Pcos Case Studies
Polycystic ovarian syndrome (aka PCOS) is a disorder that is expected in patients with irregular menses, acne, seborrhea, hirsutism, infertility, and alopecia. PCOS has recently been associated with the metabolic syndrome. Patients may develop obesity, insulin resistance, type 2 diabetes, hypertension, liver disease, and sleep apnea. Clinical diagnosis would include hematological and radiological tests. Management would be a combined effort between a patient’s dermatologist, endocrinologist, gynecologist, and nutritionist. Long term medications and lifestyle changes are essential for a successful outcome. This case study focused on the understanding of the normal and abnormal endocrine functions …show more content…
However, whether this change in LH secretion is due to a defect of the hypothalamus or due to external factors such as loss of negative feedback mechanism from the ovary, or increase in insulin levels, remain unresolved. Excessive secretion of LH has traditionally been considered as a hallmark of classic PCOS.
Patients with PCOS complain of acne not responsive to the normal line of treatment. Even if responsive, lesions recur on stopping treatment, necessitating treatment with oral medication and/or hormonal therapy. An important feature seen in these patients is the development of multiple closed comedones which rapidly transform into tender, lumpy nodules, distributed in the lower half of face and jaw-line. These tend to last beyond the usual course of 5-7 days. A pre-menstrual flare is also common. Acne lesions may not only be found on the face, but may also be seen on the chest, shoulders and back.
Typically, thick dark velvety skin situated on the nape of the neck, axillae, groins and other frictional areas may often be the first clue of insulin resistance.
Irregular menses and …show more content…
It is often difficult to treat all complaints at the same time. The most difficult one is the desire to treat both an ovulatory infertility and hirsutism. Oral contraceptives are contra-indicated in infertility treatments because they block ovulation and anti-androgens in view of their potential teratogenic effects in a male fetus. Because of these conundrums in clinical care, treatment tends to fall into two categories, either the treatment of an ovulatory infertility or the long term maintenance treatment for PCOS related symptoms (i.e., hirsutism, menstrual disorders, obesity, etc.).
Long Term Maintenance of Pcos
The term maintenance acknowledges the fact that there is no known cure for PCOS. Often hirsutism, oligo menorrhea, and obesity forms the key presenting symptoms. Glucose intolerance is the strongest risk factor for diabetes and is also an independent risk factor for cardiovascular events in these women. Additional targeted therapies for hirsutism and/or oligo menorrhea could be added depending on response to the initial therapy. Contraception should be considered if the patient is trying to avoid