Gestational hirsutism PCO case study Present illness A

Gestational hirsutism PCO case study

Present illness A 34 -year-old woman with chief complaint of increased hirsutism in pregnancy period and recurrent abortion. She is G 4 P 1 ab 3 L 1 D 1 married in 1395. The first pregnancy was in 1396 without any art that the result was boy baby. He was IUGR. His phenotype was normal. Two days of born, he was expired because of asphyxia. Her other three pregnancies were blighted ovum.

�The patient had hirsutism from 18 years old in chine and upper lip and was slow progression until to first pregnancy. �During the first pregnancy hirsutism was progressive and the growth rate of hirsutism was increased in pregnancy and decreased between pregnancy period. �With this hirsutism she had male pattern hair loss in pregnancy period. �But she hadnot acne, deepening of voice, headache, galactorrhea and other symptoms of virilization.

�Menstrual cycle was normal, but in 1397 the patient had oligomenorrhea and treated with progesterone and her cycle was regular. �In 1398 summer she had polymenorrhea and according to sonography with PCO diagnosis treated with LD contraception. �Despite that using contraceptive she became pregnant but again fail pregnancy and blighted ovum and was aborted in 17/9/1398.

Past history �Menarche: 10 years old �G 1: 2 years ago/term boy baby and IUGR/Death �G 2: 1 years ago/GA: 15 W/missed abortion/blighted ovum �G 3: in 6 month ago/GA: 5 W/missed abortion/blighted ovum �G 4: in 98/9/17/GA: 5 W/Aborted/blighted ovum

Past medical history and surgical history �Hypothyroidism: 6 months after the first pregnancy. �c/s in 1396

Family history �Hirsutism and recurrent abortion in her sisters �Hypothyroidism in her brother

Drug history �Levothyroxin 50/daily �ASA 80/daily �Metformin 500 mg/bd �Iodofolic/daily �Pearl vit. D 3/daily

Physical exam �GA: Young woman with normal features, she is not ill and toxic. �Bp: 110/80 PR: 75 T: 37 BMI: 33. 75 �H&N: Bitemporal alopecia(+)moon face(-)buffalo hump(-)supraclavicular fat(-)LAP(-)increased muscular mass(-) �Thyroid: normal size&consistency, no detectable nodule �Skin: acne(-), acanthosis nigricans(-)

Chest: lung & heart auscultation is normal. Abdomen: no tenderness or gaurding. no organomegaly, no purple striae Genitalia: no clitoromegaly, vaginal bleeding(+) Ext: normal face edema(-)cyanosis(-)clubbing()proximal weakness(-)

�Ferriman gallwey score: 13 �upper lip: 3 �Chin: 3 �Chest: 1 �Abd: 2 �Pelvis: 2 �Arm: 0 �Thigh: 2 �Upper back: 0 �Lower back: 0

98/8/28 unit Normal range WBC 10. 3 10 3/µL 4 -10 HBG 14. 1 gr/dl 11. 7 -16 PLT 324 10 3/µL 140 -450 glucose 105 mg/dl 74 -100 TSH 5. 66 u. IU/ml Urea 22 cr 1

98/8/28 FSH 0. 52 m. IU/ml LH 0. 75 m. IU/ml Prolactin 28. 39 ng/ml testeron 2. 25 ng/ml ferritin 59. 58 ng/ml 25(OH)Vit. D 21. 9 ng/ml Anti TPO 745. 88 IU/ml >0. 73 >5. 6

98/5/13 UNIT Normal rang Protein C 107 % 60 -140 proteins 129 % 60 -140 Anti thrombin III 80 % 80 -120 Factor 5 liden 5 % <10% Anti phospholipid ab(Ig. G) 0. 9 U/ml <10 Anti phospholipid ab(Ig. M) 0. 2 U/ml <10 TSH 0. 15 µIU/ml

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