Question

A woman has secondary amenorrhea, hirsutism, and a raised serum testosterone level. Which one of the following is NOT a possible cause?

• A. Self administration of testosterone
• B. Anorexia nervosa
• C. Polycystic ovary syndrome
• D. Testicular feminisation

Hint:

Look for the option that does not actually involve any excess androgen.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
The clinical picture combines secondary amenorrhea with hirsutism and a raised serum testosterone - a hyperandrogenic state. The question asks which of the four listed conditions does NOT fit as a cause of this picture.

Step 2: Key Concept or Approach:
A condition that explains raised testosterone and hirsutism must involve androgen excess, either from an outside source, from the ovary, or from androgen-producing gonadal tissue. A condition that causes amenorrhea through a completely different, hypoestrogenic route - without any androgen excess - does not belong in this list.

Step 3: Working Through the Options:
Self administration of testosterone directly raises circulating testosterone and produces hirsutism and menstrual disturbance, so it fits. Polycystic ovary syndrome is the single most common cause of hyperandrogenism with hirsutism and oligo/amenorrhea in reproductive-age women, so it fits well. Testicular feminisation (androgen insensitivity) is a state where testes are present and secrete testosterone at male-range levels, so raised testosterone is consistent with it. Anorexia nervosa, however, causes amenorrhea through severe caloric restriction suppressing the hypothalamic-pituitary-ovarian axis - gonadotropins, oestrogen, and androgens all tend to be low, not high, and hirsutism is not a feature.

Step 4: Conclusion:
The correct answer is anorexia nervosa - it produces amenorrhea through starvation-related hypothalamic suppression rather than through androgen excess, so it does not explain the hirsutism and raised testosterone described.