A 28-year-old lady has put on weight (10 kg over a period of 3 years) and has oligomenorrhoea followed by amenorrhoea for 8 months. The blood pressure is 160/100 mm of Hg. Which of the following is the most appropriate investigation?
Weight gain + Oligomenorrhea --->Cushing syndrome. Coisol inhibits gonadotropin release that explains the amenorrhea. Hypeension in these patients is secondary to increased coisol that has some mineralocoicoid activity also. Excess glucocoicoids also interfere with central regulatory systems, leading to suppression of gonadotropins with subsequent hypogonadism and amenorrhea, and suppression of the hypothalamic pituitary-thyroid axis, resulting in decreased TSH (thyroid-stimulating hormone) secretion. Weight gain + menorrhagia + isolated diastolic hypeension in the question would have prompted thyroid dysfunction as the first answer.
Serum electrolytes
Plasma coisol
Plasma testosterone and ultrasound
T3, T4 and TSH
Cushing Syndrome