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Original Question

A 17-year-old female presents to the clinic alone for evaluation of amenorrhea. She developed breast buds at the age of 12 years and her first menstrual cycle started at the age of 13 years. Starting at age 16 her cycles would last for 7 to 10 days and occur every 31 to 45 days. Her last menstrual cycle was six months ago. On exam her vital signs reveal, a heart rate of 90 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mmHg. Her height is the 40%tile for age and her weight is the 75%tile for age. She has multiple open and closed comedones scattered over her forehead, chest and upper back. The remainder of her exam is within normal limits. A urine pregnancy test is negative. What is the most likely cause of her amenorrhea? A. Testosterone-producing tumor B. Late-onset congenital adrenal hyperplasia C. Turner syndrome D. Polycystic ovarian syndrome (PCOS)

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