PCOS - Polycystic Ovary Syndrome
Patient Presentation
B.B, a 17 year old woman presented to the clinic for a high school sports physical. During the history intake she told the nurse that she began menses at 13 but has irregular menses with heavy bleeding lasting anywhere from three to seven days. She reported persistent acne that has not responded to dermatologic topical interventions and also reported excessive hair growth on her face. The patient was 195 pounds and she was 5’3 inches tall. The patient’s mother reported that she had always been overweight. Her BP was 125/60. No significant findings were noted on her physical exam. CBC, lipid panel, TSH level, CMP, and fasting blood sugar were ordered as a part of the physical.
A week later the patient was back in the office for results. Fasting blood sugar was found to be 129mg/dl, total cholesterol 205, H&H 12/38 and normal TSH levels. The nurse also learned that both the patient’s mom and older sister had been diagnosed with PCOS. The patient was offered additional testing to confirm if she also had PCOS but she declined at the time.
Differential Diagnosis
PCOS, Cushing syndrome, androgen secreting tumor, hyperandrogenism, HAIR-AN (hyperandrogenism, insulin resistance, and acanthosis nigricans) syndrome
Diagnosis
There are several blood tests that can help to diagnose PCOS including tests that look at testosterone, FSH, and LH levels. In addition, an ultrasound can be done to look for cysts on the ovaries. Management involves controlling symptoms like acne and hirsutism and conditions, such as diabetes that women who have PCOS are at risk for. Infertility, thinning hair and hair loss and changes in skin pigmentation are additional complications of PCOS.
Treatment
For this patient the priority in her plan of care was treating her elevated glucose and lipids. The doctor prescribed metformin to help with insulin resistance but the patient did not want to take mediations. Instead she wanted to first attempt diet and lifestyle modifications and weight loss. The doctor also recommended birth control to help regulate her periods and spironolactone to help with the excessive hair growth on her face. The patient declined all oral drugs. The doctor then prescribed Vaniqa® for facial hair.
Outcome
After about six months of following the diet and lifestyle modifications, the patient’s fasting blood glucose and lipids profile, although not within normal limits, had decreased. In addition, the patient lost about five pounds and reported cardiovascular exercise three times a week for at least 30 minutes. The doctor informed her that if her blood glucose levels were not within normal limits at the next six month visit, they would have to include an oral diabetic medication to add to her regimen.
Case created by Brenda Baffour, 2010.