PCO case study Present illness A 34yearold woman with chief complaint of increased hirsutism in pregnancy period and recurrent abortion She is G4P1ab3L1D1 married in 1395The first pregnancy was in 1396 without any art that the result was boy baby ID: 912763
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Slide1
Gestational hirsutism PCO case study
Slide2Present illness
A
34-year-old
woman with chief complaint of
increased
hirsutism
in pregnancy period and recurrent abortion.
She is G4P1ab3L1D1 married in 1395.The first pregnancy was in 1396 without any art that the result was boy baby
. He
was
IUGR. His
phenotype was normal
.
T
wo
days of
born, he
was expired
because
of
asphyxia.
Her other three
pregnancies were blighted ovum.
Slide3The patient had hirsutism
from 18 years old in chine and upper lip and was slow progression until to first pregnancy.
During the first pregnancy
hirsutism
was progressive and the growth rate of
hirsutism
was
increased
in pregnancy and decreased between pregnancy period.
With this
hirsutism
she had male pattern hair loss in pregnancy period.
But she
hadnot
acne,deepening
of
voice, headache,
galactorrhea
a
nd other
symptoms
of
virilization
.
Slide4Menstrual cycle was
normal, but
in 1397 the patient had
oligomenorrhea
and treated with
progesterone
and her cycle was regular.
In 1398 summer she had
polymenorrhea
and according to
sonography
with PCO diagnosis treated with LD
contraception
.
Despite that using contraceptive she became pregnant but again fail pregnancy and blighted ovum and was aborted in 17/9/1398.
Slide5Past historyMenarche:10 years
old
G1:2
years ago/term boy baby and IUGR/Death
G2:1 years ago/GA:15W/missed abortion/blighted ovum
G3:in 6 month ago/GA:5W/missed abortion/blighted ovum
G4:in 98/9/17/GA:5W/Aborted/blighted ovum
Slide6Past medical history and surgical history
Hypothyroidism:6 months after the first pregnancy.
c/s in 1396
Slide7Family historyHirsutism and recurrent abortion in her sisters
Hypothyroidism in
her brother
Slide8Drug historyLevothyroxin
50/daily
ASA 80/daily
Metformin 500mg/
bd
Iodofolic
/daily
Pearl vitD3/daily
Slide9Physical examGA
: Young
woman with normal features
, she
is not ill and toxic.
Bp:110/80 PR:75 T:37 BMI:33.75
H&N:Bitemporal
alopecia(+)moon face(-)buffalo hump(-)
supraclavicular
fat(-)LAP(-)increased muscular mass(-)
Thyroid:normal
size&consistency,no
detectable nodule
Skin:acne
(-),
acanthosis
nigricans
(-)
Slide10Chest:lung & heart
auscultation
is normal
.
Abdomen:no
tenderness or gaurding.no
organomegaly
, no
purple
striae
Genitalia: no
clitoromegaly,vaginal
bleeding(+)
Ext:normal
face edema
(-)cyanosis(-)
clubbing(-)proximal weakness(-)
Slide11Ferriman
gallwey
score:13
upper lip:3
Chin:3
Chest:1
Abd:2
Pelvis:2
Arm:0
Thigh:2
Upper back:0
Lower back:0
Slide12Normal range
unit
98/8/28
4-10
10 3/
µL
10.3
WBC
11.7-16
gr
/dl
14.1
HBG
140-450
10 3/
µL
324
PLT
74-100
mg/dl
105
glucose
uIU
/ml
5.66
TSH
22
Urea
1
cr
Slide1398/8/28
mIU
/ml
0.52
FSH
mIU
/ml
0.75
LH
ng
/ml
28.39
Prolactin
>0.73
ng
/ml
2.25
testeron
ng
/ml
59.58
ferritin
ng
/ml
21.9
25(OH)
VitD
>5.6
IU/ml
745.88
Anti
TPO
Slide14Normal
rang
UNIT
98/5/13
60-140
%
107
Protein C
60-140
%
129
proteins
80-120
%
80
Anti thrombin
III
<10%
%
5
Factor5
liden
<10
U/ml
0.9
Anti
phospholipid
ab
(
IgG
)
<10
U/ml
0.2
Anti
phospholipid
ab
(
IgM
)
µ
IU/ml
0.15
TSH
Slide15Slide16Slide17Thank you