Approach to secondary amenorrhea Quiz: Ace Your Exams
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An 18-year-old nulligravid woman presents to the clinic with a 6-month history of amenorrhea. Her cycles have always been irregular, and typically come once every 30 to 45 days. She has never gone this long without a cycle before and is concerned. A review of systems is notable for 8 kg of weight loss and intermittent diarrhea over the past year. Past medical history is notable for anemia and diabetes mellitus (DM) type 1, for which she uses an insulin pump. Family history is notable for breast cancer in her grandmother at age 58. Temperature is 36.5°C (97.8°F), pulse is 78/min, respirations are 14/min, blood pressure is 114/74 mm Hg, and body mass index is 19 kg/m2. Physical exam is unremarkable and lab results are shown in the table. A pelvic ultrasound shows normal female anatomy and a thin, homogenous endometrium. Which of the following is the most appropriate next step in the evaluation?
| Laboratory value | Result |
| Serum chemistry | |
| Follicle stimulating hormone (FSH) | 5 IU/L |
| Luteinizing hormone (LH) | 4 IU/L |
| Estradiol (E2) | low |
| Thyroid stimulating hormone (TSH) | 2.7 mU/L |
| Prolactin (PRL) | 12 ng/mL |
| Urine | |
| Human chorionic gonadotropin (HCG) | negative |
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