A 17-year-old female patient complains of amenorrhea for the last 8 months, weight gain, excessive hair growth on the arms and chest, and development of acne. Pelvic examination is normal. The clinician should recognize these are signs of:
A. Ovarian cancer
B. Endometriosis
C. Hormonal imbalance
D. Stress-induced anovulation
ANS: C
Anovulation may present with amenorrhea but also may present with dysfunctional uterine bleeding, polymenorrhea, or menorrhagia. The symptoms vary with the cause. Overweight may be seen with several of the causes, including hypothyroidism, polycystic ovarian syndrome, and pituitary and adrenal dysfunction. Underweight is seen in anorexia nervosa, excessive exercise, hyperthyroidism, or stress-induced anovulation. Hirsutism, acne, and other skin changes can be seen with imbalances in LH, FSH, and androgens, as seen in polycystic ovary disease. Delayed puberty or regression of sexual characteristics is seen in hypopituitarism; galactorrhea can be the presenting symptom in pituitary tumors.
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