Concluded Case

?PCOS ?Secondary Amenorrhea

26 yrs F presented with C/O Amenorrhea since 2.5 months, But UPT- Negative. No H/O pain abdomen or any other relevant sign & symptom. PMC- Irregular since last 10 months. Mn attained at 14 yrs of age. MF-2 yrs All Vitals are stable. Not a K/C/O HTN,T2DM & CAD. No H/O any contraception use. No H/O any ectopic pregnancy,abortion & still birth. Pt. taking Tab. Thyroxine 25 mcg OD BBF since last 2 months for newly Diagnosed mild Hypothyroidism. TFT is now WNL. S.Prolactin- WNL. Hb-11.9 g/dl Rest CBC Profile- WNL. LFT-WNL. RFT with SE- WNL. FBS-WNL. USG Pelvic Organs- Normal Study. UPT- negative. HbsAg,HCV,HIV- NR. Kindly comment on the Differential Diagnoses along with Investigation to perform now, if any and line of management & treatment.

3 Likes

LikeAnswersShare
Concluded answer

Technically it is not yet Secondary amenorrhea which occurs in women who have missed 3 months of periods. Unhealthy Lifestyle factors, and some medications can also cause amenorrhea, but you didn't eloborate upon that. Nutritional deficiencies, particularly Malnutrition may affect how the hypothalamus and pituitary gland function, which can lead to amenorrhea. Is she breastfeeding, by any chance? Having a low body weight can also prevent the hypothalamus and pituitary gland from functioning correctly( functional hypothalamic amenorrhea) Stress can affect hormone levels in the body, and it is another cause of functional hypothalamic amenorrhea. Excessive exercise can also be a cause of functional hypothalamic amenorrhea. Having an eating disorder, such as anorexia or bulimia, may also cause amenorrhea. PCOS, a commonly prevalent but little diagnosed, have an array non specific symptoms including: irregular periods, excessive hair growth, difficulty getting pregnant, weight gain, acne, and not necessarily cystic ovaries on USG PCOS may also lead to hyperandrogenemia, Some investigations with this regard : 1. Testosterone – usually elevated with PCOS. 2. Sex hormone binding globulin (SHBG) – may be reduced in PCOS 3 Anti-Müllerian hormone (AMH) – an increased level is often seen with PCOS.

All Answers

Technically it is not yet Secondary amenorrhea which occurs in women who have missed 3 months of periods. Unhealthy Lifestyle factors, and some medications can also cause amenorrhea, but you didn't eloborate upon that. Nutritional deficiencies, particularly Malnutrition may affect how the hypothalamus and pituitary gland function, which can lead to amenorrhea. Is she breastfeeding, by any chance? Having a low body weight can also prevent the hypothalamus and pituitary gland from functioning correctly( functional hypothalamic amenorrhea) Stress can affect hormone levels in the body, and it is another cause of functional hypothalamic amenorrhea. Excessive exercise can also be a cause of functional hypothalamic amenorrhea. Having an eating disorder, such as anorexia or bulimia, may also cause amenorrhea. PCOS, a commonly prevalent but little diagnosed, have an array non specific symptoms including: irregular periods, excessive hair growth, difficulty getting pregnant, weight gain, acne, and not necessarily cystic ovaries on USG PCOS may also lead to hyperandrogenemia, Some investigations with this regard : 1. Testosterone – usually elevated with PCOS. 2. Sex hormone binding globulin (SHBG) – may be reduced in PCOS 3 Anti-Müllerian hormone (AMH) – an increased level is often seen with PCOS.

BMI-WNL. No H/O any chronic medication use. She is not breastfeeding. No eating disorder.
0

View 1 other reply

Secondary amenorrhea. Possibly stress, chronic ill ness, hormone therapy, pcos. Needs to evaluate as hormone study. Life style modification. Titration of thyroxine doses every 6 to 8 weeks.

Which hormone study except mentioned in the case is required? And what about the management?
0

NEED'S.. * ANEMIA PROFILE.. * HORMONAL STUDY.. * USG STUDY.. * GYNECOLOGICAL EXAMINATION..

The investigations you are talking about are normal. Gynae exam is normal.
0

What about endometrial thickness? S.LH and S. FSH.? Do progesterone challenge test. It should be check either it is negative or positive and then diagnos the Pt step by step. Treat according to diagnosis.

Thank you doctor
0

US G abdomen Gynaecologist exam D & C Endometrial Biopsy

Hormonal tests like FSH,LH,S Testosterone should be performed and at the same USG pelvic region should be done to r/o PCOS.

Thank you doctor
0

Oval L tab take 5th day after period uvecare syrup next after period 5 th day 3month couse

Irregular Menses kanchanara guggulu, mundi churnam and varun churnam 1/8 th kashayan,ashokarishta.

Usg study. Hormonal evaluation. Experts opinion.

Drug history? Serum prolactin level?

Diseases Related to Discussion

Cases that would interest you