Re: Puzzling case
From: Joe Cutchin (forcep@intercom.net)
Tue Oct 8 17:33:55 2002
Well Charlie with a very low LH and no withdrawal bleeding something else is
occuring.This could be elevated testosterone blocking the pituitary path.The
degree of insulin resistence could be related to this also.
Charlie Chambers wrote:
> Joe,
>
> Please enlighten me on what you hope to gain by the testosterone level.
>
> Thanks
>
> On Tuesday, October 8, 2002, at 05:40 AM, Joe Cutchin wrote:
>
> > I would get a free testosterone and some type of scan of ovaries.
> >
> > "Richard Chudacoff, MD" wrote:
> >
> >> I have a patient who came to see me today, for a second opinion,
> >> because of amenorrhea and headaches. She was noted to have irregular
> >> cycles, and therefore FSH and LH were performed.Both FSH and LH were <
> >> 0.7 mIU/ML.Quantitative beta HCG was negative.Provera challenge times
> >> 3 noted no withdrawal bleeding. Prior to one year ago, she had regular
> >> withdrawal bleeding on oral contraceptive pills.Approximately one year
> >> ago withdrawal bleeding ceased. Comprehensive metabolic panel was
> >> normal, with a fasting glucose of 97 mg per deciliter, and a normal
> >> prolactin.I had seen patient previously, a considered a diagnosis of
> >> polycystic ovarian syndrome, and she was started on Glucophage.An
> >> endocrinologist and Dallas ordered a 3-hour glucose tolerance test,
> >> which had an elevated two-hour specimen of 162 mg per dl. MRI of the
> >> brain noted no evidence of pituitary mass, nor absence of the
> >> pituitary gland.
> >>
> >> Physical exam notes in obese 31-year-old female, 239 pounds, 5 ft. 6
> >> in..She is mild right lower quadrant pain, and although difficult to
> >> evaluate, there is an impression of a mass.She is scheduled for a
> >> pelvic ultrasound in two days.
> >>
> >> By question is this, other than in estradiol level, and an Inhibin
> >> level, which other studies should be drawn?Can one draw a GnRH level?
> >>
> >> Richard Chudacoff, MD, FACOG
> >>
> >> Chudacoff Obstetrics & Gynecology, PLLC
> >>
> >> 15200 Southwest Freeway, #270
> >>
> >> Sugar Land, TX 77478
> >>
> >> Tel: 281-277-3900
> >>
> >> Fax: 281-277-3901
> >>
> >> rchudacoff@mylinuxisp.com
> >>
> >> Richard.Chudacoff@obgyn.net
> >>
> >> http://www.mdhub.com/281-277-3900
> >>
> >> http://www.chudacoffobgyn.yourmd.com
> >>
> >> **********************************************************************
> >>
> >> Neither the confidentiality nor the integrity of this message
> >>
> >> can be guaranteed following transmission on the Internet.
> >>
> >> **********************************************************************
> >>
> >
> >
> *************************************************************************
> Charlie Chambers
> Hood River, OR
> cchamber@alumni.rice.edu
>
> "No matter where you go...
> there you are."
> Dr. Buckaroo Banzai
> ************************************************************************
