Polycystic Ovarian Syndrome, Case Study Example

The 20 year-old female patient in question should be evaluated more closely in order to address her irregular menstrual cycles and any risks that might occur relative to this condition. In addition, her hypertension must be monitored on a regular basis due to her family history of the condition. In addition, her weight should be monitored and perhaps she should consider weight loss to alleviate some of the risk associated with hypertension in her family. Furthermore, the presence of excess body and facial hair, also known as hirsutism, is also noticeable in this patient and is caused by excess androgen hormone in the system that contributes to this condition (Mayo Clinic, 2014). Therefore, in conjunction with her pattern of irregular menstrual periods, she should be evaluated for the possibility of polycystic ovary syndrome (Mayo Clinic, 2014). In this context, the patient requires further examination and possible ultrasound of the ovaries to confirm a definitive diagnosis of the disease (Mayo Clinic, 2014).

When evaluating the patient, a number of differential diagnoses must be considered that may be a cause of her condition. Although it is not a differential diagnosis, excess weight does not provide any benefits to the patient and may pose a threat to her level of insulin resistance and subsequent illness (Lucidi, 2013). Some of the most common differential diagnoses for polycystic ovary syndrome include the following: 1) Amenorrhea, or a lack of menstrual bleeding; 2) Cushing syndrome, whereby weight gain and irregular periods are common symptoms (Adler, 2014); 3) Hypothyroidism, which is characterized by weight gain, blood pressure concerns, and pallor (Orlander, 2014); and 4) Ovarian tumors, which may contribute to irregular menstrual cycles and other symptoms (Lucidi, 2013). Based upon the evaluation of the patient and her current state of irregular menstrual periods combined with excess weight and excess androgen contributing to increased facial and body hair, the patient appears to have polycystic ovary syndrome and requires further evaluation and treatment for the disease when an official diagnosis is made.

For this patient, it is important to make a definitive diagnosis and to determine the proper course of treatment that is required. In order to determine if the patient has polycystic ovary syndrome, no specific test to make a definitive diagnosis is available; therefore, other factors must be considered that will enable a physician to develop a proper treatment plan (Mayo Clinic, 2014). Medical history is critical in making a diagnosis, particularly if there is a history of irregular menstrual cycles, the physical exam is also critical to identify any other issues of concern, and the doctor should conduct a pelvic examination in order to determine if there are any possible irregularities or abnormalities that are contributing to the patient’s menstrual condition (Mayo Clinic, 2014). Furthermore, the patient may be evaluated by using blood tests to determine hormone levels such as androgen, in addition to glucose testing and triglyceride levels (Mayo Clinic, 2014). Finally, the patient may be evaluated by conducting a pelvic ultrasound in order to determine if any ovarian cysts or abnormal uterine thickness are present in the patient (Mayo Clinic, 2014).

For the differential diagnoses that have been identified, it is important to address the diagnostic criteria that are common. For example, amenorrhea is determined when a patient does not have regular menstrual periods on a monthly basis and may either experience irregularities in their menstrual cycle or no periods at all (Bielak, 2012). However, pregnancy must be ruled out as the cause of the condition prior to making a definitive diagnosis (Bielak, 2012). For patients with possible Cushing Syndrome, a diagnosis is made based upon obesity, the presence of facial and/or body hair at higher than normal levels, and possible hypertension (Adler, 2014). For patients with possible hypothyroidism, testing for thyroid-stimulating hormone (TSH) levels is appropriate and is elevated, accompanied by decreased free thyroxine (T4) and free thyroxine index (FTI) (Orlander, 2014). Finally, ovarian tumors are likely to be identified through a pelvic exam and subsequent ultrasound.

If a diagnosis of polycystic ovary syndrome is made, it is important to provide the patient with a viable treatment plan, which will likely include medication (Mayo Clinic, 2014). In this instance, the patient requires a method of regulation for the menstrual cycle, most commonly in the form of a combination birth control method that includes estrogen and progesterone (Mayo Clinic, 2014). Another possible option is to use a progesterone-only form of birth control, and this is used between 10 and 14 days per month; however, it does not alleviate excess androgen levels (Mayo Clinic, 2014). Furthermore, the patient may be prescribed metformin to prevent type 2 diabetes, particularly since there is excess weight to be considered and a greater risk of diabetes (Mayo Clinic, 2014). The patient may also receive Clomiphene citrate to assist in promoting ovulation, and Aldactone as a supplement to birth control to reduce androgen levels and subsequent excess hair growth (Mayo Clinic, 2014). Each of these alternatives is important because it provides a basis for enabling the patient to manage her condition effectively and to improve her quality of life.

For this patient, the most viable management plan includes the development of a weight loss and nutrition plan that also includes increased physical activity, as this will support the patient’s efforts to reduce excess weight and improve her condition (Mayo Clinic, 2014). The patient should also consider changes to current nutrition levels through a high fiber diet that includes complex carbohydrates (Mayo Clinic, 2014). Also, an increase in physical activity is likely to provide the patient with a higher level of energy and the ability to prevent insulin resistance if this becomes a problem for the patient in the future (Mayo Clinic, 2014). In the case study, the patient requires an ongoing effort to be active and to demonstrate her ability to work towards losing weight to improve her overall health and wellbeing. If necessary, the patient should have access to a nutritionist in order to address her dietary needs and to guide her in formulating a plan that will be effective in meeting her dietary concerns and requirements for the foreseeable future.

For this patient, education is critical because she is likely to be accustomed to having irregular periods without a real understanding of the reasons behind these events. Therefore, her diagnosis must be explained properly and in a detailed fashion in order to enable her to realize what steps are required to ensure that the disease is properly managed and in accordance with the chosen treatment plan. This will also enable the patient to be successful in her efforts to stimulate weight loss through lifestyle changes and to also recognize the importance of taking any medications that are prescribed in a timely manner to prevent further complications. Finally, patient education is required in order to support her long-term prognosis and why it is necessary to adhere to the treatment plan without incident.

For this patient, it is important to develop a follow-up strategy so that she is able to manage her condition effectively and is able to be successful in improving her quality of life. Therefore, barring any complications, she should visit the office in another six months for   follow-up and obtain a physical examination, including a pelvic exam, on an annual basis. It is also recommended that the patient should be provided with a strategy to address any symptoms that may arise in the interim and to contact the doctor if any unforeseen changes are observed. The patient’s history of hypertension in the family is also cause for concern; therefore, it is recommended that the patient should monitor her blood pressure on a regular basis and notify the doctor if any remarkable changes are observed.

References

Adler, G.K. (2014). Cushing Syndrome. Retrieved from http://emedicine.medscape.com/article/117365-overview

Bielak, K.M. (2012). Amenorhhea. Retrieved from http://emedicine.medscape.com/article/252928-overview

Lucidi, R.S. (2013). Polycystic ovarian syndrome differential diagnoses. Retrieved from http://emedicine.medscape.com/article/256806-differential

Mayo Clinic (2014). Polycystic Ovary Syndrome. Retrieved from http://www.mayoclinic.org/diseases-conditions/pcos/basics/lifestyle-home-remedies/con-20028841

Orlander, P.R. (2014). Hypothyroidism. Retrieved from http://emedicine.medscape.com/article/122393-overview