drdg
Forum Senior
Topics: 31
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a 15-year-old teenage girl is brought to your office by her mon for evaluation of amenorrhoea. She has not started menstruation yet, while her elder sister who has her first period at age 13. Physical exam shows breast development at Tanner stage 2, external genitalia at Tanner stage 1. Exam shows no other abnormalities. Which of following is the most appropriate next step in management:
A. Estrogen level
B. Serum LH level
C.Serum FSH level
D. Karyotyping
E. GnRH stimulation test
F. Reassurance.
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| kpmle2
Forum Guru
Topics: 77
Posts: 453
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F. Reassurance
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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F reassurance,Start investigating the ff yr ie 16 yrs of age if she's still hasamenorrhea
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| titly
Forum Elite
Topics: 21
Posts: 311
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reassuarance
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| drdg
Forum Senior
Topics: 31
Posts: 176
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The correct answer is C.
This is an UW question, so I typed the explanation below:
This patient has primary amenorrhoea (PA) and absent secondary sexual characteristics, including breast development. Isolated PA with well-developed secondary sexual characteristic can be considered normal up to the age of 16. Work-up should be started if the problem persists thereafter.
However, if secondary characteristic are absent as with this patient, work-up should not be delayed. The absence of breast development indicates lacks of estrogen, so measuring estrogen level (A) provides no addition information. PA can be due to either hypothalamic/pituitary (central) or gonadal ( peripheral) abnormalities. The distinction can be made by simple measurement of the FSH level. Increased FSH indicated a peripheral cause and visa versa. If it is central, A GnRH stimulation test is the indicated to detect whether the anomaly is of hypothalamic or pituitary origin. If it is peripheral , karyotyping would be the next step; if it is normal, diagnosis of ovarian agenesis or dysgenesis is established.
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