A CASE PRESENTATION ON POLYCYSTIC OVARIAN SYNDROME

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A CASE PRESENTATION ON POLYCYSTIC OVARIAN SYNDROME


A CASE PRESENTATION ON POLYCYSTIC OVARIAN SYNDROME Lana  

5 years ago

~3.9 mins read

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BIODATA
Patient’s name: KJ
Age: 18years old
Last menstrual period: 08/10/2015
Address: old jeshwang, the Gambia.
Religion: muslim
Occupation: student
Tribe: mandinka
Parity: p0+0

Presenting complaint: irregular menstruation: 18 months
                                         Lower abdominal pain: 18months
                                         Increasing size: 2 years
                                         Increasing hair around the jaw area: 1 year.

 History of presenting complaints: the patient was apparently well until two years prior to presentation when she noticed her clothes were beginning to be tight on her, she initially thought it was due to the fact that she just got married. Approximately 6months later menses started becoming irregular and she was having constant lower abdominal pain. Within the past 2 years her periods were irregular for the first 6months and then ceased completely since then. Also within the past year she has noticed strong curly hair around her jaw line. The irregular periods are not associated with pain and she also has no pain during sexual intercourse.

Gynecology history: patient attained menarche at 12 years of age.

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Prior to 2 years ago menses occurred every 28days and lasted 5days. Menses were not associated with any dysmenorrhea or menorrhagia. She has never used any contraceptives and has had no history of any sexually transmitted infection. The patient has never done a pap smear before and does not do routine self breast examination.

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Coitarche was at age 15 and she has had one sexual partner her whole life.

Past medical history: the patient had an appendectomy 3years ago. She has no history of any chronic illnesses and has never received blood transfusion.

Drug and allergy history: the patient is on no chronic medication and is not allergic to any known drugs, food or animals.

Family and social history: the patient hails from a polygamous family and is also in a polygamous relationship (second wife) with her husband. She is in a consanginous marriage. She has no family history of any chronic illnesses like diabetes mellitus, hypertension or sickle cell disease. The patient does not smoke tobacco or drink alcohol. Her 3 female siblings are of normal weight and healthy.

General examination: the patient looks heavy, hair is of normal female distribution, dry and coarse, she is not pale, she is anicteric, afebrile, acyanosed. The patient has lots of coarse curly hair on her jaw, she has no palpable lymphadenopathy, no finger clubbing and no pedal edema.

Physical measurement: weight=90kg, height=160cm (1.6m), BMI= 35.16kg/m2, waist circumference was 85cm.

Vital signs: blood pressure:135/84mmHg, PR=96bpm, RR= 30cycles, temp= 36.7oc.

Systemic Review:

Abdomen : full, moves with respiration, no scars. Tender in the suprapubic region, no palpable organomegaly, no fluid thrills and bowel sounds were present.
CNS: patient was conscious, alert and oriented.
CVS: pulse was full and regular, S1 and S2 were heard, no murmurs.
RESP: chest is clinically clear

SUMMARY

In summary, I have presented madam KJ, an 18 yr old nulliparous female whose LMP was 08/10/2015, who presented with increasing body hair and weight, amenorrhea and lower abdominal pain.

ASSESMENT: polycystic ovarian syndrome

Investigations:
1.      Hormonal panel
2.      Transvaginal  ultrasound scan
3.      Lipid profile
4.      Oral glucose tolerance test
5.      Appointment for 15/11/16.

Appointment day: on 15/11/2016, results of her tests were revised.

Oral glucose tolerance test (OGTT
0hr                           1hr                               2hrs
 
6.1mmol/l             10.2mmol/L           9.1mmol/L
Insulin (mU/l)
37.0                        113.6                        117.8
LIPID PROFILE TEST
 
Total-Ch (mmol/l)
6.2
HDL-Ch (mmol/l)
0.93
LDL-Ch (mmol/l)
3.7
TG (mmol/l)
4.65
 
HORMONAL PROFILE
NORMAL RANGE
Follicle-stimulating hormone (U/l)= 6.0
3.3–6.06
Luteinizing hormone (U/l) 12.0
4.8–10.73
Testosterone (nmol/l) 4.5
0.42–2.05
Estradiol (nmol/l)= 0.18
0.143–0.324
17-OH progesterone (nmol/l)=2.6
<4.4
 
1.      Patient was advised to lose weight
2.      P/O metformin 500mg 3 times daily x 1/12
3.      p/o progesterone 10mg
4.      p/o clomid (clomiphene citrate) 50mg x 5days.
5.      Combined oral contraceptives I tab a day
6.      Spironolactone 100mg per day..

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6 likes
 

VincentNoel (Basic)   4 wks
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Nanya (Basic)   2 mths
Thank you for this wonderful update
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