Case Study: 14-Year-Old Female - PCOS Diagnosis & Lab Tests, Slides of Pediatrics

Download Case Study: 14-Year-Old Female - PCOS Diagnosis & Lab Tests and more Slides Pediatrics in PDF only on Docsity!

Adolescent Case

Presentation

Case history

 14 y/o female

 CC: 3-6 months of irregular periods

and unexplained weight gain

 In USOH, has not been ill in last few

months

 PMH- not significant

Case History

 HEADS interview negative

 Home: lives with parents, no sibs, gets

along fine

 Education: 9th^ grade, A-B student, has

good group of friends

 Activities: rows for school crew team,

movies & hanging out with friends

Case History

 Drugs: never smokes, drank, or tried any

drugs, no friends hace either

 Diet: parents MD’s and help her eat a

balanced diet, she reports no increased

eating habits since weight gain

 Sex: never been active, never had a

girl/boyfriend

 Suicide: no h/o depression

Case History

Menstrual hx-

 menarche at age 12

 Regular periods over past year and

then irregular for about 6months; no

periods for about 3 months now

 Never been sexually active

Case History

 FHx- NC, no female family member

with abnormal periods, no problems

with cycle, fertility. No cancers

Physical Exam

 VS: HR 65; RR18; BP112/80; wt 93.5kg

(>99th%); ht 160cm (50th%); BMI= 36

 HEENT: fat pad behind neck, thickening &

slight hyperpigmentation of posterior

neck skin, nl thyroid

 CV: S1+S2, no R/G/M, RR

 Lungs: CTA bilat

 Abd: obese, soft, +BS, striae across

abdomen and lower hips

Physical Exam

 Ext: FROM, nl muscle tone, 2+ cap

refill, pulses normal

 Skin- dry but no lesions, rashes,

acne noted over face, chest, back,

no excess hair.

 GU- no external abnormalities,

Tanner 5, normal clitoris

QUESTIONS on H& P???

How about a differential for

secondary amenorrhea?

Differential Diagnosis

 Pregnancy

 PCO

 Hypothyroidism

 Ovarian tumor

 Pituitary tumor

Less likely differential

 CAH

 Female Athlete Triad (hypothalamic

amenorrhea)

 Turner’s syndrome

 Testicular Feminization

Which labs would you think about at

this initial presentation?

Laboratory Tests

 B-HCG

 Thyroid

 LH/FSH

 Prolactin

 Free/total testosterone

Laboratory Tests

 Fasting glucose

 Fasting Insulin level

 Fasting Lipid profile

 Androstenedione

 Fasting 17-OPH and cortisol

 DHEAS

 Karyotype

Our patient

 Nl TFT’s

 Glucose 81

 Lipid profile all

WNL

 LH 4.

 FSH 6.

 PRL 5.

 Andro 181

 17-OHPS 58

 Insulin 5.

 Ttest 36

 Free test 6.7 (only

abn lab)

What is PCOS?

 Increased androgen production from

ovaries and adrenal glands

What does it mean to have PCOS? Well, unfortunately, it means

a lot of difficult things for many women. I started to have facial hair growth in early highschool -- this was pretty embarassing, especially when I realized that it wasn't "normal" compared to my other friends. Of course, I had lots of hair on my legs and arms too, at an even younger age -- growing up in Southern California meant that I was doing a lot of hair removal all the time so as to not look like a freak in shorts or a bathing suit. My skin just didn't ever seem to clear up -- I spent many hours at the dermatologist. I also "learned" early on that I couldn't eat very much at all -- if I did, I immediately gained a lot of weight and it didn't want to come off. My cycles were horrible, when I had them, I understood why some women called it "the curse".

I was diagnosed when I was 17 and immediately went on birth control pills to control my symptoms. This was the only practical "treatment" known at that time. Later on, PCOS was the reason I couldn't easily conceive and then miscarried the 2 times I did conceive naturally. I think this is the most acutely painful aspect of this syndrome, and it is certainly the focus of many women's pain. Wanting a child and being unable to have one was one of the most difficult times of my life. Needing to take in order to conceive and carry a pregnancy can have some very subtle effects on how a woman thinks about herself, and when she has a condition that already makes her feel less attractive, less desirable and less feminine (at least by our culture's standards), she can end up seeing herself as pretty defective. Later in life, PCOS presents some serious health problems. Women with PCOS are significantly more likely to have type II diabetes and heart disease and there appears to be a link to breast and colon cancer, so it isn't just a "cosmetic" or "infertility" condition -- it can be ugly.

PCOS

 Spectrum of clinical d/o’s not

diagnosed by lab

 Clinical presentation includes:

 Hirsuitism & acne

 Obesity

 Oligomenorrhea

 Anovulation

 Infertility

PCOS

Pituitary gland is heightened to GnRH



Exaggerated pulsatile LH release



LH/FSH ratio may be elevated



 LH stimulate ovary to secrete  androgen



Androgens are converted to estrone and estradiol

 Estrogens secreted tonically  Augment pituitary sensitivity to GnRH  And vicious cycle continues to  LH  ovaries overproduce androstenedione and testosterone

Other interesting findings

 Androgens  SHBG;  free testosterone

 Anovulation and insulin resistance- exact

pathogenesis unclear

 in basal insulin secretion  in hepatic uptake  B-cell dysfunction  insulin has direct effect on pituitary in LH secretion and the ovary for androgen production