A 28-year-old woman with secondary amenorrhea has FSH 42 IU/L, LH 18 IU/L, estradiol 30 pg/mL, and normal prolactin. She is 162 cm tall, has no breast development, and a normal uterus on ultrasound. Which is the most likely diagnosis?

• A Sheehan syndrome
• B Hypothalamic amenorrhea
• C Premature ovarian insufficiency ✓
• D Asherman syndrome

Explanation

Elevated FSH (>25 IU/L) with low estradiol in a woman under 40 confirms premature ovarian insufficiency. The absent breast development suggests gonadal dysgenesis or Turner mosaic. Hypothalamic amenorrhea would show low or normal FSH and LH. Sheehan syndrome follows postpartum hemorrhage with panhypopituitarism. Asherman syndrome presents with normal hormones but absent endometrium.

Reference: Williams Gynecology, 4th ed.

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