Question

What I need is for you diagnose, Tell me why you chose that diagnosis. Signs, Symptoms, Age, lifestyle, any other factors to lead you to your conclusion. Give some diagnostic tests to confirm your Dx. Then a treatment plan.

Case 1

Bella is a 31 year old nervous young lady who came to see me because she and her husband have been trying to get pregnant, but have not been successful. She has been so afraid that she will never have kids that she started to cry in my office. Her husband has another child from a previous relationship, so she worried that there is “something wrong” with her.

Problems conceiving are actually quite common. It’s not always as easy to get pregnant as television makes it seem. In fact, it takes the average healthy couple an average of one year to get pregnant. Yep, that’s right--that means some get pregnant before one year, and some take a tad longer than one year.

Bella told me that she had been off birth control and trying for about two years, so I knew it was possible that there was more going on.

Once I dug a little deeper, I learned that Bella’s periods have “always” been irregular since the very beginning. She does get her periods, but perhaps once every one to three months; and during a time when she gained 10 pounds, she went as long as six months without a period.

1. Hirsutism:
2. Acanthosis Nigracans:
3. Being overweight: She is about five feet tall and 20 pounds overweight, and she carries most of her weight in the mid section. She admits that she has a tough time losing weight, no matter how hard she tries.
4. Acne: She suffers from a mild case of acne on her face and upper back.

Answer 1

PROBABLE DIAGNOSIS: POLYCYSTIC OVARIAN SYNDROME (PCOS)

FACTORS LEADING TO THE DIAGNOSIS OF PCOS:

• IRREGULAR PERIODS.
• PROBLEMS CONCEIVING
• OVERWEIGHT
• HIRSUTISM:EXTRA HAIR GROWTH ON FACE AND BACK
• ACANTHOSIS NIGRACANS:HIGHER LEVEL OF INSULIN DEVELOPS DARK SKIN PATCHES ON THE BACK OF THE NECK, UNDERARM AND IN THE GROIN.
• ACNE
• ANXIETY AND STRESSFUL

DIAGNOSTIC TESTS TO CONFIRM PCOS:

• BMI: TO ASSESS THE OVERWEIGHT.
• BLOOD TESTS:
• FSH: ESSENTIAL TO GET PREGNANT. IN PCOS IT IS IN LOWER LEVEL THAN NORMAL.
• LH:ENCOURAGES OVULATION.LEVEL IS INCREASED THAN NORMAL IN PCOS.
• TESTOSTERONE: SEX HORMONE. HIGHER THAN THE NORMAL LEVEL IN PCOS.
• ESTROGEN: REQUIRED TO GET REGULAR PERIODS. INCREASED THAN NORMAL LEVEL IN PCOS.
• SEX HORMONE BINDING GLOBULIN (SHBG): LOWER THAN NORMAL LEVEL IN PCOS.
• ANDROSTENEDIONE: HIGHER THAN NORMAL LEVEL IN PCOS.
• BLOOD GLUCOSE: TO ESTIMATE THE BLOOD GLUCOSE LEVEL.
• LIPID PROFILE: TO CHECK FOR CHOLESTEROL AND TRIGLYCERIDES LEVEL.

HORMONE TEST:

• hCG : HUMAN CHORIONIC GONADOTROPIN : TO CONFIRM PREGNANCY.
• ANTI-MULLERIAN HORMONE (AMH): TO ASSESS THE FUNCTIONS OF THE OVARIES.HIGHER THAN THE NORMAL LEVEL IN PCOS.

PELVIC ULTRASOUND (SONOGRAM):

• TO CHECK FOR CYSTES IN OVARIES AND THE LINING OF THE UTERUS.
• THICK UTERINE LINING RESULTS IN NO PERIODS.

TREATMENT PLAN FOR PCOS:

1. REGULAR EXERCISE
2. DIET AVOIDING CARBOHYDRATES AND FAT.
3. HORMONAL BIRTH CONTROL:

• TO HELP RESTORE REGULAR PERIODS
• TREAT ACNE AND UNWANTED HAIR GROWTH
• TREATMENT WITH PROGESTIN HELPS TO GET BACK PERIODS REGULARLY AND DOES NOT PREVENT PREGNANCY.
• TREATMENT WITH INSULIN AND DRUGS TO CONTROL CHOLESTEROL LEVEL.