CASE 30: AMENORRHOEA
History
A 23-year-old actress presents to her general practitioner (GP) complaining that she has
not had a menstrual period for 5 months. She started having periods aged 13 years and
previously they had been regular. On direct questioning she states that she has lost 8 kg in
weight over the past year although she says her appetite is good. She has had no serious
medical illnesses. Currently she is out of work. She split up from her boyfriend 1 year ago.
She drinks 10 units of alcohol per week and is a non-smoker. She is taking no regular
medication.
Examination
She has lost muscle mass especially on her limbs and buttocks. She is 1.7 m (5 ft 9 in) tall and
weighs only 41 kg. She has excessive hair growth over her cheeks, neck and forearms. Her
pulse rate is 52/min regular, blood pressure 96/60 mmHg. Examination is otherwise normal.
NormalHaemoglobin 15.2 g/dL 11.7–15.7 g/dL
Mean corpuscular volume (MCV) 84 fL 80–99 fL
White cell count 4.1% 109 /L 3.5–11.0% 109 /L
Platelets 365 % 109 /L 150–440% 109 /L
Sodium 136 mmol/L 135–145 mmol/L
Potassium 2.9 mmol/L 3.5–5.0 mmol/L
Chloride 90 mmol/L 95–105 mmol/L
Bicarbonate 33 mmol/L 24–30 mmol/L
Urea 4.2 mmol/L 2.5–6.7 mmol/L
Creatinine 43 &mol/L 70–120&mol/L
Glucose 5.6 mmol/L 4.0–6.0 mmol/L
Albumin 41 g/L 35–50 g/LINVESTIGATIONS
Questions
- What is the clinical diagnosis?
- How should this patient be investigated and managed?