29-year-old nulligravid woman comes to the office because she has not menstruated since stopping her birth
control. Menarche was at age 14, and she had irregular, heavy menstrual periods from age 14-16. The patient
then took combination oral contraceptives until 6 months ago. Since stopping her medication, she has had more
frequent headaches and increasing acne but has had no weight changes, pelvic pain, or abnormal hair loss or
growth. The patient is a high school teacher and coaches the cross-country and track teams. She runs
recreationally and eats a well-balanced diet. She does not use tobacco, alcohol, or illicit drugs. Vital signs are
normal and BMI is 22 kg/m2• A few open comedones are seen on the forehead. The remainder of the physical
examination, including pelvic examination, is normal. Urine pregnancy test is negative and pelvic ultrasound is
normal. Which of the following is the best next step in evaluation of this patient?
- 0 A. Karyotype analysis
- 0 8. MRI of the pituitary
- 0 C. No further evaluation indicated
- 0 D. Serum 17-hydroxyprogesterone level
- 0 E. Serum prolactin level
0 voters