A 28-year-old woman presents with secondary amenorrhea for 6 months. Serum FSH is 52 mIU/mL and LH is 38 mIU/mL. Estradiol is 15 pg/mL. She has no galactorrhea and no symptoms of hypoestrogenism. What is the MOST likely diagnosis?

• A Premature ovarian insufficiency (POI) ✓
• B Hypothalamic amenorrhea (functional)
• C Hyperprolactinemia
• D PCOS

Explanation

Premature ovarian insufficiency (POI) is characterized by hypergonadotropic hypogonadism in women under 40: elevated FSH (>25 IU/L on two measurements 4 weeks apart), low estradiol, and amenorrhea. This patient has FSH 52 mIU/mL with low estradiol — the classic biochemical picture of POI. Hypothalamic amenorrhea is hypogonadotropic (low FSH/LH). PCOS typically has mildly elevated LH, normal-high FSH, and normal estradiol. Hyperprolactinemia causes low FSH/LH with elevated prolactin.

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

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