A 24-year-old woman presents with secondary amenorrhoea for 8 months, weight 43 kg, BMI 16 kg/m², hair loss, and cold intolerance. FSH 2.1 IU/L, LH 1.4 IU/L, E2 12 pmol/L, normal prolactin. The diagnosis is:

• A Hypothalamic amenorrhoea (functional) ✓
• B Primary ovarian insufficiency
• C Hypopituitarism due to pituitary macroadenoma
• D Premature ovarian failure with compensatory FSH elevation

Explanation

This clinical picture of secondary amenorrhoea in a young underweight woman with low gonadotropins (FSH 2.1, LH 1.4 IU/L) — i.e., hypo-gonadotropic hypogonadism — and low oestrogen without hyperprolactinaemia in the context of low BMI is characteristic of functional hypothalamic amenorrhoea (FHA), caused by nutritional deficiency suppressing GnRH pulsatility. Primary ovarian insufficiency (POI) would show elevated FSH (>25 IU/L). Pituitary macroadenoma would typically raise prolactin. Weight restoration is the primary treatment.

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

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Written and medically reviewed by the StethoPrep medical team.