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Re: Puzzling case From: Braun, R. Daniel (rbraun@iupui.edu) Wed Oct 9 06:27:58 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Depo-Provera Tied to Increased Heart Disease Risk in Small Study" Previous message: Tony Blair: "Re: Puzzling case" Maybe in reply to: Richard Chudacoff, MD: "Puzzling case" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Puzzling case" Reply: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Puzzling case" NOTE: One year ago, her withdrawal bleeding to Oral Contraceptive Pills (ESTROGEN and Progestin) ceased. She not only doesn't withdraw from estrogen, she also does not withdraw from estrogen and progestin. HYSTEROSCOPY HYSTEROSCOPY Dan -----Original Message----- From: Tony Blair [mailto:antoineb@cgocable.ca] Sent: Wednesday, October 09, 2002 12:47 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Puzzling case If the pelvic US is normal, the diagnosis would be "hypogonadotrophic hypogonadic amenorrhea" ( low GnRH and low E3 : no bleeding with Provera ). Sheehan, Asherman, hysteroscopy ????? Remember : common things are common... The treatment should be HRT (cyclic) or OC depending on the need for family planning or not, because this women is at risk for osteoporosis (low E3) Just my opinion. Tony Blair Ob/Gyn Canada >----- Original Message ----- From: Richard <mailto:rchudacoff@mylinuxisp.com> Chudacoff, MD To: Multiple recipients of list OB-GYN-L <mailto:ob-gyn-l@mail.medispecialty.com> Sent: Monday, October 07, 2002 7:37 PM Subject: Puzzling case 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 Next message: Efrain Ramirez: "Depo-Provera Tied to Increased Heart Disease Risk in Small Study" Previous message: Tony Blair: "Re: Puzzling case" Maybe in reply to: Richard Chudacoff, MD: "Puzzling case" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Puzzling case" Reply: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Puzzling case"

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