Can't beat starting the day with morning report with APD Dr. @MariaYialamas! Today we delved into the world of ♀️ health with a case of amenorrhea!
In generating your ddx, common causes along the HPO axis include functional amenorrhea (due to any physical or emotional stress 😬), elevated prolactin, and PCOS.
Don't forget to include structural causes - mainly adhesions due to prior D&C
Exam pearl alert 🚨: rapid onset hirsutism, hair growth on back or upper abdomen, clitoromegaly ➡️ androgen secreting malignancy > PCOS.
Can be judicious in first pass - FSH, TSH, and PRL capture many common abnormalities!
Another 💎: Prolactin can be elevated by eating or stress - if mildly elevated (20-50) be sure to repeat before going to brain MRI.
FSH interpretation for the internist!
⬆️ think loss of negative feedback & POI
⬇️ or normal then assess estrogen status to assess central vs. ovarian etiology
Progesterone induced bleed indicates +estrogen effect on endometrium and can separate PCOS from central/hypothalamic!
In our case, pt had ⬆️ T + anovulation = PCOS! 1st line = wt loss if overweight and COC which protect endometrium and dec hyperandrogenism!
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