A 24-year-old woman has secondary amenorrhoea for 8 months. Serum FSH is 55 IU/L, LH is 42 IU/L, oestradiol is 32 pmol/L, prolactin is normal, TSH is normal. Pregnancy test is negative. The MOST likely diagnosis is:

• A Hypothalamic amenorrhoea
• B Polycystic ovary syndrome
• C Asherman's syndrome
• D Premature ovarian insufficiency (POI) ✓

Explanation

Premature ovarian insufficiency (POI) is defined as hypergonadotrophic hypogonadism before age 40: elevated FSH (> 25 IU/L on two occasions 4 weeks apart), low oestradiol, and amenorrhoea. This woman has FSH 55 IU/L and LH 42 IU/L (both markedly elevated) with low oestradiol — a hypergonadotrophic pattern. Hypothalamic amenorrhoea gives low/normal gonadotrophins (hypogonadotrophic). PCOS gives normal/elevated LH with normal/low FSH and normal oestradiol. Asherman's gives normal hormones with absent withdrawal bleed.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.