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Functional hypothalamic amenorrhoea — SCE Endocrinology MCQ

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ModerateReproductive endocrinologyFunctional hypothalamic amenorrhoeaSCE Endocrinology

A 28-year-old elite runner has secondary amenorrhoea, stress fractures and BMI 18 kg/m2. FSH and LH are low-normal, oestradiol is low, prolactin and TSH are normal and pregnancy test is negative. What is the underlying pathophysiology?

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Correct answer: B — Functional hypothalamic suppression of GnRH pulsatility

Functional hypothalamic suppression of GnRH pulsatility is best because low energy availability suppresses hypothalamic GnRH pulsatility, causing hypogonadotrophic hypo-oestrogenism. The alternatives are less appropriate because ovarian insufficiency raises FSH; PCOS causes androgen excess; prolactinoma raises prolactin; activating FSH receptor mutation is not the clinical pattern. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: Endocrine Society functional hypothalamic amenorrhoea guideline