[18F] Experiencing amenorrhea, weight management issues, and other systemic symptoms

Patient Description

An 18-year-old female presents with a constellation of symptoms that have been persisting for about a year. She reports severe acne, primarily on her jawline and cheeks, which has worsened over time. She has been unable to gain weight despite increased caloric intake and decreased exercise. The patient notes a persistently low heart rate and experiences fatigue, frequent urination, pronounced hunger, and a constant feeling of being cold. She also mentions that she has not had a menstrual period for approximately a year, with only occasional spotting, and has been experiencing constipation. The patient has a rounded facial appearance that developed over the past 6 months. She has a history suggestive of Irritable Bowel Syndrome (IBS) but no severe headaches, vision changes, dizziness, or fainting spells. No allergies or adverse reactions to medications have been reported, and she is not currently taking any medications.

Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

Hypothyroidism: This is a condition where your thyroid gland doesn't produce enough thyroid hormones. Symptoms can include fatigue, constipation, dry skin, weight gain, puffy face, and feeling cold. It can also cause menstrual changes such as heavy periods or amenorrhea.
- Treatment typically involves taking a daily hormone replacement pill to restore normal thyroid hormone levels.
Polycystic Ovary Syndrome (PCOS): This is a hormonal disorder common among women of reproductive age. Symptoms can include irregular periods or prolonged periods, excess androgen which can result in severe acne and facial hair, and polycystic ovaries. Difficulty gaining weight is not typically associated with PCOS, but each individual may experience symptoms differently.
- Treatment of PCOS typically involves lifestyle modifications and medication to manage individual symptoms, such as birth control pills to regulate menstruation and medication for acne.
Anorexia Nervosa: This is an eating disorder characterized by an intense fear of gaining weight, a distorted body image, and self-imposed starvation leading to extreme weight loss. It can cause amenorrhea, constipation, and feeling cold. However, you mentioned that you have been trying to gain weight, which is not typically associated with this condition.
- Treatment typically involves a combination of medical, nutritional, and psychological therapy.
Diabetes Insipidus: This is a rare condition that causes frequent urination. Symptoms can include extreme thirst and the passage of large amounts of urine. It does not typically cause weight loss or amenorrhea.
- Treatment typically involves medication to help your body produce less urine.

What you can do

It would be best to consult a doctor about your symptoms so that they can provide a formal assessment and order relevant tests if necessary. In the meantime, you can try the following:

Keep a symptom diary: This can help you and your doctor identify patterns and triggers for your symptoms.
Stay hydrated: This is particularly important if you are urinating frequently.
Eat a balanced diet: This can help manage your weight and ensure you are getting the necessary nutrients.