Differential Diagnosis for Infertility and Irregular Cycles
- Single Most Likely Diagnosis
- Polycystic Ovary Syndrome (PCOS): This is the most likely diagnosis given the patient's history of irregular cycles, which have become increasingly infrequent, and symptoms such as fatigue and night sweats. Although PCOS is often associated with obesity, it can also occur in women with a normal BMI. The patient's history of successful pregnancy in the past does not rule out PCOS, as the condition can manifest at any time and may be influenced by various factors including weight changes and hormonal imbalances.
- Other Likely Diagnoses
- Hypothalamic Amenorrhea: Given the patient's symptoms of fatigue and night sweats, along with her history of irregular cycles and recent amenorrhea, hypothalamic amenorrhea is a possible diagnosis. This condition can be caused by stress, significant weight loss, or intense exercise, though none are explicitly mentioned, it's worth considering given the broad range of potential triggers.
- Premature Ovarian Failure (POF): Although less common, POF should be considered, especially given the patient's age and the sudden onset of amenorrhea. However, her previous successful pregnancy makes this less likely.
- Thyroid Dysfunction: Despite the patient's normal TSH, thyroid dysfunction can sometimes present with subtle symptoms and may contribute to menstrual irregularities. It's essential to ensure that her levothyroxine dose is adequate and that her thyroid function is stable.
- Do Not Miss Diagnoses
- Pituitary Tumor: A pituitary tumor could cause amenorrhea and infertility due to its impact on hormone regulation. The patient's symptoms of fatigue and night sweats could be indicative of a hormonal imbalance caused by such a tumor. Although rare, missing this diagnosis could have significant consequences.
- Hyperprolactinemia: Elevated prolactin levels can cause amenorrhea and infertility. This condition can be due to various causes, including pituitary tumors, and is crucial not to miss.
- Rare Diagnoses
- Congenital Adrenal Hyperplasia: This is a rare genetic disorder that can affect hormone production and lead to infertility and menstrual irregularities. It's less likely given the patient's history of a previous successful pregnancy but should be considered in the differential diagnosis due to its potential impact on fertility and menstrual cycles.
- Asherman Syndrome: This condition, characterized by the formation of adhesions in the uterus, can lead to amenorrhea and infertility. It is a rare cause of secondary amenorrhea but should be considered, especially if there was any history of uterine surgery or instrumentation, which is not mentioned in this case.