E.B. is a 24-year-old woman who went to see her physiclan because she and her flanc...

 

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E.B. is a 24-year-old woman who went to see her physiclan because she and her flancé were interested in having chikdren but she was not having a regular period. History: E.B. stated that she entered puberty early and has experienced oligomenorhea and occasional amenorhea since menarche at age 11. E.B.s amenorrhea responded to a progesterone challenge with medroxyprogesterone acetate (Provera). Prior to her physical, E B. was referred to a gynecologist "to see if she had too many male hormones," because she did not have regular menstrual cycles. She was concemed about what her options were for future fertility. Physical Exam: • Height: 54", Weight 184 Ibs.; BMI: 31; BP: 118/76, Pulse: 80; • Skin: hirsutism, acne, acanthosis nigricans • The rest of her physical exam was normal including her pelvic exam. Lab Tests: Endocrine Screening EB. Lovels 49 ng/mi Hormone Progesterone (uteal phase) FSH (day 3 of menstrual cycle) LH (day 3 of menstrual cycle) LH FSH ratio (day 3 of menstrual cycle) Total Testosterone Free Testosterone DHEA-S Thyroid Stamulating Hormone 3.4 mlU/ml 10.2 mlU/ml 3:1 124 ng/ml 092 pg/ml 284 ug/di 18 ulU/mi Normal Levels > 15ng/ml 2.8-11.3 mlU/ml 0.6-11.6 milU/ml 1:1 6-86 ng/mi 0.7-36 pg/ml 35-430 ug/di 0.6-4.5 ulU/mi Ultrasound Exam Trans-vaginal ultrasound finds an abnormally high number of small antral follicles (E B. > 30 antral follicies, normal range = 10-25). Blue line outlines the ovary (see image at nght). Questions EB s physician performed a progesterone chalienge to furnher eamine the undortying cause of E B.'s amanorrhea. menstual.oroblen EB samenomea responded to the orogesterone dhalerge What is a postve reapanse to the progesterone chalenge I What does the resut sayabout nerute LEAsamenmen csed ya defectan the ovay ora derdeteuter Exearicr 2 EB's endoorine screening shows she has an abnormally high LH:FSH rato and high total Teatoaterone levela a How does her abnomal hormone levels cause high antral follicle count? b. Is EB. ovulating or menstruating? Explain how her abnormal hormone levels cause her தாணeி 3 What is hirsutism? What hormonal irregularity causes this condition? 4 What is your diagnosis (name of the condition)? Use evidence from the medical history, physical exam, endocrine scroening, and ultrasound exram to justify your answer. Given E.B.'s diagnosis, her physician ordered blood glucose screening. The results of these tests are shown below: Blood Glucose Screening Test E.B. Lovels Normal lovols | Glucoso Fasting blood glucose 142 mg/dL 188 mg/dL 70-99 mg/dL <140 mg/dL 2.hour oral glucose tolerance test Insulin Fasting Insuln 2-hour Insulin oral glucose tolerance test 152 miU/ml 82 mlU//ml <10 mlU/ml 6-50 mlU/ml S ExamineE8.s blood glucose and insulin tests. What do these results Indicate about EB.3 ability of her body to produce and mspond to insulin and her body's ability to regulate blood 6 Research the refationship between insulin. gondotropins and androgena. How mightEB.S In order to increase E.B.s chances of becoming pregnant her physiclan has E.B. perform the following • Inducing menstrualtion Provera (progesterone) a given for 5 to 10 days at a dose of 5 or 10 mg daly. The period usually starts within 2./ days after the last Provera pill is taken. Inducino.colation, Clomid (100 mg daily) is taken for five days from cycle days 3 through / The average day that ovuation.occurs s about 8 to 10 days after completing a 5 day course of Clomid. 7 How does Clomid act to induce ovulation? Expan the effect of Clomid on the nypothalamus pituitary.ovary axis. E.B. is a 24-year-old woman who went to see her physiclan because she and her flancé were interested in having chikdren but she was not having a regular period. History: E.B. stated that she entered puberty early and has experienced oligomenorhea and occasional amenorhea since menarche at age 11. E.B.s amenorrhea responded to a progesterone challenge with medroxyprogesterone acetate (Provera). Prior to her physical, E B. was referred to a gynecologist "to see if she had too many male hormones," because she did not have regular menstrual cycles. She was concemed about what her options were for future fertility. Physical Exam: • Height: 54", Weight 184 Ibs.; BMI: 31; BP: 118/76, Pulse: 80; • Skin: hirsutism, acne, acanthosis nigricans • The rest of her physical exam was normal including her pelvic exam. Lab Tests: Endocrine Screening EB. Lovels 49 ng/mi Hormone Progesterone (uteal phase) FSH (day 3 of menstrual cycle) LH (day 3 of menstrual cycle) LH FSH ratio (day 3 of menstrual cycle) Total Testosterone Free Testosterone DHEA-S Thyroid Stamulating Hormone 3.4 mlU/ml 10.2 mlU/ml 3:1 124 ng/ml 092 pg/ml 284 ug/di 18 ulU/mi Normal Levels > 15ng/ml 2.8-11.3 mlU/ml 0.6-11.6 milU/ml 1:1 6-86 ng/mi 0.7-36 pg/ml 35-430 ug/di 0.6-4.5 ulU/mi Ultrasound Exam Trans-vaginal ultrasound finds an abnormally high number of small antral follicles (E B. > 30 antral follicies, normal range = 10-25). Blue line outlines the ovary (see image at nght). Questions EB s physician performed a progesterone chalienge to furnher eamine the undortying cause of E B.'s amanorrhea. menstual.oroblen EB samenomea responded to the orogesterone dhalerge What is a postve reapanse to the progesterone chalenge I What does the resut sayabout nerute LEAsamenmen csed ya defectan the ovay ora derdeteuter Exearicr 2 EB's endoorine screening shows she has an abnormally high LH:FSH rato and high total Teatoaterone levela a How does her abnomal hormone levels cause high antral follicle count? b. Is EB. ovulating or menstruating? Explain how her abnormal hormone levels cause her தாணeி 3 What is hirsutism? What hormonal irregularity causes this condition? 4 What is your diagnosis (name of the condition)? Use evidence from the medical history, physical exam, endocrine scroening, and ultrasound exram to justify your answer. Given E.B.'s diagnosis, her physician ordered blood glucose screening. The results of these tests are shown below: Blood Glucose Screening Test E.B. Lovels Normal lovols | Glucoso Fasting blood glucose 142 mg/dL 188 mg/dL 70-99 mg/dL <140 mg/dL 2.hour oral glucose tolerance test Insulin Fasting Insuln 2-hour Insulin oral glucose tolerance test 152 miU/ml 82 mlU//ml <10 mlU/ml 6-50 mlU/ml S ExamineE8.s blood glucose and insulin tests. What do these results Indicate about EB.3 ability of her body to produce and mspond to insulin and her body's ability to regulate blood 6 Research the refationship between insulin. gondotropins and androgena. How mightEB.S In order to increase E.B.s chances of becoming pregnant her physiclan has E.B. perform the following • Inducing menstrualtion Provera (progesterone) a given for 5 to 10 days at a dose of 5 or 10 mg daly. The period usually starts within 2./ days after the last Provera pill is taken. Inducino.colation, Clomid (100 mg daily) is taken for five days from cycle days 3 through / The average day that ovuation.occurs s about 8 to 10 days after completing a 5 day course of Clomid. 7 How does Clomid act to induce ovulation? Expan the effect of Clomid on the nypothalamus pituitary.ovary axis.