Approach to primary amenorrhea Quiz: Ace Your Exams
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A 14-year-old girl presents for evaluation of primary amenorrhea. Past medical history is non-contributory. Family history is notable for hypothyroidism in her mother. The patient is a high school honors student who is active on the cross-country team; eats a healthy diet; is not sexually active; and does not use alcohol, tobacco, or other recreational drugs. Her temperature is 36.5°C (97.8°F), pulse is 82/min, respirations are 16/min, blood pressure is 114/78 mmHg, and body mass index is 17.1 kg/m2. On exam, the patient lacks breast and pubic hair development. The remainder of the exam is unremarkable. Labs are obtained and shown below. Which of the following is the most likely underlying cause of amenorrhea in this patient?
| Laboratory value | Result add normals |
| Urine | |
| Urine pregnancy test | negative |
| Serum chemistries | |
| Follicle-stimulating hormone | 4 IU/L |
| Luteinizing hormone | 3 IU/L |
| Estradiol | low |
| Prolactin | 14 ng/mL |
| Thyroid-stimulating hormone | 2.4 mU/L |
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