Time Remaining :

Times Up!

History :
This G1P1 36 yo F complains of missing period for 3 months. Her periods have been regular but
prolonged (5-6 weeks, and it used to come in 4 weeks) for a year. She also noticed decreased
bleeding in recent cycles and last longer (7 days, used to be 5 days). She reports gaining 15 lb in a
year without appetite change, hair growth at chin and nipple discharge recently. She denied voice
change, cold/hot intolerance, visual change, headache, or dysmenorrhea.
ROS: wNL except above mentioned
Allergy:NKDA
MEdication:OCPs for 8 years
PHx:none
SHx:none
FHx:non contributory
Pregnancy: G1P1, with Vaginal delivery without complication 10 years ago
Social Hx:no smoking, no drinking, sexually active with her husband, no STD Hx.

Physical Examination :
Patient is alert and without stress.
VS: WNL
HEENT: symmetric pupils, react to light, pink conjunctiva,
NE: visual fields intact, CN: II-XII: wnl
Neck: no palpable mass, thyroid: wnl
Chest: clear bilaterally,
Heart:RRR, no murmur
Limb: no edema, no bruises
Abdomen: no tenderness

Diagnosis 1 :
Hyperprolactinemia

History Findings Physical Exam Findings

1) nipple discharge 1) Hair overgrowth at chin
2) hirtusism
3) oligomenorrhea
4) weight gain

Diagnosis 2 :
Polycystic ovary disease
 History Findings Physical Exam Findings
1) weight gain 1) Hair overgrowth at chin
2) oligomenorrhea
3) hirtusism

Diagnosis 3 :
Hypothyroidism

History Findings Physical Exam Findings

1) Oligomenorrhea
2) weight gain

Diagnostic Study/Studies - Labs

1) Pelvic exam
2) U/S-pelvis
3) Prolactin
4) FSH/LH
5) Brain-MRI
6) TSH