- You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts.
- All replies must be constructive and use literature where possible.
Weekly Clinical Experience 3
Elizabeth Varona-Martin
Module 3
My clinical experience continues to be gratifying. I got more relaxed and accustomed to the clinic atmosphere as I continued to study to become an Advanced Nurse Practitioner. I’ve had a great time with it, and I’m happy to continue my learning experience.
S.P., a 19 years old Hispanic female, came into the office complaining that her menstrual periods have been irregular, and she hasn’t had one for the last year. She is not sexually active. The patient has been gaining weight, suffers from acne, and has facial hair growth. Her hair is brittle and falls out easily. She has no breast discharge from nipples. She feels tired and has daytime sleepiness. She feels like she needs to take a nap after lunch.
Her sister has Polycystic Ovaries.
She received the COVID 19 vac. She is a College student and works in admissions at Physician Regional Hospital.
Vital signs
Ht: 5’8 WT: 118.7 kg BMI: 39.66 B/P: 118/72 HR: 92bpm RR: 16 RPM O2Sat: 98%
Differential Diagnosis:
Physiologic adolescent anovulation: The most prevalent reason for teenage menstruation irregularity is physiologic adolescent anovulation. It produces only modest menstrual cycle irregularity: most cycles last 21–45 days, throughout the first postmenarcheal year, and 90 percent by the fourth year (Rosenfield, 2020).
Related congenital disorders of adrenal steroid metabolism or action: Defects in glucocorticoid receptor signaling produce glucocorticoid resistance. It is a rare congenital variant of ACTH-dependent adrenal hyperandrogenism caused by insufficient negative feedback from cortisol, resulting in excessive ACTH release (Rosenfield, 2020).
Cushing syndrome: In rare cases, several types of Cushing syndrome caused by adrenal hyperplasia are related to hyperandrogenic anovulation (Rosenfield, 2020).
Thyroid dysfunction: Thyroid disorder disrupts the metabolism of sex hormones and causes menstrual irregularities. Hypothyroidism also results in multicystic ovarian abnormalities and low sex hormone-binding globulin levels in the blood. It can be confused with hyperandrogenism because it causes coarsening of the hair, which can be misinterpreted as hirsutism (Rosenfield, 2020).
Impression and Plan
Diagnosis
PCOS (polycystic ovarian syndrome) – ICD10-CM E28.2
Amenorrhea – ICD10-CM N91.2.
Labs : B-hCG, CRP, CBC, Prolactin levels, LH, FSH, Testosterone level, CMP, HbA1c, TSH
Follow up in two weeks to review lab results.
Obesity – ICD10-CM E66.9.
We emphasized the need for lifestyle modification, including diet therapy which includes a low calorie and low-fat diet. We encouraged the need for daily exercises.
Amenorrhea or lack of menstruation can be a transitory, intermittent, or permanent disorder caused by hypothalamic, pituitary, ovarian, uterine, or vaginal malfunction. It is categorized as either primary when a patient by the age of 15 years or older never got her period, or secondary when after having regular menstrual cycles, menses are absent for more than three months or six months patients who previously had irregular menstrual cycles. A pregnancy test is advised as the initial step in examining any woman who has secondary amenorrhea (Welt & Barbieri, 2020).
Polycystic ovarian syndrome (PCOS) often presents around adolescence and is mainly characterized by ovulatory failure and hyperandrogenism. It comprises a range of clinical symptoms, including menstrual inconsistency ( oligo- or amenorrhea, or irregular bleeding), cutaneous manifestations of hyperandrogenism like hirsutism, moderate to severe acne, ovaries with polycystic cysts, and Insulin resistance and obesity (Rosenfield, 2020).
Diagnosing and treating polycystic ovarian syndrome (PCOS) in teenagers is critical for managing the symptoms of hyperandrogenism and irregular menstruation. Furthermore, PCOS raises the risk of infertility, endometrial hyperplasia and carcinoma, type 2 diabetes mellitus, metabolic syndrome, and, perhaps, cardiovascular disease (Rosenfield, 2020).
References
Rosenfield, R. L. (2020, August 10). Definition, clinical features, and differential diagnosis of polycystic ovary syndrome in adolescents. UpToDate. Retrieved from https://www.uptodate.com/contents/definition-clinical-features-and-differential-diagnosis-of-polycystic-ovary-syndrome-in-adolescents?search=PCOS&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3.
Welt, C. K., & Barbieri, R. L. (2020, June 28). Evaluation and management of secondary amenorrhea. UpToDate. Retrieved from https://www.uptodate.com/contents/evaluation-and-management-of-secondary-amenorrhea?search=amenorrhea&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.
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