Review Question - QID 109607

This patient is presenting with amenorrhea in the setting of being a competitive athlete, suggesting a diagnosis of stress-induced amenorrhea. A prolonged state of excess exercise and a low BMI can predispose patients to osteoporosis.

Women who exercise excessively and have a low BMI may experience amenorrhea. The increased stress can increase corticotropin releasing hormone (CRH) which reduces the pulsatile release of gonadotropin releasing hormone (GnRH). Low GnRH decreases the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH) which can lead to decreased estrogen production and amenorrhea. The low estrogen state can also predispose women to osteoporosis and breast atrophy.

Incorrect Answers:
Answer 1: Endometrial cancer risk is increased with chronic anovulation and an increased estrogen state (which this patient does not have). It is possible that this patient's risk of endometrial cancer is increased; however, her risk for osteoporosis is even higher.

Answer 2: Infertility is certainly a possible acute complication; however, this is reversible if the patient were to increase her BMI and exercise less.

Answer 3: Osteoarthritis typically occurs in overweight patients with repetitive trauma to their joints. Though strenuous exercise could put this patient at risk, this is less likely an outcome than osteoporosis.

Answer 5: Anorexia nervosa is an impulse control disorder in which individuals perpetually try to lose weight. One method of maintaining a low weight is excessive exercise; however, this patient is exercising appropriately for her sport.

Bullet Summary:
Excess exercise and a low BMI is a risk factor for osteoporosis in female athletes.