Amenorrhea Quiz: Ace Your Exams

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A 17-year-old girl comes to the office for the evaluation of amenorrhea. The patient’s menarche was at the age of 13, and her menstrual cycle has been regular with menses occurring every 28 days. For the past 8 months, the patient has not menstruated. She is sexually active with her boyfriend and uses condoms consistently. The patient plays on the high school soccer team and frequently competes in local beauty pageants. She follows a calorie-restricted dietary regimen and exercises 3 hours every day. Temperature is 37°C (98.6°F), pulse is 95/min, respirations are 18/min and blood pressure is 90/55 mmHg. BMI is 16 kg/m2. Physical examination shows a pale, thin girl of normal stature with fine hair and Tanner stage III breast and pubic hair growth. Rest of the examination is within normal limits. Urine pregnancy test is negative. Which of the following set of hormonal changes will be observed in this patient?  

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