Amenorrhea in 19-year-old athlete

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Ms. T is a 19 year-old female who presented for her annual exam as a new patient to the practice.  During her history she reported menarche at age 16 and irregular menses.  She stated that she only gets her period three to four times a year.  Her last menstrual period was 13 months ago. 

Ms. T denies any sexual activity in the past 11 months, having broken up with her high school boyfriend when she went away for college.  She denies any significant medical or surgical history.  She does not smoke, drink alcohol or use any illicit drugs. She takes no medications.

Ms. T has been a long distance runner since high school and continued to run for her college team.  She was not particularly distressed about the amenorrhea; she actually stated that she liked not having a period while she was training for important races. Ms. T's height was 5'6” and weight was 118 lbs with a BMI of 19.  She reported eating a very healthy diet to support her training with no sweets, soda or junk food. 

Physical exam was unremarkable, with normal secondary sexual characteristics and normal female pelvic anatomy. No hirsutism or acne was noted on exam.

Lab work showed a negative serum pregnancy test, while thyroid and prolactin levels were within normal range. Luteinizing hormone and follicle-stimulating hormone serum levels were both low.  Subsequent MRI of the brain was negative for pituitary tumors.

What is your diagnosis?

A)    PCOS (Polycystic Ovarian Syndrome)

B)   Premature Ovarian Failure

C)    Exercised associated amenorrhea

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