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Obstetrics & Gynecology

Answer 3
  1. The patient has hypothalamic amenorrhea. The patient’s history is highly suggestive of hypothalamic dysfunction as the cause of her secondary amenorrhea. Women who exercise vigorously or experience high levels of emotional stress may develop inadequate hypothalamic function. The only tests needed to confirm the diagnosis of hypothalamic amenorrhea are serum FSH and LH. In patients with hypothalamic amenorrhea, the levels of FSH and LH are very low. The patient does not have premature ovarian failure because her serum gonadotropin levels were low-normal. In premature ovarian failure, these hormones are abnormally high. The patient does not have PCOD because she did not have withdrawal bleeding after treatment with medroxyprogesterone acetate. Intrauterine synechiae usually develops after postpartum or postabortion curettage, and this patient has never been pregnant. MRI of the pituitary gland is not necessary because serum prolactin levels in patients with hypothalamic amenorrhea are usually top-normal and never elevated.

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