Internal Medicine Flashcard|Articles in Press

Secondary amenorrhoea with absent axillary hair

Published:March 11, 2023DOI:
      A 39-year-old female presented with progressive fatigue, extreme tiredness, muscle pain, giddiness and shortness of breath for six months. On further questioning she reported lack of menses for 19 years, since her last pregnancy. She reported that she had a home delivery 19 years ago with post partum haemorrhage that required hospitalisation and three units of blood transfusion. Clinical examination showed pallor, with no axillary (Fig. 1A) and pubic hair. Biochemical evaluation showed the presence of hypoprolactinaemia (Prolactin - 0.8 ng/ml; NR 2.8–29.2), secondary hypocortisolism (Cortisol - 0.63 mcg/dl; RR 8.7–22.4; ACTH – 45 pg/ml; RR <46), secondary hypothyroidism with a low FT4 (FT4 - 0.4 ng/dL; RR 0.89–1.76), and low FT3 (FT3 - 0.9 pg/mL; RR 2.3–4.2) and an inappropriately normal thyroid-stimulating hormone (TSH) [2.59 mU/L; (RR 0.30–5.5)]. She also had central hypogonadism with a low oestradiol (<5 pg/mL; RR 12.5–166), an inappropriately low luteinizing hormone (LH) [1.0 mU/mL; (RR 1.9–12.5)] and follicle-stimulating hormone (FSH) [0.21 mU/ml; (RR 2·5–10·2)]. An MRI pituitary (Fig. 1B) revealed a low volume pituitary with an empty sella (arrow).
      Fig. 1
      Fig. 1Panel A – Right axillary area showing the absence of axillary hair; Panel B – MRI sagittal section showing an empty sella.


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