Secondary amenorrhea and weight gain

Author: Dr fatima ali shah     Published: 3 years ago 3 Replies

16 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?
Dr. Ahmed Farhan, 3 years ago

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

Dr fatima ali shah, 3 years ago

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.
Dr. Ahmed Farhan, 3 years ago

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