Author: Jill Inouye, MD
Co Author #1: Dr. Ann Gateley
Co Author #2: Dr. Chris McGrew
Co Author #3: Dr. Shane Cass
Editor: Kristine Karlson, MD
22-year-old female cross country athlete who came to the training room clinic with primary amenorrhea.
Patient was born and raised in Canada, never started her period. She had multiple work-ups for primary amenorrhea at age 15, 19, and 21, including work-ups at 2 other U.S.A. Division I Universities. The patient had always been slender, with a BMI of 15 or 16. Her family members were also thin, but her mother and grandmother each had menarche at age 15. Her past work-ups included 2 normal pelvic ultrasounds and 2 normal pelvic exams. When older lab results were reviewed, she had normal LH, FSH, anterior pituitary labs, TSH, and prolactin. She had low estradiol, progesterone, and serum testosterone. She did not have a withdrawal bleed with Provera. A DEXA scan was completed at one of the other universities and this showed osteopenia of the lumbar spine. She was diagnosed with hypothalamic pituitary amenorrhea and was encouraged to gain weight; however, the patient did not feel she had been adequately instructed on how she should gain weight. She was offered oral contraceptive pills but thought this was an "unnatural" way to get her periods. She did not have any stress fractures at this time but did have a history of stress reactions in the past. There were no signs of disordered eating.
Vitals: Temperature 97.6 Â°F, BP 97/61 mmHg, Weight 45.0 kg Ht 164 cm BMI 16.8
General: Athlete is slender, no acute distress
Physical exam was otherwise normal.
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