Case report

1. Case report

2. Case1 A 32 y woman, BMI 31kg/m2 with hirsutism, hair loss and menstrual cycles with 40-45 days interval and no evidence of Cushing syndrome and no rapid progress of hirsutism referred to your clinic. What are the tests that should be ordered? 1- Total testosterone 3-170HP 2-DHEAS 4-TSH-PRL 5-AMH 6-Ovarian sonography

3. Case 2 A 14y.o girl with chief complaints of excessive hair growth and irregular menses. Menarche occurred 1.5 years ago, and she has 4 cycle/year. She is in Tanner breast stage 5, obese(BMI percentile:97%), has facial hirsutism. What are your requested tests: 1- DHEAS 3-Ovary sonography 2-LH/FSH 4-AMH 5-Total Testosterone 6-none, start traetment

4. Case 3 A 23-year-old woman with known PCOS visits her family physician. She has taken oral contraceptive pills in the past but did not tolerate them and is not currently receiving any treatment. She has oligomenorrhea and is not interested in becoming pregnant now, but she will be getting married in a year. She has heard that the polycystic ovary syndrome is associated with diabetes and is concerned because both her mother and father have type 2 diabetes • What do you requested: 1- FBS 2-OGTT75 gr 3-HbA1C 4-FBS-Insulin 5- lipid profile

5. Case 4 A 22 y.o women with oligomenorrhea since menarche and hirsutism has been refereed. She has elevated testosterone and the other hormonal assessment is unremarkable. Her mother was diagnosed with type 2 diabetes at 56 years of age, her BMI=34kg/m2, had acanthosis nigricans. She had no medication. What is your next step? 1- measuring fasting Insulin 2-FBS 3-Lipid profile and OGTT 75 gr 4- begin pharmacologic treatment without further testing 5- none of above

6. Case 5 • A 32 y.o woman with a BMI 30.5 kg/m2, with irregular mense and hirsutism interested in using OCP. She had gestational diabetes and pre-eclampsia. Her OGTT demonstrated IGT. She has normal BP and lipid profile. What do you recommend? • No OCP due to her risk of diabetes • No OCP due to her BMI • Can use OCP but need frequent monitoring of lipid profiles • She is candidate for OCPs and should be advised regarding lifestyle change to reduce her diabetes risk • No OCP due to pre-eclampsia

7. Case 6 A 25 y.o women with BMI 36 kg/m2 seeks treatment for chronic excessive hair growth and oligomenorrhea. Clinical features do not suggest symptoms of estrogen deficiency, Cushing. BP=120/70, T: upper limit of normal, normal TSH, normal 17-OH-P. normal OGTT and lipid profile. • What is the most appropriate first line treatment for her symptoms? • Metformin • Dian • Yasmin • Diet and exercise aiming for 5-10% weight loss • Pioglitazone • Atrovastatin

8. خانمی 45 ساله مبتلا به سندروم تخمدان پلی کیستیک که سالهاست تحت درمان هیرسوتیسم می باشد از شما در مورد انجام هیسترکتومی و اوفورکتومی دو طرفه برای کنترل بهتر بیماری خود سوال می کند. شما به او توضیح می دهید. 1- این عمل نقشی در درمان بیماری او ندارد. 2- انجام این عمل به کنترل بیماری او کمک می کند. 3- انجام این عمل پس از یائسگی توصیه می شود. 4- این عمل سبب تشدید بیماری او می شود.

9. خانمی 43 ساله G2P2 مبتلا به سندروم تخمدان پلی کیستیک به مدت 14 سال است از قرص های ضد بارداری استفاده می کند. او اظهار می کند که خواهرش در سال جاری به واسطه ی ابتلا به کانسر پستان تحت عمل جراحی قرار گرفته است. در مورد ادامه استفاده از قرص های ضد بارداری به او چه توصیه ای می کنید؟ الف: ادامه قرص تا زمان یائسگی بلامانع است. ب: ادامه قرص منع مصرف دارد. ج: ادامه قرص در صورت اثبات موتاسیون منع مصرف دارد.

10. Case 7 A 33 years old patient with history of primary infertility for 3 years was referred to our program for infertility treatment .She was diagnosed as PCOS according to Rotterdam criteria with history of acne, hirsutism and oligomenorrhea. The clinical profile showed that she had BMI 28, LH=4, FSH=1.5, LH/FSH=2. The patient had history of both clomiphen failure and metformin administration for more than 6 months. She also underwent laparoscopy and ovarian cauterization approximately 1 year before. Infertility work up for the husband showed normal spermatogram 1-IVF 2 -Life style modification + gluccocorticoid 3-life style modification + IUI with gonadotropin 4- down regulation before induction ovulation

11. Case 8 A 30-year-old woman with PCOS and primary infertility requests a consultation after failing to ovulate with clomiphene. She has a long history of oligomenorrhea, hirsutism, elevated serum free testosterone, and a serum dehydroepiandrosterone (DHEAS) of 2.3 μg/mL (normal range: 0.7 to 3.4 μg/mL). Her BMI is 27.8 The patient’s hysterosalpingogram is normal, as is her partner’s semen analysis. Her physician prescribed clomiphene 50 mg daily for cycle days 5 to 9, but the patient did not ovulate. She then was given clomiphene 100 mg daily for cycle days 5 to 9, but still did not ovulate 1- letrozol5mg from D2 till D6 2-Life style modification 3-Metformin (monotherapy) 4-clomiphen + metformin

12. Case 9 38 y/o lady with history of 12 years primary infertility ,with BMI = 25 and AMH =2.5 she was under treatment till 2 years ago and then stopped it In previous history she has received induction ovulation with clomiphene and letrozole for 3 cycles and with HMG for 2 cyles SFA and HSG are normal 1.metformin 2.LOD 3.IUI 4.IVF

13. Case 10 25 y/o lady with primary infertility 2 years .she had 3 cycles mensturation with clomiphen without pregnancy and with 25 days interval for her mensturation Sperm analysis normal HSG salpingitis AMH 4.5 1.Change to letrozole 2. clomiphen + HCG 3.metformin 4.none