Seeking care at a community clinic, a 26-year-old female reports that her menses completely stopped 11 months ago. She additionally describes experiencing sudden episodes of intense body warmth and sweating that frequently awaken her at night, along with new-onset vaginal discomfort during sexual intercourse. Prior to this, her menstrual cycles were regular every 29 days since menarche at age 13. She has no significant past medical history and takes no medications. Her body mass index is 21 kg/m². A urine pregnancy test performed in the office is negative. Which of the following serum hormone profiles is most likely present in this patient?
- Increased follicle-stimulating hormone, decreased estradiolAnswer
- BDecreased follicle-stimulating hormone, decreased estradiol
- CNormal follicle-stimulating hormone, increased testosterone
- DIncreased prolactin, decreased follicle-stimulating hormone
- EIncreased human chorionic gonadotropin, increased estradiol
Answer
Increased follicle-stimulating hormone, decreased estradiol
The patient's presentation of secondary amenorrhea, nocturnal vasomotor symptoms (night sweats/hot flashes), and vaginal atrophy at age 26 is highly characteristic of primary ovarian insufficiency (POI). POI occurs when there is a depletion or dysfunction of ovarian follicles before age 40. Because the follicles are not developing properly, they produce very little estradiol, causing the systemic symptoms of estrogen deficiency. The lack of circulating estradiol and inhibin removes the normal negative feedback on the anterior pituitary gland, which subsequently secretes excessive amounts of follicle-stimulating hormone (FSH) in a futile attempt to stimulate the ovaries. Therefore, the expected laboratory profile is an increased FSH and a decreased estradiol level.
Step-by-Step Solution
Key Concept
Primary Ovarian Insufficiency (Hypergonadotropic Hypogonadism)