It is typical polycystic ovaries to diagnose PCOD. Find out other criterias like oligomenorrhea / clinical , biochemical signs of hyperandrogenimi. Advise TFT , Prolactin levels , weight reduction & life style modifications. Also look for insulin resistance features like acanthosis nigra, abnormal GTT, Metformin 500mgs. BD . Tab. Clomifen citrate ( minimum endogenous oestrogens essential ) of fails Tab Letrozol 2.5 mg.bd from day 3 to 7 with clomifen.Gonadotropins can be used to induce ovulation , in clomifen resistance cases with proper , close monitor to prevent side effects of hormones. Most imp is rule out other causes of infertility. Very last think of ovarian drilling.
Typical case of PCOD. Do day 2 LH,FSH,S.prolactin. TSH. Fbs,s.insulin. Adv lifestyle modifications. Wt loss Counsel regarding diet. Start tab krimson 35 of for 6 months cyclically. Tab metphormin 500 mg bd Myoinositol : chiro inositol combination sachets daily once. If pesistent pcod after medical treatment, then go for laproscopic puncturing along with Hysteroscopic viewing of uterus. Endometrial tissue for TB PCR.to be done. Induction can be done with tab.clomiphene 100 mg OD. For 5 days from 2 nd day to 7 the day of period. Follicular study from 10 the day on alt days.if follicle is mature 18 mm × 20 mm. Inj huchog 10000 for trigger. Tab progetrone support s.od for15 days. If still resistant induction with gonadotropin s
A case of pcod, to be treated before inducing ovulation. Oc pills for 2 months along with metformin 500 mg bd. Later induce ovulation with clomiphene alone or along with gonadotrophins, follicular study. Advise wt reduction , exercise, b complex , vitamin e supplements
Typical findings of PCOS. Needs LSM Yoga Wt reduction Put her on Krimson or Ginnete 35 for 6 cycles. Then put on Inositol Clomiphene citrate 50 mg 1st cycle then increas dose as per findings. Sos Pcos drilling with hysteroscopy.
Necklace pattern confirms pcod. Hyperandroginism and hypothyroidism to be r/o. Then you can proceed with management. Pt counseling is crucial as she becomes anxious with failed cycles
polycystic ovaries.... need lap puncture
Take proper history regarding family history of DM malignancies TIA stroke DVT Also past history of Deranged sugars hypothyroidism Migraines LIVER DS TIA STROKE DVT THROMBOPHILIAS Menstrual history regarding any irregularities in cycle flow dietary history to be taken On examination BMI to be calculated Look for signs of sugar intolerance with hyperandrogenimia Clinical breast examination to be done rule out galactorrhea Thyroid to be evaluated Get her investigations done ABO RH CBC HIV HBS AG HCV VDRL HPLC RUBELLA IGG VARICELLA ZOSTER IGG LFT RFT FBS PPBS HBA1C FASTING INSULIN PP INSULIN DHEAS FREE AND TOTAL TESTOSTERONE DAY TWO LH FSH E2 Counsel her for lifestyle modification Dietary advises Exercises Lose weight Tell her about timed intercourse Also sensitise her about risks of DM metabolic syndrome endometrial cancer
She is a case of polycystic ovaries....If she has oligomenorrhea n needs correction for that you can put her on ocps...If she needs treatment for infertility ,,she needs induction with clomiphene ...If she is not ovularing with clomiphene...You can increase the dose till 150 mg...If clomiphene resistance is seen you can start her on letrazole.....If that's not working....You can go for gonadotropin s...You can also add metformin 500 mg bd or myo_chiroinositol powder bd ....Anyhow weight reduction is a must
induction with clomephene citrate and do follicular study. if circulatory, try 6cycles of OI, and metformin or myoinositol along with.
This is a case of PCOD, planning a child as soon as possible, even through ovulation induction by clomiphene citrate
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A 34-year-old nulligravid woman comes to clinic complaining of difficulty getting pregnant for the past 15 months. The woman reports that her menses have always been irregular. The woman has a BMI of 31 and hirsutism on physical exam. What is the most likely cause of infertility in this patient?Prachi Saluja6 Likes27 Answers
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24 year old married obese girl with this classical finding on USG. patient is planning a child. lets discuss management and diagnosisDr. Pallavi Mittal4 Likes54 Answers
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Associated Conditions Obesity (See Diet: Obesity.) Infertility (see topic) Hirsutism (see topic) Acne Endometrial hyperplasia and cancer (See Endometrial Hyperplasia and Endometrial Cancer.) Depression Sleep disorders (see topic) Hypertension (see topic) Insulin resistance DM Type 2 Metabolic syndrome (see topic) Cardiovascular disease ------------------------------------------ Diagnosis Signs and Symptoms History Oligo-ovulation: Amenorrhea (see chapter) Oligomenorrhea (See Bleeding, Abnormal Uterine: Oligomenorrhea.) Menorrhagia/Heavy bleeding (See Bleeding, Abnormal Uterine: Heavy Menstrual Bleeding.) Midline hair growth, acne, hair thinning or loss, voice changes Infertility, desire for fertility History of gestational DM or HTN Overweight/Obesity/Weight gain Family history DM or cardiovascular disease Individual goals for treatment Review of Systems Mood, appetite, energy, sleep Weight and diet ------------------------------------------ Physical Exam BP, pulse, height, weight, BMI, waist circumference, hip circumference, waist:hip ratio Thyroid: Nodules, enlargement Skin: Acanthosis nigricans, acne, hirsutism, balding, skin tags Breast: Galactorrhea Abdomen: Masses or organomegaly Extremities: Edema, DTRs GU: Clitoromegaly, adnexal masses Tests Rotterdam Criteria (2/3 with other causes of hyperandrogenism excluded): Oligo- or anovulation Clinical and/or biochemical signs of hyperandrogenism PCO (on US) Labs Pregnancy test Clinical criteria may be sufficient, with labs to rule out other causes TSH, Free T4, prolactin, DHEAS, total testosterone, 17-hydroxyprogesterone Fasting lipids, glucose and 2-hour GTT after 75-gm load No longer considered useful: LH:FSH ratio (pulsatile, can be normal in PCOS) Fasting glucose:insulin ratio (can miss glucose tolerance aberrations) Imaging TVU: >12 antral (<10 mm) follicles on a single ovary or ovarian volume >10 cm3 Endometrial thickness Differential Diagnosis Pregnancy Prolactinoma Thyroid dysfunction (See Thyroid Disease.) Androgen-secreting tumor (See Ovarian Tumors, Virilizing.) Adrenal enzyme defect: Late onset CAH (See Congenital Adrenal Hyperplasia.) Cushing's disease Metabolic/Endocrine Impaired fasting glucose (IFG): >100 mg/dL Impaired glucose tolerance (IGT): 2-hour glucose >140 mg/dL DM: Glucose fasting >126 mg/dL or 2-hour >200 mg/dL Metabolic syndrome (3 or more of): WC >85 cm (35 in) IGT or IFG SBP ≥140 mm Hg or DBP ≥85 mm Hg Triglycerides ≥150 mg/dL HDL cholesterol <50 mg/dL Tumor/Malignancy Risk of endometrial hyperplasia and malignancy Consider endometrial biopsy: US EC >9 mm <2 menses/year ========================== Treatment General Measures If overweight or obese: 5–10% weight loss to improve ovulation, hirsutism, fertility, pregnancy safety Calorie restriction, 30 minutes of vigorous exercise 5 times a week If IGT, lifestyle modification better than medication at preventing DM and metabolic syndrome Medication (Drugs) Endometrial protection: OCPs (monitor lipids and BP) or progestin withdrawal every 3–4 months Hirsutism control (try modalities for 6 months) OCPs Antiandrogens (use contraception) Spironolactone 100–200 mg/d (monitor electrolytes) Flutamide 130–500 mg/d (hepatotoxicity) Eflornithine cream (Vaniqa): b.i.d. only on face Rosiglitazone (4–8 mg/d): Mild improvement: Monitor electrolytes, kidney, liver function ± Weight gain (water retention) P.159 Metabolic (controversial for adolescents): Metformin HCl 1,500 mg–2,000 mg/d for prevention of DM and metabolic syndrome if IGT: Nausea, diarrhea, fatigue, ± weight loss; start 500 mg and increase slowly Rare-lactic acidosis; Monitor electrolytes, liver, kidney every 6–12 months Hold drug for surgery or contrast dye Pregnancy Considerations Ovulation Induction with timed intercourse, intrauterine insemination, or IVF Insulin sensitizers, alone or with clomiphene: Metformin 1,500 mg/d (Category B): May improve miscarriage rate if continued during pregnancy (but studies are small) Rosiglitazone 4–8 mg/d (Category C) Clomiphene citrate, 50–200 mg/d, 4–6 cycles: Cycle days 3–7 or 5–9 Alone or with insulin sensitizer 8–10% multiple pregnancy rate Vasomotor effects, visual symptoms (d/c) Aromatase inhibitors (Letrozole): 5 mg/d, 4–6 cycles (use instead of clomiphene controversial) Gonadotropin injections, FSH or LH: 20–30% multiple pregnancy rate Higher risk of ovarian hyperstimulation syndrome Surgery Ovarian drilling/diathermy via laparoscopy: Similar live birth rates to gonadotropin injections Temporary (6 months) spontaneous ovulation Risk of adhesion formationDr. Sowbarnika Amarnath2 Likes2 Answers
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27 year old female presented with infertility and amenorrhea. She has undergone a pelvic ultrasound scan. Images are shown below.Dr. Vandana Thawani2 Likes17 Answers
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MY RESEARCH ARTICLE PUBLISHED IN INTERNATIONAL JOURNAL OF MEDICAL SCIENCES.. HAIR-AN SYNDROME WITH PCOS AND HASHIMOTOS THYROIDITIS: (CITE FULL ARTICLE : Kulkarni A, Srivastav SK, Susarla S, Kulkarni U, Ashok Kumar C, Chikkala S, Tabassum SM. Hyperandrogenism-insulin resistance- acanthosis nigricans syndrome with PCOS and Hashimoto’s thyroiditis: case report. Int J Res Med Sci 2015;3:2514-23.) Female hyperandrogenism is a frequent motive of consultation. It is revealed by hirsutism, acne or seborrhea, and disorders in menstruation cycle combined or not with virilisation signs. Several etiologies are incriminated but the hyperandrogenism-insulin resistance-acanthosis nigricans syndrome is rare. A 21-year female, having had a three- year-old secondary amenorrhea, known case of hypothyroidism since 4 years on medication. The exam revealed a patient, hypertensive with blood pressure at 170/110 mmHg with a Body Mass Index (BMI) at 40.08 (Obese Class-3, as per WHO 2004) and a waist measurement of 106cm, a severe hirsutism assessed to be 27 according to Ferriman and Gallwey scale, acanthosis nigricans behind the neck and elbows. The assessment carried out revealed testosteronemia at 1.07 ng/mL, which is more than twice the upper normal of the laboratory. Imaging studies revealed enlarged right adrenal gland, hepatomegaly with fatty infiltration of grade-1 also bilateral polycystic ovaries. The retained diagnosis is HAIR-AN syndrome with polycystic ovaries, hypertension, type-II diabetes mellitus, hypothyroidism since last 4-years and dyslipidemia and was provided with metformin 500 mg thrice daily, spironolactone 25 mg twice daily, atorvastatin 20 mg once daily, telmisartan 20 mg once daily with continuation of eltroxin 50 Mcg for hypothyroidism. To our knowledge this is the first case report of HAIR-AN syndrome in 21 year old female associated with Hashimoto’s thyroiditis, dyslipidaemia, hypertension and type-2-diabetes and this case also highlights about early diagnosis and management of HAIR-AN Syndrome with PCOS and Hashimoto’s thyroiditis which could help prevent long-term sequalae such as cardiovascular disease and endometrial cancer and with the advent of knowledge and availability of health resources we can prevent long-term adverse effects (threefold) on health of women. This woman should be observed for these ailments in later life.Dr. Shashank Kumar Srivastav7 Likes13 Answers