In Addison disease, what menstrual irregularity can occur?

• A. Amenorrhea
• B. Heavy menses
• C. Metrorrhagia
• D. Regular menses

Answer: (A)

Amenorrhea is most likely in Addison disease because primary adrenal insufficiency lowers cortisol and adrenal androgens, which disrupts the hypothalamic–pituitary–ovarian axis. Illness and cortisol deficiency can reduce GnRH release and subsequently lower LH/FSH, leading to decreased ovarian estrogen production and anovulation. With the ovaries not ovulating and estrogen levels falling, menses may stop entirely. The adrenal hormone deficiency can also blunt androgen support for the estrogen axis, further contributing to absence of menses. In this situation, heavy or regular menses are less likely, whereas the absence of menses fits the hypoestrogenic, anovulatory state seen with adrenal insufficiency.