Case Discussion

[walidhassabala]

A 26-year-old woman is evaluated for a 4-month history of amenorrhea. Menses began at age 13 years. At age 18 years, the patient was placed on an oral contraceptive pill to control heavy bleeding. She discontinued the oral contraceptive pill 4 months ago because she and her husband want to become pregnant, and she has had no menses since then. There is no family history of infertility or premature menopause.

On physical examination, vital signs are normal, and BMI is 24. There is no acne, hirsutism, or galactorrhea. Examination of the thyroid gland and visual field testing yield normal findings. Pelvic examination findings are also normal. An office pregnancy test is negative.

Laboratory studies:
Follicle-stimulating hormone

2 mU/mL (2 U/L)
Prolactin

17 ng/mL (17 µg/L)
Thyroid-stimulating hormone

1.1 µU/mL (1.1 mU/L)
Thyroxine (T4), free

1.0 ng/dL (12.9 pmol/L)

Which of the following is the most appropriate next diagnostic test?
AMeasurement of the plasma dehydroepiandrosterone sulfate level
BMeasurement of serum estradiol level
CMRI of the pituitary gland
DProgestin withdrawal challenge

[ismailalamin]

MRI of the pituitary gland

[walidhassabala]

nop

[ismailalamin]

Progestin withdrawal challenge

[walidhassabala]

why?