Jamie Lynn Willis

Human Diseases
11/24/2014

PCOS CASE STUDY

by
Jamie Lynn Willis

Date: 04/15/14
Name: Jamie Brown
Age: 25
DOB: 1/09/89
Gender: Female
Race: Caucasian
Occupation: Full time Student
Chief Complaint: I havent had a period in almost 4 months.
Subjective: 25 year old female patient present with amenorrhea, acne, and obesity.
Differential Diagnosis

Clinical Presentation

Hyperandrogenism

Acne, increase amount of body hair, obesity,

irregular menstrual cycles, increased
androgen levels, infertility, deep voice,
muscle bulk, ect.
Nervousness, Anxiety, perspiration, temperate
intolerance, palpitations, stare, weight loss,
reduction in menstrual flow, ect.
Acne, weight gain with fatty tissues around
midsection, stretch marks, slow healing,
thicker body hair, irregular or absent
menstrual cycles, ect.
Acne, depression, irregular or absent
menstrual cycles, hirsutism, infertility,
obesity, insulin resistant, ect.

Hyperthyroidism

Cushing Syndrome

Polycystic Ovary Syndrome (PCOS)

HPI: 25 year old female patient present with amenorrhea, acne, and obesity. She is complaining
that she hasnt had a menstrual cycle in almost 4 months. She says she has taken numerous at
home pregnancy test, and all have been negative. She says shes had a cramping pain where her
right ovary is. Patient has gained 20 pounds in the last year. Patient denies any vomiting,

diarrhea, or change in eating habits. She claims she was a healthy weight when she was
younger, then in her teens she just started gaining weight and having irregular menstrual cycles.

Diagnostic Test:

CBC

Ultrasound of the ovaries and uterus

Blood work for thyroid, androgens, and insulin

Pregnancy test

Results:

CBC- all within normal ranges

Ultrasound of ovaries and uterus- multiple cyst found on ovaries and the uterus is small

Thyroid levels were within normal ranges. Androgens were higher than normal for a
female. Insulin was on the high end as well.

Pregnancy test came back negative.

Differential Diagnosis

Pertinent Positives

Pertinent Negatives

Hyperandrogenism

High levels of androgens

Acne
Irregular menstrual cycles
Obesity
Small uterus
Irregular menstrual cycles

Hair loss
Increased muscle bulk
Smaller breast

Hyperthyroidism

Tremor
Anxiety
Weight loss
Normal thyroid levels

Cushing Syndrome

Polycystic Ovary Syndrome

Acne
Weight gain
Amenorrhea
Insulin intolerance
Acne
Weight gain
Amenorrhea
High androgen levels
Cyst on ovaries
Insulin resistance

Bone loss
Cognitive difficulties

Depression
Breathing problems
Hirsutism

Discussion and Pathophysiology:

We are not sure what the cause of PCOS is, but more studies are being done and we are
getting closer to an answer. One theory is that PCOS is hereditarily. If a birth mother or aunt has
PCOS then the possibilities of having PCOS are increased. An unhealthy lifestyle can also lead
to PCOS. Also, those with PCOS are much more likely to have some form of insulin resistance.
Were not sure if PCOS is caused by insulin resistance, or vice versa. Perhaps, they are
unrelated. It has been shown that a diabetic diet and exercise can help with managing PCOS. We
also know that the increase in androgens causes many of the symptoms of PCOS.
Normal Physiology

Disease State

Ultrasound of ovaries are normal

Ultrasound on ovaries reveals cyst

With normal weight range

Obese

Regular menstrual cycles

Amenorrhea or irregular menstrual cycles

Normal androgen levels

High androgen levels

Little to no acne

Acne

Normal amount of fatty tissue around

midsection

High amounts of fatty tissue around

midsection

Insulin reactions normal

Insulin resistance

There were a few differential diagnoses, but only one fit all the signs and symptoms. The
patients weight gain is from the insulin resistance and how the body now deals with sugars and
carbohydrates. The amenorrhea is being caused by the hormone imbalance from the androgens.
The androgen levels are also encouraging the acne.

The normal treatment for PCOS is Metformin, Aldactone, and birth control. The Metformin
is for the insulin resistance, the Aldactone for acne and hair loss, and the birth control for normal
menstrual cycles. Metformin does come with a couple side effects. The most common one being
GI upset. Despite all this, the best way to control the symptoms of PCOS is weight loss and
maintaining a healthy lifestyle.

I have talked with the patient about the best course of action and other courses, such as
surgery. We both feel that surgery is too extreme at the moment. She has agreed to take the
Metformin, Aldactone, and birth control. I also went over the best diet for patients with PCOS,
but I will refer her to a dietician as well. The diet best for the patient is a low carb, low fat diet.
With a lifestyle change, Im confident my patient can manage her symptoms even though she
will not be cured.

References:

Hyperandrogensim, (2014, June 17 Retrieved from

http://www.rightdiagnosis.com/h/hyperandrogenism/symptoms.htm
Hyperthyriodism (overactive thyroid), (2012, November 20) Retrieved from
http://www.mayoclinic.org/diseases-conditions/hyperthyroidism/basics/symptoms/con-20020986
Cushing Syndrome, (2013, March 28) Retrieved from http://www.mayoclinic.org/diseasesconditions/cushing-syndrome/basics/symptoms/con-20032115
Polycystic Ovary Syndrome, (2014, March 12) Retrieved from
http://www.webmd.com/women/tc/polycystic-ovary-syndrome-pcos-symptoms