Endocrine and Musculoskeletal Conditions, Essay Example

Differential Diagnosis

The patient’s differential diagnosis includes polycystic ovarian syndrome (PCOS), Cushing’s syndrome, and hypothyroidism.  According to the Mayo Clinic (2011), PCOS is an endocrine disorder which can create metabolic and reproductive dysfunction.  Symptoms include obesity, abnormal menstrual cycle, insulin resistance, cardiovascular dysfunction, hyperandrogenism, acne, and hormonal changes.  Cushing’s syndrome (CS) is a complex endocrine disorder resulting in high levels of cortisol (Ammini, Tandon, Gupta, Bhalla, Devasenaspathy, Kumar, Sahoo, Chittawar, Philip, Baruah, Dwarakanath & Tripathi, 2014). CS is often caused by an adrenocorticotropic hormone (ACTH) dependency.  It is usually ectopic and related to pituitary dysfunction, but may also be caused by primary adrenal disease.  Hypothyroidism occurs when the thyroid gland does not make enough of the thyroid hormone (Garber, Cobin, Gharib, Hennessey, Klein, Mechanick, Pessah-Pollack, Singer & Woeber, 2012).  While thyroiditis is the most common etiology, hypothyroid may also be caused by an autoimmune disease or an environmental iodine deficiency. Both CS and hypothyroidism display similar characteristics to PCOS in women, including irregular periods, weight gain, insulin resistance, hormonal changes, and hyperandrogenism.

PCOS is most likely the diagnosis. Hypothyroidism is associated more with women 50 years or older with menopause.  There was no mention of a goiter and overall fatigue which are common characteristics of an underactive thyroid.  Cushing’s syndrome is associated with high levels of cortisol as opposed increased androgen hormones associated with PCOS.  While the patient does have hirsituism and irregular menses, she does not exhibit other symptoms related to Cushing’s disease, such as truncal obesity.  Both can be ruled out by a blood test and diagnostic imaging, such as ultrasound.

Treatment and Management

According to the Mayo Clinic (2011), treatment for PCOS would begin with weight maintenance and dietary changes.  The patient would be placed on a dietary regimen lowering carbs with a focus on complex carbohydrates like whole grains to manage insulin resistance and weight gain in addition to an exercise routine.  To help the patient regulate their menstrual cycle, a low-dose birth control pill or progesterone would be prescribed to decrease androgen to reduce the risk of endometrial cancer and abnormal bleeding. Metformin, a type 2 diabetes medication, could be prescribed to improve ovulation and weight loss, in addition to help with insulin resistance.  Clomiphene citrate, an anti-estrogen medication would be prescribed for ovulation if the patient is trying to become pregnant.  If clomiphene citrate or metformin is not effective, gonadotropin or luteinizing hormone injections might be used as a substitute.  Excessive hair growth would be reduced by spironolactone if the patient does not want to become pregnant.

Alternative therapies are available to reduce the symptoms of PCOS in addition to diet changes and exercise.  A study testing the effects of taking omega-3 supplements in addition to a lower carbohydrate diet significantly controlled PCOS while balancing follicle stimulating hormones and testosterone (Ouladsahebmadarek, Khaki, Khanahmadi, Ahmadi, Paknejad, & Ayubi, 2011).  Other studies have shown that acupuncture and to a lesser extent resveratrol may improve metabolic, hormonal and psychological profiles of PCOS in women (Aquino & Nori, 2014).

Education

The student would direct the patient’s treatment through medication and lifestyle changes.  A weight loss regimen focusing on a lowered carbohydrate diet and exercise would be prescribed to assist with hormone levels.  Low-dose birth control pills or progesterone would be prescribed to help maintain a normal menstrual cycle.  Metformin is prescribed additionally for weight loss, normalizing ovulation, and maintaining blood sugar levels (Mayo Clinic Staff, 2011).

If the patient has plans for pregnancy, birth control would not be prescribed. Instead clomiphene citrate, gonadotropin or luteinizing hormone injections would be used to help induce ovulation.  Additional therapies could be discussed like acupuncture or resveratrol supplements to help maintain PCOS would be discussed (Aquino & Nori, 2014).

References

Ammini, C.A., Tandon, N., Gupta, N., Bhalla, A.S., Devasenaspathy, K., Kumar, G., Sahoo, J.P., Chittawar, S., Philip, J., Baruah, M.P., Dwarakanath, C.S., & Tripathi, S. (2014). Etiology and clinical profile of patients with Cushing’s syndrome: A single center experience. Indian Journal of Endocrinology and Metabolism, 18, 99-105.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968742/

Aquino, C.I., & Nori, S.L. (2014, April 24). National Center for Biotechnology Information. Complementary Therapy in Polycystic Ovary Syndrome. Retrieved May 13, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC412377/Garber, J.R., Cobin, R.H., Gharib, H., Hennessey, J.V., Klein, I., Mechanick, J.I., Pessah-Pollack, R., Singer, P.A, & Woeber, K.A. (2012). Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. THYROID, 22, 1200-1235. doi: 10.1089/thy.2012.0205.

Mayo Clinic Staff (2011, August 04). Mayo Clinic – Mayo Clinic. Polycystic ovary syndrome (PCOS) Treatments and drugs – Diseases and Conditions – Mayo Clinic. Retrieved May 13, 2014, from http://www.mayoclinic.org/diseases-conditions/pcos/basics/treatment/con-20028841

Ouladsahebmadarek, E., Khaki, A., Khanahmadi, S., Ahmadi, H.A., Paknejad, P., & Ayubi, M.R. (2014). Hormonal and metabolic effects of polyunsaturated fatty acid (omega-3) on polycystic ovary syndrome induced rats under diet. Iranian Journal of Basic Medical Sciences, 17,123-127. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976750/