Amenorrhea Quiz: Ace Your Exams

A 27-year-old woman comes to the clinic for the evaluation of irregular periods. For the last three years, the patient has had about four periods a year. She recently began shaving her upper lip and chin due to excessive hair growth. Review of systems is significant for 30 lbs weight gain in the last 7 months. Past medical history is unremarkable. She has a family history of breast cancer in her mother at age 49 and myocardial infarction in her father at age 52. Temperature is 36.9°C (98.4°F), pulse is 74/min, respirations are 13/min, and blood pressure is 124/72 mmHg. Physical examination shows terminal hair on the upper lip and nipples. The abdomen is obese and nontender with no masses or tenderness. Development is Tanner stage V. A transvaginal ultrasound shows polycystic ovaries bilaterally. Serum TSH is within normal limits. Which of the following sets of hormonal changes will most likely be observed in this patient?