The best mrcp mcqs

A 42-year-old woman was seen in Endocrinology Clinic with a 4-month history of amenorrhoea. On questioning, she reports having to wax her arms and upper lip. Her mother went through early menopause at 28 after having an emergency hysterectomy post-partum. On examination, her body mass index is 38 kg/m² but otherwise unremarkable.

Her GP has kindly ordered blood tests prior to her appointment

Investigations

LH 40 IU/L (5 to 25 IU/L)
FSH 8 IU/ (1 to 11 IU/L)
Estradiol 720 pmol/L (70-500 pmol/L)
Progesterone 220 nmol/L (35-92 nmol/L)
Thyroid Stimulating Hormone 5.6 mIU/L (0.5 -6.0 mIU/L)
Prolactin 700 mIU/L (105-548mIU/L)

What is the most likely diagnosis?

Prolactinoma

Polycystic Ovarian Syndrome

Premature Ovarian Failure

Pregnancy

Subclinical Hypothyroidism

The most likely diagnosis is pregnancy. The elevated estradiol and progesterone are characteristic with a slight rise in the LH level.

The prolactin level is only mildly elevated so a prolactinoma is unlikely especially with the rise is other hormone levels. Polycystic ovarian syndrome is associated with androgen excess and an elevated LH to FSH ratio. While androgen (testosterone) hasn’t been measured, it is not associated with rises in estradiol or progesterone.

Premature Ovarian Failure typically presents with low levels of estradiol and a raised FSH level. Subclinical hypothyroidism is linked with oligo-ovulation but in this case, the TSH level is normal excluding this as a diagnosis