NR508 week 1 discussion 1 - Discussion Part One(graded...

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Discussion Part One (graded) Emily, a relatively healthy 5’5”, 32-year-old young woman weighing 190 pounds, presents to your clinicwith hirsutism, anovulation, oligomenorrhea, and at times amenorrhea. Biochemical blood tests reveal elevated luteinizing hormone (LH, without a mid-cycle surge) and androgen elevation. She mentions that she also has a family history of irregular cycles, and that her grandmother experienced early menopause. She also states that she is sexually active, occasionally smokes (1 pack/month), and desires to be prescribed one medication to mitigate her symptoms, as well as, prevent her from becoming pregnant.Please provide a list of differential diagnoses, as well as an indication of your primary diagnosis. Once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.This first case study presents with a 32 year old female who is obese, smokes, and is sexually active with symptoms of hirsutism, anovulation, oligomenorrhea, and amenorrhea at times. She states her family has a history of irregular cycles and her grandmother experienced early menopause. Her desire is to be prescribed one medication to mitigate her symptoms, as well as preventing her from becoming pregnant. Polycystic Ovary Syndrome (PCOS)– PCOS is a common endocrine disorder affecting women of reproductive age. This disorder is characterized by menstrual irregularities, hyperandrogenism (hirsutism), and infertility. The prevalence of PCOS depends on ethnicity, environmental and genetic factors which include obesity, hyperinsulinemia, and insulin resistance. Patients with PCOS disorder havea high risk for developing cardiovascular disease, type 2 diabetes, and endometrial cancer. The etiology of PCOS is unknown, however most women have altered gonadotropin levels manifested by increased release of luteinizing hormone (LH) (Ali, 2015). Metabolic syndrome is also more common in women with PCOS compared with BMI-comparable control women. Further contributing factor is an associationof PCOS and obstructive sleep apnea (OSA). The risk of OSA is 5-10 times higher in PCOS than in BMI-matched control women (Barber, Dimitriadis, Andreou, & Franks (2015). Diagnostic evaluation include; TSH Prolactin to rule out thyroid dysfunction, 17-OHP to measure the follicular level, total and free testosterone, luteal phase progesterone to assess ovulation, and 24 hour urinary free cortisol to screen for Cushing’s syndrome (Goodarzi, Dumesic, Chazenbalk, & Azziz, 2011). Our patient presents with several of the clinical characteristics of PCOS and is my primary differential.Secondary Amenorrhea– Defined as cessation of menses for at least 3 months or having irregular or prolonged cycles with an absence of menses for 9 months. Causes of secondary amenorrhea include: ovarian, pituitary, or hypothalamic disorders; intrauterine adhesions; and pituitary tumor. Thyroid disorders and anovulatory cycles affect menstrual cycles.

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