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Secondary amenorrhea and weight gain
Dr fatima ali shah, 4 years ago 3 Replies16 yrd old frmale pt with no previous comorbs presented with C/O secondary amenorrhea , easy fatiguability and weight gain (13kg) for 1 year , hair fall, heat intolerance , sweating, imsomnia, on and off head ache e blirring of vision.
On examination pt has fine tremors, pruple striae on Rt side of abdomen , hirsutism but normal axillary and pubic hair distribution .Pt has used COCs for 8 months then primulut for 3 cycles then stopped 1 month ago currently she on tab Evion for last 1 month
Labs
Serum cortisol morning 18.7
Serum cortisol 17.7
DHEA 9.7
U/S abd pelvis normal
Pt is advised serum prolactin, FSH and LH
And MRI brain
Q what are the probable diagnoses?
Few points should be clarified before the diagnosis is made:
- are there any visual field defects?
- Fundus examination?
- any other clinical features of hypercortisolism like diabetes, hypertension, proximal myopathy, etc
- What about thyroid function tests?
- Dexamethasone suppression tests?
- Ultrasound pelvis?
TSH 1.2
T3 1.1
T4 1.6
Bp 120/80
Ultrasound pelvis normal studies no evidence of PCOs
Rest of examination findings and investigatioms are not avaible
Cushing's disease should be investigated in this patient as a possible cause if weight gain, headache, amenorrhea, hirsuitism, and purplish abdominal striae.
The following investigations may be advised:
- MRI with pituitary protocol
- Dexamethasone suppression test
- Other pituitary hormonal levels
- Ancillary tests such as blood glucose, serum electrolytes, and workup for osteoporosis.