Endocrine Abstracts

A 21-year-old lady was reviewed for consideration of acceptance into the Tier 3 weight management programme. Past history included PCOS, MAFLD, Hidradenitis suppurativa and T2 DM on Mounjaro. XX’s key concern however, was that she was seeking pregnancy and had never had an unstimulated period. XX was accepted into the programme and referred onto our Diabetes clinic for assessment of her endocrinopathies and to maximise her glycaemic co-morbidities. When seen in the diabetes clinic three months later, on single agent Mounjaro therapy, her HbA1 c had improved from 60 to 35 mmol/mol with weight loss from 119 to 111 kg (7% of body weight). On review of history, she had been referred age 16 to Gynaecology for primary amenorrhea. She had reported going through puberty at the same stage as her peers and it was noted at age 16 she had a C-cup bra and a BMI of 34. Biochemistry identified hyperandrogenism (Testosterone 2.19 nmol/l) but no hirsutism or acne was reported. An USS showed a normal sized uterus and bilateral small ovarian follicles consistent with PCOS however the report stated that this was likely normal for her age. She went on to have 3 months of cyclical norethisterone with withdraw bleeds. She was diagnosed with amenorrhoea secondary to probable anovulatory PCOS. XX wanted these issues reviewed again feeling that despite weight loss she still hadn’t had regular cycles which were important to her for achieving motherhood. This was significantly affecting her mental health. On review of old notes oestradiol was consistently <150 nmol/l with a non-elevated LH and FSH. Her prolactin and other pituitary axes were intact. Biochemical hyperandrogenism was again present but she reported a Ferriman-Gallway score of 24 (hirsutism). A screen for CAH and cortisol excess were negative. On further review four months later, with further weight loss to 101 kg, (BMI 32.2, 15% weight loss) XX had reported the first spontaneous period. This case report identifies a young lady with amenorrhoea secondary to PCOS or obesity-related hypogonadotropic hypogonadism which resolved on weight loss. Neither obesity-related menstrual irregularities or male testosterone deficiency are identified in NICE guidelines as weight-related health conditions for Mounjaro. Their presence could be considered when identifying the benefit of ongoing titration of Mounjaro/GLP-1 therapy in patients with T2 DM despite achieving euglycemia.