A 16-Year-Old Girl Comes to the Office for a Pre-Participatory

A 16-year-old girl comes to the office for a pre-participatory school sports examination.  She plays on her high school soccer team and also frequently competes in local beauty pageants.  The patient follows strict dietary limitations and exercises strenuously 2 hours a day.  Onset of menses was at age 13, but her last menstrual period was 8 months ago.  She otherwise feels well.  Her height is 165 cm (5 ft 5 in) and her weight is 45.3 kg (100 lb) , with a BMI of 16.6 kg/m².  Physical examination shows a pale and thin girl with fine hair around her trunk, but the remainder is otherwise normal.  Urine pregnancy test is negative.  Which of the following is the most likely mechanism of her amenorrhea?

A) Hyperprolactinemia
B) Hyperthyroidism
C) Hypothalamic suppression
D) Primary ovarian failure
E) Primary pituitary dysfunction

Correct Answer:

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