![Results 1
Metformin compared to insulin lowered the risk of neonatal
hypoglycaemia [risk ratio (RR) = 0.63; 95% confidence
interval (95% CI), 0.45 to 0.87]
large for gestational age babies (RR = 0.80; 95% CI, 0.64 to
0.99)
pregnancy-induced hypertension (RR = 0.56; 95% CI, 0.37
to 0.85)
total maternal pregnancy weight gain [mean difference (MD)
-2.07; 95% CI -2.88 to -1.27].](https://image.slidesharecdn.com/tipsandtricksinendocrinedisordersinwomen-181210031204/75/Interesting-Endocrine-cases-in-Women-67-2048.jpg)
Uploaded byDr. Om J Lakhani
Interesting Endocrine cases in Women
The document discusses various endocrine cases in women, detailing diagnosis and treatment approaches for conditions such as hyperprolactinemia, hypothyroidism, gestational thyrotoxicosis, and gestational diabetes. Key lessons emphasize the importance of medication review in hyperprolactinemia, the need for comprehensive thyroid function testing, and the utility of metformin in managing gestational diabetes. Additionally, it highlights recent guidelines regarding the management of subclinical hypothyroidism in pregnancy.
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Introduction to a presentation by Dr. Om J Lakhani discussing endocrine cases affecting women.
A married woman with oligomenorrhea and nipple discharge; elevated prolactin levels lead to discussion of potential diagnosis and therapy including impact of medications.
Focus on medications causing hyperprolactinemia, including common drugs and their effects, emphasizing the need for review after drug cessation.
A 61-year-old woman with fatigue; evaluation of thyroid function leads to discussions on hypothyroidism types, including subclinical and overt primary hypothyroidism.
Symptoms of Sheehan’s syndrome and diagnosis; emphasizes key warning signs and MRI characteristics.
A pregnant woman with hyperemesis; thyroid tests indicate gestational thyrotoxicosis; differentiating it from Graves’ disease and treatment approach.
30-year-old woman with GDM; focuses on diagnosis using OGTT, treatment with metformin, and monitoring recommendations.
Routine thyroid function in a pregnant woman; discusses management options and new recommendations against Levothyroxine for certain subclinical cases.
Invitation to join a WhatsApp group for further discussion and thanks to the audience for their attention.
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Interesting Endocrine cases in Women
- 1. Interesting Endocrine cases inwomen DR. OM J LAKHANI CONSULTANT ENDOCRINOLOGIST ZYDUS HOSPITAL, AHMEDABAD & ANAND
- 2.
- 3. A 29 yearold married woman comes with history of Oligo-amenorrhea and whitish discharge from the nipple
- 4. She has pasthistory of Dyspepsia for which she is taking multiple medications
- 5. Prolactin value is60 ng/dl Repeat value is also 70 ng/dl
- 6. What would youdo next ? A) Start Cabergoline B) Ask for an MRI Pituitary C) Both A and B D) Neither A nor B
- 7. What would youdo next ? A) Start Cabergoline B) Ask for an MRI Pituitary C) Both A and C D) Neither A nor C
- 8. A MRI wasordered by her physician which was Normal
- 9. We reviewed herdrug history and we found she was taking
- 10. We stopped themedication, reviewed the patient again after 2 months and found that Prolactin to be 18 ng/dl and nipple discharge had stopped
- 11. Case 1 -Lessons to learn
- 12. PROLACTIN VALUE AND DIAGNOSIS Valueof Prolactin often gives hint of the diagnosis Value of 30-40 ng/dl - typically can be seen in PCOS Again, 30-40 ng/dl- may be typically associated with Drugs like Metoclopromide or Domperidone Values of 70-80 ng/dl- May be drug induced due to Levosulpiride Values of >100 ng/dl- Thing of Pituitary tumors and ask for an MRI
- 13. Antagonists against theDopamigeric D2 receptors often produce hyperprolactinemia
- 14. Domperidone, Metoclopromide and Levosulpirideare common culprits
- 15. Anti-Psychotic drugs like Risperiodonecan cause SEVERE hyperprolactinemia- often values in 100s
- 16. If Drug inducedhyperprolactinemia is suspected- it is not a bad idea to review the patient again after stopping the offending drug.
- 17.
- 18. This is acase of a 61 year old female. She was complaining of weakness and fatigue for a long time. Someone ordered a TSH, which was 6.3 ng/dl
- 19. What would youdo next ? a) Get a complete thyroid function- T3, T4 and TSH b) Ask for Anti-TPO antibody c) Both A and B d) Neither A nor B
- 20. What would youdo next ? a) Get a complete thyroid function- T3, T4 and TSH b) Ask for Anti-TPO antibody c) Both A and B d) Neither A nor B
- 21. We ordered athyroid function which shows T3 and T4- Reduced TSH- 6.3 Anti-TPO- negative
- 22. What does thissuggest ? a) Subclinical hypothyroidism b) Overt Primary hypothyroidism c) Possible central hypothyroidism d) Normal thyroid function
- 23. What does thissuggest ? a) Subclinical hypothyroidism b) Overt Primary hypothyroidism c) Possible central hypothyroidism d) Normal thyroid function
- 24. T3 and T4-Normal TSH - elevated Subclinical Hypothyroidism
- 25. T3 and T4-Low TSH - Elevated- value >20 mIU/ml Overt Primary hypothyroidism
- 26. T3 and T4-Low TSH - Elevated- value <20 mIU/ml (some use 10 as cut-off) Think of Central hypothyroidism
- 27. T3 and T4-Low TSH - Normal Think of Central hypothyroidism
- 28. T3 and T4-Low TSH - low Think of Central hypothyroidism
- 29. We ordered testfor anterior pituitary function S. Cortisol- low FSH and LH - low Prolactin - also low
- 30. Q. What happensto FSH and LH in a post-menopausal woman ?
- 31. On taking adetailed history, the patient revealed she had a history of post-partum hemorrhage 23 years back in her last delivery. Following this she had amenorrhea and lactational failure.
- 32. We ordered anMRI which showed the following :
- 34. Q. What isthe Diagnosis ?
- 35. Q. What isthe Diagnosis ? Sheehan’s syndrome
- 36. Lessons from case2- When to suspect Sheehan’s ?
- 37. Low T4, LowT3 with Normal, High or Low TSH
- 38. History of severePost-Postpartum haemorrhage
- 39. History of Lactationalfailure after delivery
- 40. History of Secondaryamenorrhea persistent after delivery
- 41. Unexplained Hyponatremia andHypoglycemia
- 42.
- 43. Empty sella onan MRI
- 44.
- 45. This is acase of a 28 year old Primigravida 10 weeks of pregnancy
- 46.
- 47. A thyroid functiontest is ordered which shows elevated T3 and T4 with low TSH
- 48. What would youdo next ? a) Start Carbimazole b) Start PTU c) Evaluate further
- 49. What would youdo next ? a) Start Carbimazole b) Start PTU c) Evaluate further
- 50. A TSH Receptorantibody was ordered - which was negative
- 51. Our Diagnosis -Gestational thyrotoxicosis
- 52. Patient was closelyfollowed-up during pregnancy- thyroid function remained normal subsequently
- 53. Q. Which hormoneis responsible for Gestational thyrotoxicosis ?
- 54. Q. Which hormoneis responsible for Gestational thyrotoxicosis ? Answer- HCG
- 55. Gestational thyrotoxicosis canbe differentiated from Graves’ disease by a) TSH Receptor antibody b) Thyroid ultrasound and Doppler
- 56. Gestational thyrotoxicosis canbe differentiated from Graves’ disease by a) TSH Receptor antibody b) Thyroid ultrasound and Doppler
- 57. Gestational thyrotoxicosis doesnot require any treatment While Graves’ disease needs to be treated
- 58.
- 59. A 30 yearold primigravida is referred to me with following results on OGTT Fasting- 81 (>92) 1 hr – 207 (>180) 2 hr- 186 (>153)
- 60. She has astrong family history of Diabetes mellitus Diagnosed to have GDM in last pregnancy
- 61. She had previouslyundergone only Fasting plasma glucose twice both of which were normal.
- 62. Gestational diabetes isoften missed out when diagnosed using fasting plasma glucose- OGTT is the diagnostic test for GDM
- 63. We started heron Metformin + 1800 Kcal meal plan- followed her up with CGMS
- 65. Target values ofGestational diabetes in pregnancy Fasting <95 mg/dl 1 hr post meal <140 mg/dl 2 hr post meal <120 mg/dl
- 67. Results 1 Metformin comparedto insulin lowered the risk of neonatal hypoglycaemia [risk ratio (RR) = 0.63; 95% confidence interval (95% CI), 0.45 to 0.87] large for gestational age babies (RR = 0.80; 95% CI, 0.64 to 0.99) pregnancy-induced hypertension (RR = 0.56; 95% CI, 0.37 to 0.85) total maternal pregnancy weight gain [mean difference (MD) -2.07; 95% CI -2.88 to -1.27].
- 68. Results 2 Metformin comparedto insulin did not increase preterm delivery (RR = 1.18; 95% CI 0.67 to 2.07) small for gestational age babies (RR = 1.20; 95% CI, 0.67 to 2.14) perinatal mortality (RR = 0.82; 95% CI, 0.17 to 3.92) Caesarean section (RR = 0.97; 95% CI, 0.80 to 1.19).
- 69.
- 70. Screen all Indianwomen for GDM- using OGTT
- 71. CGMS is usefulfor monitoring such women
- 72. Metformin is usefuland safe in GDM
- 73.
- 74. A 28 yearold Primigravida Routine thyroid function test was done in First trimester
- 75. Total T3- Normal TotalT4- Normal TSH - 3.8 mIU/ml
- 76. Anti-TPO antibody -negative
- 77. Anti-TPO antibody -negative
- 78. What would youdo next ? a) Start Levothyroxine b) Wait and watch - repeat thyroid function after an interval.
- 79. What would youdo next ? a) Start Levothyroxine b) Wait and watch - repeat thyroid function after an interval.
- 81.
- 82. Newer ATA recommendationfor Hypothyroidism in Pregnancy do not recommend the use of LT4 in when with Subclinical hypothyroidism having TSH 2.5-4.0 with anti-anti-TPO negative.
- 84. Join our WhatsAppGroup Endocrine Disorders in Women +91 9871009021 for being added to the group
- 85.