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A 27-year-old woman presented with a 6-month history of amenorrhoea and low mood. She complained of headaches but no visual disturbance. Her past medical history included anorexia nervosa but her current weight was stable.
On examination, her body mass index was 20.2 kg/m2 (18-25). Routine physical examination was normal and there was no galactorrhoea. Visual fields were full to confrontation.
serum cortisol (09.00 h)320 nmol/L (200-700)
short tetracosactide ([email protected]) test (250 micrograms): serum cortisol (30 min after tetracosactide)630 nmol/L (>550) serum oestradiol200 pmol/L (200-400) plasma follicle-stimulating hormone2 U/L (2.5-10.0) plasma luteinising hormone4 U/L (2.5-10.0)
serum prolactin1001 mU/L (<360) serum free T418.0 pmol/L (10.0-22.0)
serum ?-human chorionic gonadotropin<5 U/L (<5)
What is the most appropriate next step in management?
A. MR scan of pituitary
B. start cabergoline 0.5 mg/week
C. encourage weight gain and reassess after 2 months
D. pregnancy test
E. ultrasound scan of ovaries
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