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Below is a summary of the responses I received - thank you all. I am going to recommend, first and foremost a repeat and then if I get the same results, possibly get the LH analysed on a different method, possibly adding on a cortisol and FT4 aswell. Summary The result that stands out is the low LH, of course. I assume that this value was obtained on your Immuno-1. This assay uses, I think, an anti-intact LH antibody. These antibodies have been implicated in the non-detection of LH in isolated cases in some assay systems. The suggestion is that the isoforms in some patients are "invisible" to anti-intact LH antibodies. As far as I know, there are NO reported cases of this phenomenon with Immuno-1, but your patient might be the first! As a precautionary measure, I suggest that you get the assays, particularly LH, performed on a different analyser. It is difficult to interprete a single profile in amenorrhoeic women who are clearly not pregnant. I have frequently seen this peculiar pattern, I usually do a progesterone and suggest repeating the profile for 2-3 times at weekly intervals to assess HPO-axis pulsatility. This pattern may indicate a luteal phase profile in a women heading for the perimenopause. A repeat sample may sometimes show a clear perimenopausal pattern with very high FSH (>30). I would keep hypopituitarism in the differential diagnosis because of the seriousness of missing this diagnosis. Looking at the problem the other way round then regular menstrual cycles are probably the best way of showing that a woman is not hypopituitary. I tend to do random cortisols but more often than not they are equivocal and perhaps I shouldn't - I suppose I am fishing for the ones that are undetectable as I would convey those with some urgency,. The other thing to think of is ferritin as haemochromatosis is a cause of hypopituitarism - unlikely perhaps in a woman of child-bearing age as her previous menstruation would be expected to protect her before it gets to the stage of causing amenorrhoea. We measure ferritin here in biochemistry so I tend to add it along with other baseline pituitary function. Low gonadotrophins are entirely consistent with anorexia (nervosa). Prolactin, TSH and FT4 are usually normal, but cortisol is often elevated and FT3 may be low (with reverse T3 being high) in this condition. we have seen a few ladies with anorexia nervosa in which the gonadotrophins have returned to pre-pubertal levels (which does not really fit with your lady's results). It does not look like PCOS either (unlikely from the history). The LH could be nadir of normal? Regards, Raheela Raheela Ajmal-Ali Senior Biochemist Whittington Hospital ******************************************************************************************************** This message and any attachments is intended solely for the addressees and is confidential. If you receive this message in error, please delete it and immediately notify the sender. Any use not in accord with its purpose, any dissemination or disclosure, either whole or partial, is prohibited. Any views expressed in this message are those of the individual sender. ******************************************************************************************************** ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/