Endocrine Abstracts

26-year-old referred with primary amenorrhea. Described puberty aged 11 years with breast and axillary hair development. One day of a menstrual period in secondary school. She has a partner and would like to start a family.

PMH

T2DM on metformin and liraglutide Undiagnosed but possible learning disability/ autism Increased BMI, 57.5 kg/m2

Examination

Increased BMI Afro-Caribbean ethnicity Normal breast development Acanthosis in axilla

Investigations Normal TV scan – normal ovaries, endometrium 3 mm FSH 3.9 U/lLH 4.8 U/lOestradial 281 pmol/lBeta HCG negative SHBG 15.8 nmol/lProlactin 120 mU/l17-OH progesterone < 1.6 nmol/lTestosterone 2.2 DHEA sulphate 7.7 umol/lTSH 1.53 T4 -19.5 Overnight dexamethasone suppression test – cortisol < 25 nmol/lChromosome analysis XX Progesterone challenge - Medroxyprogesterone – withdrawal bleed Pituitary MRI – normal appearance

Impression

Possible functional amenorrhea secondary to obesity

Management

Patient referred to tertiary centre for further management of weight.