17-year-old Girl in Medicine / Internal Medicine — 17yo Child | Endocrinology | SMLE Q#427
SMLE Question #427
Medicine / Internal Medicine
Endocrinology
Last updated: February 2026
A 17-year-old girl has never had menses. She is a competitive long-distance runner who trains intensely every day and chronically restricts calories to maintain a very low weight. BMI is at the 5th percentile. She has Tanner stage V breast and pubic hair development and no hirsutism or virilization. Urine pregnancy test is negative. What is the most important underlying cause of her amenorrhea?
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