A 26-year-old white woman who is a long distance runner comes to your office. She trains daily and participates frequently in marathons and other long-distance competitive events all around the country. She denies smoking or alcohol drinking, and says that she follows a healthy, low-fat diet. Her last menstrual period was three years ago, but this is not a problem for her as she does not want to get pregnant "at least in the next five years." After an extensive work-up, her amenorrhea was attributed to exercise. She is 168 cm (5'6'') tall and weighs 50 kg (110 lbs). Her blood pressure is 100/60 mmHg, pulse is 58/min, and respirations are 14/min. Physical examination shows no abnormality. You alert the patient that her amenorrhea poses the risk of another condition. Which of the following conditions are you referring to?

Question

A 26-year-old white woman who is a long distance runner comes to your office.  She trains daily and participates frequently in marathons and other long-distance competitive events all around the country.  She denies smoking or alcohol drinking, and says that she follows a healthy, low-fat diet.  Her last menstrual period was three years ago, but this is not a problem for her as she does not want to get pregnant "at least in the next five years."  After an extensive work-up, her amenorrhea was attributed to exercise.  She is 168 cm (5'6'') tall and weighs 50 kg (110 lbs).  Her blood pressure is 100/60 mmHg, pulse is 58/min, and respirations are 14/min.  Physical examination shows no abnormality.  You alert the patient that her amenorrhea poses the risk of another condition.  Which of the following conditions are you referring to?

Quizplus · Accepted Answer

Explanation: Females who maintain a lower weight or body mass index (BMI) due to the sport or activity that they regularly engage in (e.g. ballet dancers, gymnasts, and runners) may become hypoestrogenic and present with exercise-induced amenorrhea. They are at special risk of developing osteopenia, and even osteoporosis. Spontaneous fractures have been reported in these types of patients, with osteoporosis or osteopenia confirmed through bone densitometry. Treatment consists of improving caloric intake; if this is not possible, patients are started on hormonal replacement with oral contraceptives and supplementation with calcium and vitamin D. (Choice E)Paradoxically, there is a tendency toward hypercholesterolemia, not the opposite. (Choice C)There is no risk of early menopause, but exercise-induced amenorrhea can mimic early menopause because of estrogen deficiency. (Choices A and B)Exercise-induced amenorrhea is a diagnosis of exclusion. Thyroid hormone and prolactin level determinations are necessary in the evaluation of this patient because one/both of these may be the underlying cause (but not a complication or aftermath) of the amenorrhea. Educational objective: Exercise-induced amenorrhea is due to a decrease in the pulsatile secretion of LH, which leads to a decline in estrogen production. It can lead to osteopenia, osteoporosis, breast and vaginal atrophy, mild hypercholesterolemia, and infertility.

A 26-Year-Old White Woman Who Is a Long Distance Runner Comes