Q:

What do these tests tell us?

belongs to book: CLINICAL CASES IN ENDOCRINOLOGY|Pramila Kalra|| Chapter number:14| Question number:1.6

waelhammad

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2022-11-19

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A 25-year-old unmarried girl comes to the endocrinology OPD with history of amenorrhea for past 7 months. Her menarche happened at the age of 13 years. She has no other complaints except for mild lethargy or fatigue. She has no known endocrinological problem. She complains of some occasional episodes of sweating and palpitations. She has no complaints of headache or any visual disturbances. She has no complaints of vomiting or any change in weight. She does not give any history of any drug intake. She has not taken any treatment for amenorrhea till now. She has not undergone any gynecological procedures till now. Prior to seven months, her menses were regular. Her mother is concerned about her amenorrhea as she is getting married next month and her future conception prospects. Her height is 160 cm and her predicted height is 158 cm. Her weight is 60 kg. She has normal secondary sexual characters development. She has no features of virilization. She has no similar history in the family and she has no hirsutism or acne. She has no galactorrhea.

What do these tests tell us?

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waelhammad

2022-11-19

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If the prolactin level is high it may point towards a pituitary tumor secreting prolactin only if the levels are beyond 200 ng/mL. A level between 10 and 200 ng/mL is a borderline range. In all cases drug history should be elicited to rule out any drug induced hyperprolactinemia. Psychotropic drugs, hypothyroidism, stress, and meals can also raise prolactin levels. An FSH level of more than 40 mIU/mL shows premature ovarian failure and has to be confirmed after one month with a repeat testing. LH levels can be elevated in cases of 17,20 lyase deficiency, 17-hydroxylase deficiency, and premature ovarian failure. LH levels can vary from 50 to 400 pg/mL depending on the early follicular to preovulatory estradiol surge. In menopausal women the levels are typically less than 20 pg/mL. Amenorrhea is an uncommon presentation of thyroid disorders but TSH and T4 levels are to be done to rule out hyperthyroidism or hypothyroidism. The levels of androgens like testosterone and DHEAS point towards any cause of hyperandrogenemia leading to amenorrhea.

Her hormonal evaluation shows FSH level of 60 IU/L. Her serum E2 level is 20 pg/mL. Her TSH, T4 is in normal range. Her prolactin level is 20 ng/mL.

Her serum testosterone is 30 ng/mL. A diagnosis of premature ovarian failure is made and she is counselled about need of hormonal therapy.

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