Polycystic Ovarian Syndrome (PCOS) and Type 2 Diabetes in a 23-Year-Old Woman, Study Guides, Projects, Research of Nursing

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Case Study #4 PCOS Tiffany Lucas University of South Alabama Graduate College of Nursing AHN-595- Dr. Sturm 10/22/

CC “establish care” Case ID #: 1931-20241010- History of Present Illness A 23-year-old-woman with a medical history of type 2 diabetes and PCOS (polycystic ovarian syndrome) who presents today to establish new PCP. She started metformin in 2012, however has been off of this for the past year due to not having insurance. Over the past month she has been experiencing generalized abdominal pain and nausea-both symptoms are intermittent. Abdominal pain can last anywhere from 5-30 minutes and is sharp to a dull ache at times. She has tried Tylenol which has minor relief, and her menstrual cycle increases the intensity of the pain. She has not found anything that makes the nausea worse and has not tried anything to make it better and it normally lasts for a few minutes throughout the day and goes away on its own. She denies any heartburn, reflux, diarrhea, or constipation. Review of Systems A directed ROS is positive for abdominal pain and nausea. Her ROS is negative for headaches, visual disturbances, nasal congestion, sore throat, palpitations, chest pain, vomiting, focal weakness or numbness, confusion, fatigue, fevers, chills, flank pain, back pain, dysuria, and urinary frequency, weight gain or loss, polyphagia or polydipsia, anxiety, or depression. Relevant History The patient’s history is significant for Type 2 diabetes without complications diagnosed at age 11 and PCOS (polycystic ovarian syndrome) diagnosed at age 18; her social history is negative for drug, tobacco, or alcohol use. She reports a family history of cancer, diabetes mellitus, and hypertension. The patient lives at home alone, and she describes her family life as happy and healthy. She does not have children. Allergies: No known allergies; no known food allergies

Labs: CBC - assesses infection, anemia, cancer, and blood counts, establishing care. CMP - establish care, evaluate liver, kidney, electrolyte, and blood glucose levels. Lipid panel - assesses triglyceride and cholesterol levels, establish care. Thyroid panel - assesses thyroid function, establish care. Microalbumin -assess kidney disease, establish care and Type 2 DM. HbA1c - assesss blood glucose over 3-month period, Type 2 DM. Blood Glucose - evaluate blood sugar, Type 2 DM. Hormonal essay (LH), (FSH), testosterone, and insulin - confirm diagnosis of PCOS (Teede, et al., 2023). Differential Diagnosis: Hypothyroidism, Late-onset congenital adrenal hyperplasia, Idiopathic/familial hirsutism, Ovarian malignancies, Obesity, Cushing’s syndrome (Rasquin, Anastasopoulou, & Mayrin, 2022) Probable Diagnosis: The most likely diagnosis is PCOS. The patient has a history of PCOS, and the symptoms are very similar to those she experienced before starting metformin. The patient is experiencing abdominal pain, nauseas and excessive hair growth or male hair growth patterns and are characteristics of PCOS. The Rotterdam criteria is an excellent tool to employ when assessing a patient with PCOS. To meet the diagnostic criteria, at least two of the following three conditions must be met: polycystic ovaries on ultrasound, clinical and/or biochemical indications of hyperandrogenism, and oligo-ovulation or anovulation. The patient has a history of polycystic ovaries on ultrasound and excessive hair growth, making PCOS the likely diagnosis (Wattar, et al., 2021). Outcome: The provider restarted the patient on metformin 500 mg BID for Type 2 DM and assist in managing PCOS symptoms. The patient was referred to two specialist for further management of Type 2 DM and PCOS.

Outcomes/Patient Education When PCOS patients receive appropriate care, their outcomes are typically good. Patients can increase their fertility, control their weight, lower their risk of diabetes and cardiovascular disease, and improve their general quality of life by treating underlying metabolic and hormonal imbalances, managing symptoms, and continually monitoring for any problems. Research has shown that even a modest weight loss of 5-10% can help improve symptoms of PCOS, such as irregular periods and insulin resistance (Wattar, et al., 2021). Providing those with PCOS the knowledge and tools they need to take charge of their health is essential. Giving patients information about the illness, available treatments, lifestyle changes, and possible side effects can assist them in making decisions and following their treatment plan. For those with PCOS, counseling on fertility preservation, contraception, and pregnancy planning is especially crucial (Teede, et al., 2023). Guidelines: Two notable guidelines for the management of PCOS are the American College of Obstetricians and Gynecologists (ACOG) guidelines and the 2023 International Evidence-based Guidelines. These guidelines support the use of both laboratory tests and clinical assessments, emphasizing an integrated approach to diagnosis and management. As first-line therapy for PCOS management, the ACOG guidelines suggest a combination of lifestyle modifications such weight loss, frequent exercise, and a nutritious diet (Wattar, et al., 2021). Implementing both guidelines into practice will assist in ruling in or the diagnosis of PCOS.

References

Hello RaeVonn, I enjoyed reading your post and wanted to become more familiar with the effects of tamoxifen on patients with a history of DVTs. For patients on tamoxifen therapy, DVT is a serious concern, especially for those with pre-existing risk factors. Studies show that tamoxifen, a selective estrogen receptor modulator that is frequently administered to treat cancer, is linked to a higher risk of venous thromboembolic events (VTEs) (Nicola, Crowley, & See, 2021). Consequently, it is critical that medical professionals advise these patients about any possible risks associated with tamoxifen. Additionally, one of the most important factors in determining patient safety is the time interval between the onset of VTE and the start of tamoxifen. For patients with a higher risk of VTE, the first three months of treatment are especially important. References Nicola, A., Crowley, M., & See, M. (2021). A novel algorithm to reduce VTE in peri-operative patients on tamoxifen. The Breast, 58 (1), 88-92. doi:https://doi.org/10.1016/j.breast.2021.04.