--
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Braun,
R.
Daniel
Sent: Wednesday, October 09, 2002 10:46 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Puzzling case
The original post said that one year ago withdrawal bleeding ceased.
-----Original Message-----
From: Richard Chudacoff, MD [mailto:rchudacoff@mylinuxisp.com]
Sent: Wednesday, October 09, 2002 9:56 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Puzzling case
She stopped about 4 months ago
--
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Dr.
John
Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
Sent: Wednesday, October 09, 2002 9:11 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Puzzling case
At Wed, 9 Oct 2002, Braun, R. Daniel wrote:
>
>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
Richard its not clear if she has been on the pill since one year ago .
--
Take care, John
