Name: AARTI RAMESH MALI

AGE: 17 YEARS
SEX: FEMALE
ADDRESS: PANDHARPUR, SOLAPUR
DIAGNOSIS: PCOS

HISTORY:
17 year old female, r/o Solapur, single child, BO 3 0 CM, studied till 8th standard.
Symptomatic since 2 years.
 Menstrual irregularities x 2 year.
 Excessive hair growth x 9 months.
Patient was apparently normal 2 years ago when she noticed menstrual irregularities, used to cycle every
2-3 months associated with hypomenorrhea.
Noticed excessive hair growth: over chin f/b upper lips f/b face and then over trunk and extremities. Hair
growth is progressive and she has done waxing only once.
h/o change in voice i/f/o coarsening.
h/o weight gain over last 1.5 year from 50 kg to 72 kg
Evaluated by endocrinologist
Found to have clitoromegaly
Inv: Jan 19'- PRL: 17.6ng/ml
Feb 19'- Testosterone: 1.15ng/ml
USG: Both ovaries normal in echotexture
No focal lesion
Multiple Small Follicles +
No h/o abdominal pain
No h/o exogenous drug intake
No h/o abdominal striae/PMW/mooning/fungal infections
No h/s/o salt wasting crisis
No h/o premature pubarche
Birth h/o: FTND, Birth weight- 3.5 kg, NICU stay for 9 days i/v/o BA and facial asymmetry.
No h/o genital ambiguity noted at birth.

Age of menarche: 13 years, cycled regularly for 6 months-1 year f/b irregularity in menses.

Past History: Nothing contributory.

Family history: No other similar illness in family members.

EXAMINATION:
Weight: kg, Height: 152 cm
BMI: kg/m 2
FHT: 172 cm
MHT: 148 cm
MPH: 148.5 cm
BP: 124/82 mmHg
SMR: P4, B5 B/L, 2 perineal openings, No clitoromegaly
AN+, ST-
CNS: Right LMN facial palsy

INVESTIGATIONS: (March 2019)

FSH (m IU/ml) 4.28

LH (m IU/ml) 8.71
Testosterone (ng/ml) 0.37
0.59
DHEAS (mcg/dl) 318
ACTH Stimulated 3.23
17 (OH) P (ng/ml)
ODS Cortisol (µg/dl) 1.05
TSH (µ IU/ml) 3.5
Ca (mg/dl) 8.5
PO4 (mg/dl) 2.8
ALP (U/L) 174
Creatinine (mg%) 1.1
Albumin (g/dl) 3.8
SGOT(U/L) 29
SGPT (U/L) 27
Na (mEq/L) 140
K (mEq/L) 3.9

TC (mg/dl) 172
TG (mg/dl) 128
HDL (mg/dl) 32.9
LDL (mg/dl) 25.6
VLDL (mg/dl) 136.8
HbA1c (%) 4.0
FBS/PLBS 82/131

Hb (gm/dl) 12.7
WBC count (cells/uL) 12900
Platelet count (cells/uL) 4.0 lakh

USG Abdomen and Pelvis (27.03.2019):

Uterus: anteverted: 8 x 2.6 x 3.9 cm ; ET-4 mm
LO: 5.3x3.1x3.2 cm (27cc)
RO: 4.5x2.6x3.2 cm (20cc)
Predominant peripheral ring of small follicles with echogenic stroma in both ovaries
RI: 0.52, PI: 0.7 on Right
RI: 0.75, PI: 1.1 on Lef

Treatment: Currently on lifestyle modifications therapy, Metformin, Spirinolactone and Oral

contraceptive pills.