| name | endo-fha-inpatient-evaluation-criteria |
| description | This skill guides clinicians to assess patients with functional hypothalamic amenorrhea (FHA) for hospital admission when they exhibit severe bradycardia, hypotension, orthostasis, or significant electrolyte abnormalities. Use when a clinician says, “Her heart rate is 40 and she’s dizzy—should we admit her?” or notes phrases like “Admit for hypotension and bradycardia” or “Check for orthostatic vitals and electrolytes.” |
Evaluate for inpatient treatment based on vital signs and electrolyte instability
STEP 1 — Gather Information
Collect heart rate, blood pressure (supine and standing after 3 minutes), respiratory rate, temperature, weight, and symptoms (dizziness, syncope, fatigue). Obtain basic metabolic panel (sodium, potassium, chloride, bicarbonate, BUN, creatinine) and consider magnesium, phosphate if refeeding risk.
STEP 2 — Rule In / Rule Out
Rule in inpatient evaluation if any of the following are present: heart rate <50 beats/min, systolic blood pressure <90 mmHg, orthostatic systolic drop ≥20 mmHg or diastolic drop ≥10 mmHg, or heart rate increase ≥30 bpm upon standing; or electrolyte abnormality such as potassium <3.0 mmol/L, sodium <130 mmol/L, or glucose <60 mg/dL. Otherwise, rule out need for immediate admission based on vitals/labs.
STEP 3 — Classify or Stratify
Classify as high risk for inpatient admission if any severe vital sign or electrolyte criterion from Step 2 is met; classify as low risk if vitals are stable and electrolytes are within normal limits.
STEP 4 — Decide
For high‑risk patients, admit to a monitored inpatient setting for cardiac telemetry, electrolyte repletion, and initiation of a structured refeeding plan under dietitian supervision. For low‑risk patients, arrange outpatient multidisciplinary follow‑up (nutrition, psychotherapy, endocrinology) with close safety net instructions.
Clinical Guardrails / Mimics / Pitfalls
Do not attribute bradycardia solely to athletic training without excluding FHA; hypotension may mimic sepsis or dehydration—check volume status and consider infection. Orthostatic vitals can be falsely normal if measured too early; ensure 3‑minute standing. Avoid missing refeeding syndrome by checking phosphate and magnesium before starting nutrition. Do not delay admission for isolated mild electrolyte changes if symptomatic.
Concrete Clinical Example
An 18‑year‑old woman with known FHA presents with HR 42 bpm, supine BP 88/52 mmHg, standing BP 70/48 mmHg after 3 min (orthostatic drop 18/4), and serum potassium 2.8 mmol/L. She reports light‑headedness. Meeting bradycardia, hypotension, orthostasis, and hypokalemia criteria, she is admitted for telemetry, potassium replacement, and supervised refeeding.
Source: Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, Gordon et al., 2017, doi:10.1210/jc.2017-00131
