Examkin

Question

Difficulty: MediumReproductive Endocrinology and Infertility

Match each patient's clinical presentation and laboratory profile with the most likely underlying etiology of her infertility or amenorrhea.

  • 33-year-old woman with 6 months of amenorrhea, severe hot flashes, and vaginal atrophy; laboratories show elevated FSH and low estradiol.Primary ovarian insufficiency
  • 22-year-old cross-country runner with amenorrhea, BMI 16.5 kg/m², and normal thyroid-stimulating hormone; laboratories show low FSH, low LH, and low estradiol.Functional hypothalamic amenorrhea
  • 29-year-old woman with irregular menses, severe acne, and increased facial hair; ultrasound shows bilateral enlarged ovaries with multiple peripheral cysts.Polycystic ovary syndrome
  • 31-year-old woman with bilateral milky nipple discharge, persistent headaches, and amenorrhea; laboratories show elevated prolactin and low FSH.Pituitary adenoma

Answer

1 matches with Primary ovarian insufficiency, 2 matches with Functional hypothalamic amenorrhea, 3 matches with Polycystic ovary syndrome, 4 matches with Pituitary adenoma.
The pairings correctly utilize hypothalamic-pituitary-ovarian axis laboratory patterns. Elevated FSH with low estrogen signifies primary ovarian failure. Low FSH/LH with low estrogen in a low-BMI patient points to functional hypothalamic suppression. Elevated prolactin with mass-effect symptoms identifies a pituitary adenoma. Hyperandrogenism with irregular menses is the hallmark of PCOS.

Step-by-Step Solution

1
Analyze the gonadotropin levels (FSH and LH) to localize the defect in the hypothalamic-pituitary-ovarian axis.
Elevated FSH points to an primary defect in the ovaries, while low or normal FSH points to a central defect in the hypothalamus or pituitary.
Differentiating primary from secondary hypogonadism is the critical first step in evaluating amenorrhea.
2
Evaluate the clinical context and other hormone levels for patients with central defects.
Low BMI and heavy exercise suggest hypothalamic suppression, whereas galactorrhea and headaches suggest a pituitary mass producing prolactin.
Clinical features identify the specific etiology of hypogonadotropic hypogonadism.
3
Assess for signs of androgen excess.
Clinical evidence of acne and hirsutism paired with characteristic ultrasound findings confirms polycystic ovary syndrome.
PCOS is the leading cause of normogonadotropic anovulatory infertility and hyperandrogenism.

Key Concept

The diagnostic evaluation of secondary amenorrhea and infertility relies on the pattern of gonadotropins (FSH, LH) and specific clinical findings (BMI, hyperandrogenism, galactorrhea) to localize the defect to the hypothalamus, pituitary, or ovaries.
Rate this question

Topics

Reproductive Endocrinology and Infertility

More questions from this topic