Secondary Amenorrhea and Infertility in a 33-Year-Old Woman with PCOS 2.Natasha A 16-year-old male presents with delayed pubertal signs and social immaturity. His lab values show low testosterone. He was administered GnRH, and no LH was produced. HCG was administered, which restored testosterone to normal levels.

Secondary Amenorrhea and Infertility in a 33-Year-Old Woman with PCOS

Hello Jude

Great post!! Your post was very educative and insightful; you have clearly explained the rationale for PCOS diagnosis for 33-year-old, obese female patients. The rationale is based on the fact that infertility and amenorrhea are significant symptoms of PCOS among women of childbearing age, just like in our patient’s case. The symptoms of PCOS include infertility, insulin resistance, hyperandrogenism, obesity, anovulation, hirsutism, and excessive androgens. Since the patient exhibits some major symptoms, this led to the diagnosis (Escobar-Morreale, 2018).

Metformin and Progesterone (Prometrium) hormonal treatments constitute the recommended treatment and management procedures for PCOS. I want to add that the recommendation is to take one and not a combination of these drugs, particularly for diabetic patients. This is because progesterone can interfere with blood glucose levels, rendering diabetic medication useless, as well as metformin. Other drug-substances interactions in the body that may cause the hormone treatment to be ineffective or lead to complications include alcohol and metformin, vitamins, herbs, and grapefruit juice with Prometrium.

References

Escobar-Morreale, H. F. (2018). Polycystic ovary syndrome: definition, etiology, diagnosis, and treatment. Nature Reviews Endocrinology, 14(5), 270-284.

Hello Natasha

Thank you for your post. Your discussion was excellent and insightful; the diagnosis reveals hypogonadism for the 16-year-old male presenting the symptoms of delayed pubertal signs and social immaturity. The rationale is based on the lack of production of LH even after the administration of exogenous hormones and the low levels of testosterone. Impaired response of the gonads LH stimuli makes the pituitary gland fail in signaling the testicles to produce testosterone, which would explain why the patient test results show low levels of testosterone. The use of HCG in this seems to be the need to help the patient produce sufficient endogenous testosterone.

Independent administration of Exogenous testosterone is not encouraged because even though it enhances sexual development, it can impair spermatogenesis. Subsequently, it can create negative feedback systems within the pituitary and hypothalamus (Jayasena et al., 2021). HCG therapy is therefore encouraged to enhance the outcomes. There is a problem with the hypothalamus because LH hormones are lacking, and they are produced through the secretion of gonadotropic hormones found in the hypothalamus.

References

Jayasena, C. N., Anderson, R. A., Llahana, S., Barth, J. H., MacKenzie, F., Wilkes, S., … & Quinton, R. (2021). Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism. Clinical endocrinology.