Re: Puzzling case
From: Charlie Chambers (cchamber@gorge.net)
Fri Oct 11 12:55:31 2002
Not seen anyone using the hyperbaric test. I wonder if this is just a
more tech version of the old "roll over" test.
On Thursday, October 10, 2002, at 10:09 AM, Richard Chudacoff, MD wrote:
> Good point
>
> Richard Chudacoff, MD
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Braun,
> R.
> Daniel
> Sent: Thursday, October 10, 2002 11:58 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Puzzling case
>
> Right meaning she doesn't withdraw from ESTROGEN and progestin. Meaning
> something is wrong with her endometrium and she needs a hysteroscopy.
>
> -----Original Message-----
> From: Richard Chudacoff, MD [mailto:rchudacoff@mylinuxisp.com]
> Sent: Thursday, October 10, 2002 9:59 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: Puzzling case
>
> While she was on OCPs
>
> 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
>
*************************************************************************
Charlie Chambers
Hood River, OR
--
cchamber@alumni.rice.edu
"No matter where you go...
there you are."
Dr. Buckaroo Banzai
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