Endocrine Abstracts

Hypothalamic amenorrhoea is a diagnosis of exclusion, frequent cause of which are medications or psychiatric disorders (bulimia/anorexia). Here we present a case, when its aetiology was gender identity disorder. A 18-year-old girl presented with absence of menses during last year. Menses began at the age of 14 and were regular till age of 16, when she moved to another city. She was seen by gynaecologist because of amenorrhea, and evaluation was performed: FSH 4.6 mU/ml (1.37–9.9), LH 7.2 mU/ml (1.68–15.0), oestradiol 20 pg/ml (68–606), total testosterone 0.5 nmol/l (0.38–1.97), TSH 2 mU/l (0.4–4.0), prolactin 570 mU/l (109–557), and US, multifollicular ovaries. ‘Ovarial hypofunction’ was established, and vitaminotherapy was prescribed without any effect. She appealed to different specialists, however, definitive diagnosis wasn’t established. At the age of 17, menses were recovered spontaneously and stopped again in 6 months. Patient had not taken OC, weight remained stable. Physical examination revealed BMI 19 kg/m², hirsute number 0, breast development Tanner 5. Hormonal test results were in reference range, hCG was negative. Talking with patient, our attention was drawn by her hysterical behaviour, because she told about herself as an asexual being. Thereby, she appealed to psychiatrist, and diagnosis of gender identity disorder was established. It was interesting to note that her menses recovered at that time, when she fell in love and felt as a woman. Taking into consideration absence of pregnancy, excluded endocrine causes of amenorrhea, no history of OC, no excess or insufficient food intake, spontaneous menses recover during normal identity, there was established diagnosis of hypothalamic amenorrhoea, and psychiatric treatment was recommended. In case of amenorrhoea, body weight changes, and careful inspection are needed while suspicion of bulimia/anorexia. It is also needed to pay attention to patient’s speech, which may be a clue to diagnosis of gender identity disorder as a cause of hypothalamic amenorrhea.