7, h: opts.h || 4.0 }, opts.right || {})
  );
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);

  // Decorative circles
  s.addShape(pres.ShapeType.ellipse, { x: -0.6, y: -0.6, w: 2.8, h: 2.8,
    fill: { color: C.midPurple, transparency: 60 }, line: { color: C.midPurple, transparency: 60 } });
  s.addShape(pres.ShapeType.ellipse, { x: 7.8, y: 3.5, w: 3.5, h: 3.5,
    fill: { color: C.teal, transparency: 70 }, line: { color: C.teal, transparency: 70 } });
  s.addShape(pres.ShapeType.ellipse, { x: 8.5, y: -0.3, w: 1.5, h: 1.5,
    fill: { color: C.lilac, transparency: 60 }, line: { color: C.lilac, transparency: 60 } });

  // Horizontal rule
  s.addShape(pres.ShapeType.rect, { x: 1.0, y: 2.85, w: 8.0, h: 0.04,
    fill: { color: C.tealLight }, line: { color: C.tealLight } });

  s.addText("Puberty &", {
    x: 1.0, y: 0.9, w: 8, h: 0.9,
    fontSize: 44, bold: true, color: C.white, fontFace: "Calibri"
  });
  s.addText("Primary Amenorrhea", {
    x: 1.0, y: 1.75, w: 8, h: 0.9,
    fontSize: 44, bold: true, color: C.tealLight, fontFace: "Calibri"
  });
  s.addText("Physiology · Causes · Evaluation · Management", {
    x: 1.0, y: 3.05, w: 8, h: 0.5,
    fontSize: 17, color: C.lilac, italic: true
  });
  s.addText("Based on Berek & Novak's Gynecology, Medical Physiology (Boron & Boulpaep)", {
    x: 1.0, y: 4.85, w: 8, h: 0.35,
    fontSize: 10, color: C.grayText, italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW / OUTLINE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  leftBar(s, C.midPurple);
  headerBand(s);

  s.addText("Overview", { x: 0.25, y: 0.2, w: 9.5, h: 0.7,
    fontSize: 26, bold: true, color: C.white });

  const topics = [
    "1.  What is Puberty?",
    "2.  Hormonal Regulation of Puberty",
    "3.  Stages of Puberty (Tanner Stages)",
    "4.  Timeline of Pubertal Events",
    "5.  Definition of Primary Amenorrhea",
    "6.  Causes — Hypergonadotropic vs. Hypogonadotropic",
    "7.  Anatomic & Outflow Tract Causes",
    "8.  Key Syndromes (Turner, MRKH, Androgen Insensitivity)",
    "9.  Diagnostic Evaluation Algorithm",
    "10. Management Principles",
  ];
  bullets(s, topics, { fontSize: 15, color: C.darkText, y: 1.2 });
  slideNum(s, 2, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — WHAT IS PUBERTY
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  leftBar(s, C.teal);
  headerBand(s, C.deepPurple);

  s.addText("What is Puberty?", { x: 0.25, y: 0.2, w: 9.5, h: 0.7,
    fontSize: 26, bold: true, color: C.white });

  // Definition box
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.1, w: 9.6, h: 1.0,
    fill: { color: C.midPurple, transparency: 88 }, line: { color: C.midPurple, transparency: 60 } });
  s.addText("Puberty is the transition between the juvenile and adult states when an individual becomes capable of reproducing — driven by sex steroid hormones from the gonads and adrenals.", {
    x: 0.35, y: 1.15, w: 9.3, h: 0.9,
    fontSize: 14, color: C.darkText, italic: true
  });

  s.addText("Two Core Physiological Processes:", {
    x: 0.2, y: 2.25, w: 9.6, h: 0.4,
    fontSize: 15, bold: true, color: C.deepPurple
  });

  // Two cards
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 2.7, w: 4.55, h: 1.5,
    fill: { color: C.teal }, line: { color: C.teal } });
  s.addText([
    { text: "Gonadarche\n", options: { bold: true, breakLine: false } },
    { text: "Maturation of gonads → production of gametes & sex steroids (estrogen / testosterone)", options: {} }
  ], { x: 0.3, y: 2.75, w: 4.3, h: 1.4, fontSize: 14, color: C.white });

  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 2.7, w: 4.7, h: 1.5,
    fill: { color: C.midPurple }, line: { color: C.midPurple } });
  s.addText([
    { text: "Adrenarche\n", options: { bold: true, breakLine: false } },
    { text: "↑ DHEA, DHEAS, Androstenedione from adrenal cortex → pubarche (pubic hair) — ages 6-8 yrs", options: {} }
  ], { x: 5.2, y: 2.75, w: 4.5, h: 1.4, fontSize: 14, color: C.white });

  source(s, "Medical Physiology, Boron & Boulpaep");
  slideNum(s, 3, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — HORMONAL REGULATION
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  leftBar(s, C.teal);
  headerBand(s, C.deepPurple);

  s.addText("Hormonal Regulation of Puberty", { x: 0.25, y: 0.2, w: 9.5, h: 0.7,
    fontSize: 26, bold: true, color: C.white });

  // HPG axis diagram — text-based
  const boxes = [
    { x: 3.5, y: 1.1, w: 3.0, h: 0.7, color: C.midPurple, label: "Hypothalamus" },
    { x: 3.5, y: 2.4, w: 3.0, h: 0.7, color: C.teal,      label: "Anterior Pituitary" },
    { x: 3.5, y: 3.7, w: 3.0, h: 0.7, color: C.deepPurple, label: "Ovaries / Testes" },
  ];
  const arrows = [
    { x: 4.9, y: 1.82, label: "Pulsatile GnRH" },
    { x: 4.9, y: 3.12, label: "FSH & LH" },
  ];

  boxes.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h,
      fill: { color: b.color }, line: { color: b.color }, rectRadius: 0.1 });
    s.addText(b.label, { x: b.x, y: b.y, w: b.w, h: b.h,
      fontSize: 15, bold: true, color: C.white, align: "center", valign: "middle" });
  });

  arrows.forEach(a => {
    s.addText("▼  " + a.label, { x: a.x - 1.0, y: a.y, w: 3.0, h: 0.4,
      fontSize: 12, color: C.amber, align: "center", bold: true });
  });

  // Feedback arrow label
  s.addText("← Negative feedback (sex steroids / inhibin)", {
    x: 0.1, y: 2.4, w: 3.3, h: 0.7,
    fontSize: 11, color: C.coral, italic: true
  });

  // Key facts
  const facts = [
    "Before puberty: HPG axis is highly sensitive to negative feedback — even low steroids suppress GnRH",
    "At puberty onset: sensitivity decreases → pulsatile GnRH release (first during REM sleep, then daytime)",
    "↑ FSH & LH → folliculogenesis / spermatogenesis → sex steroid production → secondary sex characteristics",
    "Kisspeptin neurons and leptin are key modulators of GnRH pulse generator onset",
  ];
  bullets(s, facts, { x: 0.2, y: 1.1, w: 3.1, h: 3.5, fontSize: 13, color: C.darkText });

  source(s, "Medical Physiology, Boron & Boulpaep; Berek & Novak's Gynecology");
  slideNum(s, 4, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — TANNER STAGES (female)
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  leftBar(s, C.midPurple);
  headerBand(s, C.teal);

  s.addText("Tanner Stages of Female Puberty", { x: 0.25, y: 0.2, w: 9.5, h: 0.7,
    fontSize: 26, bold: true, color: C.white });

  const stages = [
    { stage: "Stage I\n(Prepubertal)", breast: "No glandular tissue", pubic: "No hair", age: "< 8 yrs", bg: C.deepPurple },
    { stage: "Stage II\n(Early)", breast: "Breast budding (thelarche)", pubic: "Sparse, fine hair along labia", age: "8-13 yrs", bg: C.midPurple },
    { stage: "Stage III\n(Mid)", breast: "Breast/areola enlargement, no contour separation", pubic: "Coarser, extends over pubis", age: "10-14 yrs", bg: C.teal },
    { stage: "Stage IV\n(Late)", breast: "Areola/papilla form secondary mound", pubic: "Adult type, not to thighs", age: "11-15 yrs", bg: C.tealLight },
    { stage: "Stage V\n(Adult)", breast: "Adult contour, only papilla projects", pubic: "Adult, spread to medial thighs", age: "12-18 yrs", bg: C.lilac },
  ];

  stages.forEach((st, i) => {
    const x = 0.1 + i * 1.96;
    s.addShape(pres.ShapeType.rect, { x, y: 1.1, w: 1.85, h: 0.65,
      fill: { color: st.bg }, line: { color: st.bg } });
    s.addText(st.stage, { x, y: 1.1, w: 1.85, h: 0.65,
      fontSize: 11.5, bold: true, color: C.white, align: "center", valign: "middle" });

    s.addShape(pres.ShapeType.rect, { x, y: 1.78, w: 1.85, h: 0.8,
      fill: { color: st.bg, transparency: 80 }, line: { color: st.bg, transparency: 50 } });
    s.addText("Breast:\n" + st.breast, { x: x + 0.05, y: 1.82, w: 1.75, h: 0.75,
      fontSize: 10, color: C.darkText });

    s.addShape(pres.ShapeType.rect, { x, y: 2.61, w: 1.85, h: 0.8,
      fill: { color: st.bg, transparency: 85 }, line: { color: st.bg, transparency: 50 } });
    s.addText("Pubic:\n" + st.pubic, { x: x + 0.05, y: 2.65, w: 1.75, h: 0.75,
      fontSize: 10, color: C.darkText });

    s.addShape(pres.ShapeType.rect, { x, y: 3.44, w: 1.85, h: 0.5,
      fill: { color: C.amber, transparency: 75 }, line: { color: C.amber, transparency: 50 } });
    s.addText("Age: " + st.age, { x, y: 3.44, w: 1.85, h: 0.5,
      fontSize: 11, bold: true, color: C.deepPurple, align: "center", valign: "middle" });
  });

  s.addText("Menarche typically occurs at Tanner Stage III-IV (mean age ~12.5 years in the US)", {
    x: 0.2, y: 4.1, w: 9.6, h: 0.45,
    fontSize: 13, color: C.coral, bold: true, italic: true
  });

  source(s, "Berek & Novak's Gynecology; Medical Physiology, Boron & Boulpaep");
  slideNum(s, 5, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — TIMELINE OF PUBERTAL EVENTS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  leftBar(s, C.amber);
  headerBand(s, C.deepPurple);

  s.addText("Timeline of Pubertal Events in Females", { x: 0.25, y: 0.2, w: 9.5, h: 0.7,
    fontSize: 26, bold: true, color: C.white });

  // Horizontal timeline arrow
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 2.75, w: 9.4, h: 0.08,
    fill: { color: C.midPurple }, line: { color: C.midPurple } });
  s.addText("►", { x: 9.5, y: 2.65, w: 0.4, h: 0.28,
    fontSize: 18, color: C.midPurple, align: "center" });

  const events = [
    { x: 0.3, label: "Adrenarche\n↑ DHEA, DHEAS", age: "~6-8 y", top: true },
    { x: 2.1, label: "Thelarche\n(Breast budding)", age: "~8-13 y", top: false },
    { x: 4.0, label: "Pubarche\n(Pubic hair)", age: "~9-10 y", top: true },
    { x: 5.9, label: "Peak height\nvelocity", age: "~11-12 y", top: false },
    { x: 7.6, label: "Menarche\n(1st period)", age: "~12-13 y", top: true },
  ];

  events.forEach(ev => {
    // dot
    s.addShape(pres.ShapeType.ellipse, { x: ev.x + 0.3, y: 2.66, w: 0.22, h: 0.22,
      fill: { color: C.amber }, line: { color: C.deepPurple } });

    if (ev.top) {
      s.addText(ev.label, { x: ev.x, y: 1.5, w: 1.8, h: 0.9,
        fontSize: 12, color: C.darkText, align: "center" });
      s.addText(ev.age, { x: ev.x, y: 2.38, w: 1.8, h: 0.3,
        fontSize: 11, bold: true, color: C.coral, align: "center" });
      s.addShape(pres.ShapeType.rect, { x: ev.x + 0.7, y: 2.3, w: 0.02, h: 0.36,
        fill: { color: C.grayText }, line: { color: C.grayText } });
    } else {
      s.addShape(pres.ShapeType.rect, { x: ev.x + 0.7, y: 2.88, w: 0.02, h: 0.38,
        fill: { color: C.grayText }, line: { color: C.grayText } });
      s.addText(ev.age, { x: ev.x, y: 3.28, w: 1.8, h: 0.3,
        fontSize: 11, bold: true, color: C.coral, align: "center" });
      s.addText(ev.label, { x: ev.x, y: 3.58, w: 1.8, h: 0.9,
        fontSize: 12, color: C.darkText, align: "center" });
    }
  });

  source(s, "Medical Physiology, Boron & Boulpaep; Berek & Novak's Gynecology");
  slideNum(s, 6, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — DEFINITION OF PRIMARY AMENORRHEA
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);

  s.addShape(pres.ShapeType.ellipse, { x: 7.5, y: -0.5, w: 3.5, h: 3.5,
    fill: { color: C.teal, transparency: 80 }, line: { color: C.teal, transparency: 80 } });

  s.addText("Primary Amenorrhea", { x: 0.4, y: 0.25, w: 9.2, h: 0.7,
    fontSize: 30, bold: true, color: C.tealLight });

  s.addText("Definition", { x: 0.4, y: 1.05, w: 3.0, h: 0.45,
    fontSize: 16, bold: true, color: C.amber });

  // Two definition cards
  const cards = [
    {
      title: "No Secondary Sexual Characteristics",
      body: "Absence of menses by age 13 years\n(2 SD above mean age of secondary sex characteristic development)",
      color: C.midPurple
    },
    {
      title: "Normal Secondary Sexual Characteristics",
      body: "Absence of menses by age 15 years\n(includes normal breast development and pubic hair)",
      color: C.teal
    }
  ];
  cards.forEach((c, i) => {
    const y = 1.55 + i * 1.5;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 9.4, h: 1.3,
      fill: { color: c.color, transparency: 20 }, line: { color: c.color } });
    s.addText(c.title, { x: 0.5, y: y + 0.05, w: 9.0, h: 0.4,
      fontSize: 15, bold: true, color: C.white });
    s.addText(c.body, { x: 0.5, y: y + 0.48, w: 9.0, h: 0.75,
      fontSize: 14, color: C.white });
  });

  s.addText([
    { text: "Key rule: ", options: { bold: true } },
    { text: "Failure to begin breast development by age 13 ", options: { color: C.coral, bold: true } },
    { text: "always warrants investigation (first sign of estrogen exposure in puberty)", options: {} }
  ], { x: 0.3, y: 4.7, w: 9.4, h: 0.55, fontSize: 13, color: C.white });

  source(s, "Berek & Novak's Gynecology, p.1856");
  slideNum(s, 7, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — CAUSES: WHO CLASSIFICATION & OVERVIEW
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  leftBar(s, C.coral);
  headerBand(s, C.deepPurple);

  s.addText("Causes of Primary Amenorrhea — Overview", { x: 0.25, y: 0.2, w: 9.5, h: 0.7,
    fontSize: 24, bold: true, color: C.white });

  // Three WHO group boxes
  const groups = [
    { title: "WHO Group I\nHypogonadotropic Hypogonadism", body: "No endogenous estrogen, normal/low FSH & prolactin\nNo HPG lesion on imaging", color: C.teal },
    { title: "WHO Group II\nNormogonadotropic Anovulation", body: "Evidence of estrogen production\nNormal FSH & prolactin levels (e.g. PCOS)", color: C.midPurple },
    { title: "WHO Group III\nHypergonadotropic Hypogonadism", body: "Elevated FSH → gonadal insufficiency / failure\n(e.g. Turner syndrome, gonadal dysgenesis)", color: C.coral },
  ];

  groups.forEach((g, i) => {
    const x = 0.15 + i * 3.28;
    s.addShape(pres.ShapeType.rect, { x, y: 1.1, w: 3.1, h: 1.5,
      fill: { color: g.color }, line: { color: g.color } });
    s.addText(g.title, { x: x + 0.1, y: 1.12, w: 2.9, h: 0.65,
      fontSize: 12, bold: true, color: C.white, align: "center" });
    s.addText(g.body, { x: x + 0.1, y: 1.77, w: 2.9, h: 0.8,
      fontSize: 11, color: C.white });
  });

  s.addText("Common causes by anatomic compartment:", {
    x: 0.2, y: 2.75, w: 9.5, h: 0.35,
    fontSize: 14, bold: true, color: C.deepPurple
  });

  twoCol(s,
    [
      "Outflow tract: Imperforate hymen, vaginal atresia, MRKH syndrome (Mullerian agenesis)",
      "Uterine: Congenital absence of uterus",
      "Ovarian: Turner syndrome, gonadal dysgenesis (45,X), XX gonadal dysgenesis",
    ],
    [
      "Ovarian: 17α-Hydroxylase deficiency, POI, resistant ovary syndrome, PCOS",
      "Pituitary/Hypothalamic: Hypopituitarism, Kallmann syndrome, constitutional delay",
      "Adrenal/Thyroid: CAH, hypothyroidism",
    ],
    { y: 3.15, h: 2.2, left: { fontSize: 13, color: C.darkText }, right: { fontSize: 13, color: C.darkText } }
  );

  source(s, "Tietz Laboratory Medicine 7e; Berek & Novak's Gynecology");
  slideNum(s, 8, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — HYPERGONADOTROPIC CAUSES (Turner, Gonadal Dysgenesis)
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  leftBar(s, C.coral);
  headerBand(s, C.coral);

  s.addText("Hypergonadotropic Causes — Turner & Gonadal Dysgenesis", {
    x: 0.25, y: 0.2, w: 9.5, h: 0.7, fontSize: 21, bold: true, color: C.white
  });

  const cards = [
    {
      title: "Turner Syndrome (45,X)",
      points: [
        "Most common cause of primary amenorrhea from gonadal dysgenesis",
        "Streak gonads → no estrogen → no breast development",
        "Features: short stature, webbed neck, shield chest, coarctation of aorta",
        "High FSH & LH (hypergonadotropic), low estradiol",
        "Karyotype: 45,X (or mosaic 45,X/46,XX)",
      ],
      color: C.coral, x: 0.15, y: 1.1
    },
    {
      title: "46,XX Gonadal Dysgenesis",
      points: [
        "Normal female phenotype but streak gonads",
        "Elevated FSH — ovaries cannot produce estrogen",
        "May have associated hearing loss (Perrault syndrome)",
        "Karyotype: 46,XX — no Turner features",
      ],
      color: C.midPurple, x: 5.1, y: 1.1
    }
  ];

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    s.addText(c.title, { x: c.x + 0.1, y: c.y, w: 4.55, h: 0.45,
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  s.addText("Note: When gonadal failure occurs with primary amenorrhea, there is a HIGH incidence of abnormal karyotype — karyotyping is essential.", {
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  source(s, "Berek & Novak's Gynecology, p.1858");
  slideNum(s, 9, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — ANATOMIC CAUSES (MRKH, Outflow Tract)
// ═══════════════════════════════════════════════════════════════════════════════
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    fontSize: 26, bold: true, color: C.white });

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      title: "MRKH Syndrome",
      subtitle: "(Müllerian Agenesis)",
      points: [
        "Mayer-Rokitansky-Küster-Hauser syndrome",
        "Congenital absence of vagina ± uterus",
        "46,XX karyotype — normal ovarian function",
        "Normal secondary sex characteristics (breast, pubic hair)",
        "Normal estrogen levels; FSH normal",
        "2nd most common cause of primary amenorrhea (~15%)",
        "Rx: vaginal dilators or surgical creation of neovagina",
      ],
      color: C.teal, x: 0.15
    },
    {
      title: "Imperforate Hymen",
      subtitle: "(Cryptomenorrhea)",
      points: [
        "Obstruction of outflow tract — blood accumulates",
        "Normal internal anatomy (uterus, ovaries present)",
        "Presents with cyclic pelvic pain but no visible blood",
        "Hematocolpos / hematometra on ultrasound",
        "Rx: surgical hymenotomy",
      ],
      color: C.midPurple, x: 5.1
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  source(s, "Tietz Laboratory Medicine 7e; Berek & Novak's Gynecology");
  slideNum(s, 10, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — ANDROGEN INSENSITIVITY SYNDROME
// ═══════════════════════════════════════════════════════════════════════════════
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  s.addText("Androgen Insensitivity Syndrome (AIS)", {
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    { label: "Karyotype", val: "46,XY — testes present (intra-abdominal or inguinal)", color: C.midPurple },
    { label: "Mechanism", val: "Androgen receptor defect → cells unable to respond to testosterone", color: C.teal },
    { label: "Phenotype", val: "Normal female external genitalia; normal breast development (aromatized estrogen from testes)", color: C.deepPurple },
    { label: "Absent structures", val: "No uterus, no upper vagina (Müllerian regression by AMH); blind vaginal pouch", color: C.coral },
    { label: "Hormones", val: "High testosterone (male range), high LH, normal/high estradiol", color: C.midPurple },
    { label: "Gonad management", val: "Gonadectomy recommended after puberty (risk of gonadoblastoma) or preventively; hormone replacement therapy needed", color: C.teal },
  ];

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  source(s, "Berek & Novak's Gynecology; Tietz Laboratory Medicine 7e");
  slideNum(s, 11, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — HYPOGONADOTROPIC CAUSES (Kallmann, etc.)
// ═══════════════════════════════════════════════════════════════════════════════
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  headerBand(s, C.midPurple);

  s.addText("Hypogonadotropic Causes", { x: 0.25, y: 0.2, w: 9.5, h: 0.7,
    fontSize: 26, bold: true, color: C.white });

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    "Kallmann Syndrome:",
    "  • GnRH neuron migration failure from olfactory placode",
    "  • Low/absent GnRH → low FSH & LH → no gonadarche",
    "  • Classic feature: anosmia (absent sense of smell)",
    "  • 46,XX; normal female anatomy; no breast development",
    "  • Rx: pulsatile GnRH or gonadotropin therapy",
    "",
    "Constitutional Delay:",
    "  • Physiologic — delayed but normal puberty",
    "  • Bone age < chronological age",
    "  • Family history often positive",
    "  • No intervention usually needed",
  ];

  const right = [
    "Hypopituitarism:",
    "  • Deficiency of FSH/LH (± other pituitary hormones)",
    "  • Causes: craniopharyngioma, pituitary adenoma, radiation",
    "  • MRI pituitary required",
    "",
    "Functional Hypothalamic Amenorrhea:",
    "  • Extreme weight loss, excessive exercise, stress",
    "  • Low leptin → decreased GnRH pulsatility",
    "  • Low estrogen → bone loss risk",
    "  • Rx: treat underlying cause; nutritional rehabilitation",
    "",
    "Other: Nutritional disorders, chronic illness",
  ];

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  source(s, "Tietz Laboratory Medicine 7e; Berek & Novak's Gynecology");
  slideNum(s, 12, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — DIAGNOSTIC EVALUATION ALGORITHM
// ═══════════════════════════════════════════════════════════════════════════════
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  s.addText("Diagnostic Evaluation Algorithm", { x: 0.25, y: 0.2, w: 9.5, h: 0.7,
    fontSize: 26, bold: true, color: C.white });

  // Step 1: History & PE
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    { x: 3.6, label: "↓ FSH + ↓ LH\n(Hypogonadotropic)", outcome: "Kallmann / Hypo-\npituitarism → MRI", color: C.midPurple },
    { x: 7.05, label: "Normal FSH\nAnatomy normal?", outcome: "Outflow obstruction\nMüllerian anomaly → US / MRI pelvis", color: C.teal },
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  source(s, "Berek & Novak's Gynecology, p.1860; Tietz Laboratory Medicine 7e");
  slideNum(s, 13, 14);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — MANAGEMENT
// ═══════════════════════════════════════════════════════════════════════════════
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      title: "Treat the Underlying Cause",
      body: "Surgical: hymenotomy (imperforate hymen), vaginal reconstruction (MRKH), gonadectomy (AIS/dysgenesis)\nMedical: thyroid or prolactin disorder treatment",
      color: C.teal
    },
    {
      icon: "②",
      title: "Hormone Replacement Therapy",
      body: "Initiate and maintain secondary sexual characteristics in hypogonadal patients\nEstrogen ± progesterone; titrate to adult female physiology; protect bone density",
      color: C.midPurple
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    {
      icon: "③",
      title: "Bone Health",
      body: "Low estrogen → osteoporosis risk\nHRT + calcium 1000-1200 mg/day + Vitamin D 600-800 IU/day",
      color: C.coral
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    {
      icon: "④",
      title: "Fertility Considerations",
      body: "Functional hypothalamic: pulsatile GnRH or FSH/LH therapy for ovulation induction\nTurner syndrome: oocyte donation for IVF\nMRKH: surrogacy (own oocytes possible if ovaries present)",
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  source(s, "Berek & Novak's Gynecology, p.1861-1865");
  slideNum(s, 14, 14);
}

// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/puberty-amenorrhea-ppt/Puberty_and_Primary_Amenorrhea.pptx" })
  .then(() => console.log("PPT created successfully!"))
  .catch(err => console.error("Error:", err));