A 14-year-old girl with type 1 diabetes mellitus since age 8 presents with primary amenorrhea. She has Tanner stage 2 breasts and Tanner stage 1 pubic hair. Her HbA1c has been consistently above 10% over the past 3 years. FSH is 35 IU/L and LH is 18 IU/L. Which of the following best explains her pubertal delay?
- A Hypothalamic suppression from poorly controlled diabetes ✓
- B Premature ovarian failure from autoimmune oophoritis
- C Turner syndrome with mosaic karyotype
- D Polycystic ovary syndrome
Correct answer: A. Hypothalamic suppression from poorly controlled diabetes
Explanation
Poorly controlled type 1 diabetes can suppress the hypothalamic-pituitary-ovarian axis, leading to delayed puberty and amenorrhea. Chronic hyperglycemia and elevated HbA1c impair GnRH pulsatility. While autoimmune oophoritis can occur in type 1 diabetes, it would present with elevated FSH (>40 IU/L) and is less common. Turner syndrome would show a characteristic karyotype. PCOS typically presents with signs of hyperandrogenism and oligomenorrhea after menarche, not primary amenorrhea with delayed puberty.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.