A young woman with yellow hands and secondary amenorrhoea.

A personal trainer, 26 years of age, presented because of a 12-month history of secondary amenorrhoea since ceasing the oral contraceptive pill. In addition, a friend had commented on the yellow pigmentation of her hands, which had been present for an uncertain duration. Menarche occurred at 13 years of age, and menses had been regular prior to commencing the oral contraceptive pill for menorrhagia. The patient did 30–45 minutes of physical exercise five days per week and reported having a balanced diet. There were no other symptoms suggestive of pituitary hormone deficiency or mass effect. On examination, the patient had yellow hands (Figure 1) and feet, sclerae were normal and body mass index (BMI) was 24.1 kg/m. She was clinically eupituitary, visual fields and fundi were normal, and a pregnancy test was negative. Laboratory investigations are presented in Table 1.