Loading presentation...

Present Remotely

Send the link below via email or IM


Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.



No description

Anna Schuettge

on 8 March 2013

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of PCOS

Polycystic Ovary Syndrome
in the Adolescent Physical Exam Findings Summary ZS presents with amenorrhea, abnormal hair growth, obesity, high blood pressure and difficulty losing weight. She also has elevated testosterone, elevated LH and FSH levels, decreased SHBG and elevated DHEAS. She is in the impaired glucose tolerance category. This array of symptoms and lab results is a clinically typical presentation for a diagnosis of PCOS. Making the Diagnosis Long Term Complications Infertility
Diabetes/gestational diabetes
Premature delivery
Cervical cancer
Preeclampsia Management and Referral Weight loss and lifestyle modification
Monitor for hypertriglyceridemia and HTN
Manage possible co-morbidities
Combined estrogen-progestin contraceptives Patient Education Lifestyle modification:
Nutritional changes
Increased physical activity, daily
Overall behavior changes
Familial and peer support A Case Presentation The Case ZS is a 17-year-old African American female who presents today with no period for 5 months and hair growth. ZS had menarche at age 10 and had regular periods monthly until last year when they became irregular. ZS is not sexually active and has never been pregnant. She is 5’5’’ and 150 lbs, which is the 50th percentile for height and 85th percentile for weight. BMI 25. ZS plays intramural hockey & lacrosse, she joined both teams her freshman year. She has been trying to diet but has been unable to lose weight. 3 months ago, patient has noticed increasing hair on her abdomen and her perianal area and is embarrassed to change in the locker room. She has occasional abdominal pain. ZS enjoys school and receives A’s & B’s. She has many friends and doesn’t identify any particular stresses in her life. She lives at home with her parents. What is it? Co-Morbidities Obesity, metabolic syndrome
Insulin Resistance
Sleep apnea
Acanthosis nigricans
Dyslipidemia Diagnosis of exclusion
Tricky as teens often have irregular menses and acne
Consider risk factors:
Premature adrenarche
Atypical sexual precocity
Obesity with acanthosis nigricans Laboratory Findings Serum testosterone
Thyroid function tests (TSH)
Prolactin, FSH, LH
Cortisol levels
Fasting lipid panel
Endometrial biopsy
Vaginal u/s Lab Results for ZS Pregnancy test is negative
Glucose (from OGTT): 150 mg/dL *impaired glucose tolerance
TSH: 1.2 mIU/mL (normal)
Prolactin: 19 ng/mL (normal)17-OHP: 58 ng/dL *slightly elevated
Total & free testosterone: 65 ng/dL (total), 9.0 pg/mL (free) *elevated
LH/FSH ratio: 2.5 *elevated
SHBG: 22 nmol/L *decreased
DHEA-S: 550 µg/dL *elevated Differential Diagnosis 1) Polycystic Ovary Syndrome (PCOS)
2) Pregnancy
3) Cushing's Syndrome
4) Congenital Adrenal Hyperplasia
5) Hypothyroidism Rule Out General: alert and cooperative during visit
T 99.8F, RR 18, BP 130/85
Skin: moderate facial acne, scattered acne on back
Abdomen: soft, normoactive bowel sounds, tender in LLQ, no masses
GU: Tanner stage 5, hair growth on chest, pubic hair growing toward umbilicus Pregnancy: not sexually active, (-) pregnancy test
Cushing's: (-) buffalo hump, (-) rounded face (-) pink/purple striae, (-) decrease in growth rate or delayed skeletal maturation
Congenital Adrenal hyperplasia: (-) enlarged clitoris, (-) precocious puberty
Hypothyroidism: TSH and T4 WNL Most common endocrine disorder affecting reproductive age women, including adolescents
Presence of hyperandrogenism (hirsutism and hyperandrogenemia) and at least 1 of the following:
Ovarian dysfunction (chronic oligoovulation or anovulation)
Polycystic ovaries Lab for blood work
Gynecologist Referrals Thank you! Mimi Hayward
Adina Noff
Anna Schuettge Secondary Amenorrhea PCOS
Full transcript