A 28-year-old woman has secondary amenorrhea for 8 months. Serum FSH is 68 IU/L (high), LH 52 IU/L (high), estradiol 22 pmol/L (low). Karyotype is 46,XX. The MOST LIKELY diagnosis is:

• A Premature ovarian insufficiency (POI) ✓
• B Hypothalamic amenorrhea (functional hypogonadotropic hypogonadism)
• C Polycystic ovary syndrome
• D Prolactinoma

Explanation

High FSH (>25 IU/L on two occasions ≥4 weeks apart) combined with low estradiol and amenorrhea in a woman under 40 years defines premature ovarian insufficiency (POI). FSH of 68 IU/L is markedly elevated (hypergonadotropic hypogonadism). Hypothalamic amenorrhea would show low FSH and LH. PCOS shows normal or mildly elevated LH with normal FSH. Prolactinoma presents with elevated prolactin and low FSH/LH. 46,XX excludes Turner syndrome. FMR1 premutation, autoimmune oophoritis, and iatrogenic causes must be investigated.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.