A 17-year-old athlete presents with amenorrhea for 8 months, BMI 17, and stress fracture of the tibial shaft. Her FSH is low, LH is low, and estradiol is low. The underlying mechanism is:

• A Primary ovarian insufficiency
• B Hyperprolactinemia from strenuous exercise
• C Hypothalamic amenorrhea from low energy availability suppressing GnRH pulsatility ✓
• D Constitutional delay of puberty

Explanation

This is the Female Athlete Triad: disordered eating/low energy availability, amenorrhea, and low bone density (stress fracture). Low energy availability suppresses kisspeptin-GnRH pulsatility, leading to hypogonadotropic hypogonadism with low FSH, LH, and estradiol. This is functional hypothalamic amenorrhea, not a structural or primary ovarian disorder. Treatment focuses on restoring caloric intake and reducing exercise intensity.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.