Adolescent Case
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Case Study: 14-Year-Old Female - PCOS Diagnosis & Lab Tests, Slides of Pediatrics
A case study of a 14-year-old female presenting with irregular periods, unexplained weight gain, and no significant past medical history. A detailed case history, physical exam findings, and a differential diagnosis suggesting polycystic ovary syndrome (pcos). Laboratory tests recommended for diagnosis and management of pcos are also listed.
Typology: Slides
2012/2013
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Adolescent Case
Presentation
Case history
14 y/o female
CC: 3-6 months of irregular periods
and unexplained weight gain
In USOH, has not been ill in last few
months
PMH- not significant
Case History
Drugs: never smokes, drank, or tried any
drugs, no friends hace either
Diet: parents MD’s and help her eat a
balanced diet, she reports no increased
eating habits since weight gain
Sex: never been active, never had a
girl/boyfriend
Suicide: no h/o depression
Case History
Menstrual hx-
menarche at age 12
Regular periods over past year and
then irregular for about 6months; no
periods for about 3 months now
Never been sexually active
Physical Exam
VS: HR 65; RR18; BP112/80; wt 93.5kg
(>99th%); ht 160cm (50th%); BMI= 36
HEENT: fat pad behind neck, thickening &
slight hyperpigmentation of posterior
neck skin, nl thyroid
CV: S1+S2, no R/G/M, RR
Lungs: CTA bilat
Abd: obese, soft, +BS, striae across
abdomen and lower hips
Physical Exam
Ext: FROM, nl muscle tone, 2+ cap
refill, pulses normal
Skin- dry but no lesions, rashes,
acne noted over face, chest, back,
no excess hair.
GU- no external abnormalities,
Tanner 5, normal clitoris
How about a differential for
secondary amenorrhea?
Differential Diagnosis
Pregnancy
PCO
Hypothyroidism
Ovarian tumor
Pituitary tumor
Which labs would you think about at
this initial presentation?
Laboratory Tests
B-HCG
Thyroid
LH/FSH
Prolactin
Free/total testosterone
Our patient
Nl TFT’s
Glucose 81
Lipid profile all
WNL
LH 4.
FSH 6.
PRL 5.
Andro 181
17-OHPS 58
Insulin 5.
Ttest 36
Free test 6.7 (only
abn lab)
What is PCOS?
Increased androgen production from
ovaries and adrenal glands
I was diagnosed when I was 17 and immediately went on birth control pills to control my symptoms. This was the only practical "treatment" known at that time. Later on, PCOS was the reason I couldn't easily conceive and then miscarried the 2 times I did conceive naturally. I think this is the most acutely painful aspect of this syndrome, and it is certainly the focus of many women's pain. Wanting a child and being unable to have one was one of the most difficult times of my life. Needing to take in order to conceive and carry a pregnancy can have some very subtle effects on how a woman thinks about herself, and when she has a condition that already makes her feel less attractive, less desirable and less feminine (at least by our culture's standards), she can end up seeing herself as pretty defective. Later in life, PCOS presents some serious health problems. Women with PCOS are significantly more likely to have type II diabetes and heart disease and there appears to be a link to breast and colon cancer, so it isn't just a "cosmetic" or "infertility" condition -- it can be ugly.