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A 15-year-old teenage girl is brought to your office by her mother for evaluation of amenorrhoea. She has not started menstruation yet, unlike her elder sister who had her first periods at age 13. Physical examination shows breast development at Tanner stage 2, external genitalia at Tanner stage 1. Examination shows no other abnormalities. Which of the following is the most appropriate next step in management?

A.Estrogen levels

B.Serum LH levels

C.Serum FSH levels


E.GnRH stimulation test






Edited by msyamp on Aug 07, 2006 - 5:19 PM


the ans is C


this girl presented with absent breast develaopment, so indicates lack of estrogen. so A or B doesn't help much in the diagnosis.

Primary amenorrhoeaa can be waited until age 16 if the secondary sexual characters are well developed. this pt does not have well dev 2^o sexual characters. so reassuarance is not appropriate.

so to know which part of HPO axis is affected, do FSH levels.


Actually we see both FSH and LH right?


thans som this has totally taken my away. thank you very much


msyamp, i picked F too initially. but this was the nice explanation given in UW

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