Thread by @IndiaESI

PCOS - finding the root cause is everything. A thread

A 28 year old woman with BMI 22 kg/m2 was referred in view of irregular cycles. The patient had attained menarche at the age of 14 years. She had regular cycles initially. Since the past 6 years, her cycles were irregular.

She had cycles once in 3-4 months. She had also noticed thick terminal hair on her face and upper chest. Her physician had suspected PCOS ( polycystic ovarian syndrome). Ultrasound abdomen confirmed the diagnosis of PCOS. She was then started on oral contraceptive pills

Her cycles regularised while on the oral contraceptive pills. But there was no improvement in the hair growth on her face. She then stopped the pills by herself. She did not menstruate for 6 months after she stopped the pills. She then consulted a gynaecologist

Her gynaecologist did a thyroid function test which was normal. Irregularities in thyroid function can also cause PCOS. Since thyroid function test was normal, she was advised to continue the oral contraceptive pill for another 6 months. She continued the oral contraceptive pills

She consulted dermatology and underwent multiple laser sessions for hair removal. Unfortunately it was not very effective. She still had thigh terminal hair growth over her face and upper chest.

In the meantime she got married. She stopped oral contraceptive pills right after her marriage. She didn’t menstruate again. She was also anxious to conceive. 2 years after her marriage, she still had irregular cycles n was unable to conceive. She consulted another gynaecologist

This time, as a part of her infertility work up, prolactin was done which was high - 120 ng/ml. She was referred to endocrinology. High prolactin levels can be a common feature of PCOS because of the hyperestrogenemia but..

Prolactin secreting pituitary adenomas can also cause secondary PCOS. This was suspected and a MRI pituitary protocol was done. MRI showed the presence of a pituitary microadenoma. She was diagnosed with secondary PCOS, ie PCOS secondary to the high prolactin levels

She was started on tab cabergoline for the high prolactin levels. 3 months later, her prolactin normalised. Her cycles regularised and she even noticed improvement in the hair growth over the face.
4 months later, she conceived.

Finding the cause of PCOS is important for effective treatment.

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