Examkin

Soru

Zorluk: KolayMenstrual Cycle Abnormalities and Contraception

A 2626-year-old woman comes to the office due to a 77-month history of absent menses. Her menarche was at age 1212, and her menses were previously regular, occurring every 2828 days. She reports feeling excessively tired over the last few months, along with new-onset constipation and an unintended 4.54.5-kg (1010-lb) weight gain. She has no headaches, visual changes, or nipple discharge. Vital signs show a blood pressure of 110/70110/70 mm Hg, a pulse of 5656/min, and a body mass index (BMI) of 2525 kg/m 2^2. Physical examination reveals normal secondary sexual characteristics, delayed relaxation of deep tendon reflexes, and no hirsutism or acne. A urine pregnancy test is negative. Which of the following is the most appropriate next step in the evaluation of this patient?

  1. A
    Endometrial biopsy
  2. B
    Measurement of serum free thyroxine (T 4_4)
  3. Measurement of serum thyroid-stimulating hormone and prolactinCevap
  4. D
    Administration of medroxyprogesterone acetate
  5. E
    Measurement of serum testosterone and dehydroepiandrosterone sulfate

Cevap

Measurement of serum thyroid-stimulating hormone and prolactin is the most appropriate next step.
The correct answer involves measuring serum thyroid-stimulating hormone (TSH) and prolactin. This patient is presenting with secondary amenorrhea, which requires a systematic evaluation. Given that her pregnancy test is negative, the most common endocrine causes must be ruled out. Furthermore, her clinical presentation (bradycardia, weight gain, constipation, and delayed deep tendon reflexes) is highly suspicious for primary hypothyroidism. Hypothyroidism causes decreased levels of thyroxine, which stimulates the release of thyrotropin-releasing hormone (TRH). Elevated TRH stimulates both TSH and prolactin secretion from the anterior pituitary. Hyperprolactinemia subsequently suppresses gonadotropin-releasing hormone (GnRH), leading to anovulation and amenorrhea. Therefore, TSH and prolactin are the most appropriate initial diagnostic tests.

Adım Adım Çözüm

1
Identify the primary clinical problem.
The patient has secondary amenorrhea, defined as the absence of menses for ≥3\geq 3 months in a woman with previously regular cycles.
Establishing the correct diagnosis guides the evaluation algorithm.
2
Evaluate the patient's symptoms and physical exam findings.
The patient exhibits fatigue, weight gain, constipation, bradycardia, and delayed deep tendon reflexes, which strongly suggest hypothyroidism.
Clinical signs and symptoms point toward a specific etiology for the amenorrhea.
3
Determine the next best step in management.
After confirming a negative pregnancy test, the initial laboratory evaluation for secondary amenorrhea should include serum thyroid-stimulating hormone (TSH) and prolactin levels.
Hypothyroidism is a common cause of secondary amenorrhea and can also lead to hyperprolactinemia, making these tests critical first steps.

Anahtar Kavram

The initial evaluation of secondary amenorrhea, following a negative pregnancy test, involves measuring serum thyroid-stimulating hormone (TSH), prolactin, and follicle-stimulating hormone (FSH) to identify common endocrine etiologies such as thyroid dysfunction and hyperprolactinemia.
Tahmini Süre:1m 0s
Bu soruyu puanla

Konular

Menstrual Cycle Abnormalities and Contraception

Bu konudan daha fazla soru