Abdominal Pain

Determining the Cause

Chief Complaint: Amenorrhea

a. History: Absence of menses by age 16

b. Physical Exam: Ambiguous genitalia and early appearance of axillary and pubic hair

Differential Diagnosis

- Hormonal/Endocrine Disorders: Polycystic ovary syndrome (PCOS), hypothyroidism, hyperprolactinemia.
- Structural Issues: Uterine scarring (Asherman syndrome), congenital absence of reproductive organs.
- Lifestyle Factors: Excessive exercise, significant weight loss, eating disorders, or chronic stress.
- Medications: Hormonal contraceptives or medications affecting dopamine or other pathways.
- Genetic Conditions: Turner syndrome, androgen insensitivity syndrome.

Next Pivotal Assessment	Finding

[Relevant laboratory findings include elevated urinary 17-ketosteroids, elevated serum dehydroepiandrosterone (DHEA) sulfate, and normal or decreased 17-hydroxycorticosteroids, genetic testing reveals 46,XX genotype, and CT head scan reveals no sign of tumor.]