Diagnostic Considerations

Failure to diagnose the female athlete triad in a timely manner is probably the main medicolegal issue associated with this condition.

Because the diagnosis was formalized in the past decade or so, the direction the legal community has decided to take regarding the triad is still being established. Medical malpractice suits are likely to follow patterns established in the diagnosis of anorexia and bulimia. Although the diagnosis of the female athlete triad is relatively new, legal-civil penalties could be harsh because of the severity of the disease and the population it affects.

As with most diseases, timely diagnosis and initiation of treatment are paramount for avoiding lawsuits. Diagnosis of the female athlete triad can be delayed because in most cases, the stress fracture is diagnosed first, followed by the amenorrhea and finally by the eating disorder (the opposite of the order in which these components of the triad actually develop).

What may make civil litigation difficult are the secretive nature of the disease and the significant rate of patient noncompliance with treatment. Even with rapid diagnosis and treatment, bad outcomes are possible.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Drug interactions
Hypogonadotropic hypoestrogenism
Hypothalamic disorders
Hyperthyroidism
Luteal-phase inadequacy
Nutritional deficiencies
Ovarian defect (eg, gonadal dysgenesis)
Pituitary disorders

Differential Diagnoses

Workup

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Author

Laura M Gottschlich, DO Assistant Professor of Family and Community Medicine and Orthopedic Surgery, Medical College of Wisconsin; Consulting Staff, Family Medicine Residency Program, All Saints Hospital, Wheaton Franciscan Healthcare

Laura M Gottschlich, DO is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, American Medical Society for Sports Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Boone Barrow, MD Consulting Staff, Department of Family Medicine, Scott and White Clinic

Boone Barrow, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, American Medical Society for Sports Medicine, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Leslie Milne, MD Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Female Athlete Triad Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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