Question of the Week # 421

421) A 34-year-old woman with history of oligomenorrhea presents to your clinic to discuss her results of recent work-up. One week ago, she has undergone extensive work-up for her menstrual abnormality. A serum pregnancy test is negative. Thyroid stimulating hormone, serum prolactin  level and Follicle Stimulating Hormone levels are within normal limits. Serum total testosterone is 120ng/dl ( N = 30 to 90ng/dl) and serum free testosterone is 0.9 ng/dl ( N= 0.4 to 0.8 ng/dl) . A dehydro-epiandrosterone level is 400 mcg/dl (45- 270 ug/dL) . A pelvic ultrasound reveals multiple cysts in the ovaries bilaterally. On examination, she is obese with a BMI of 32. She has excess thick and pigmented hair above her upper lip and on the chin. Which of the following is indicated in this patient at this time?

A) Fasting Plasma Glucose

B) Random Blood Glucose

C) Hemoglobin A1C

D) Oral Glucose Tolerance Test

E) Start Metformin

18 Responses

  1. start metformin(E)

  2. fasting glucose ( A )

  3. C) Hemoglobin A1C – more reliable for measuring her insulin resistant status before starting metformin

    • D) Oral Glucose Tolerance Test – is the recommended test to screen for insulin resistance in patients with PCOS

  4. D oral glucose tolerance test

  5. c

  6. d,,,,,,,,,,,,

  7. Oral glucose tolerance test

  8. Oral Glucose Tolerance Test

  9. a

  10. start metffomin for polycystic ovaries

  11. obviuos clinical hx start metformin. She has PCOD written in her forehead

  12. A should be done ist then OGT then metformin.

  13. The Correct answer is E

    A,B,C,D are all correct and approved methods of diagnosing Diabetes Mellitus. OGTT is done in pregnancy and again the 3 hour OGTT is confirmatory. This patient has high androgens, PCOS cystic ovaries, oligomenorrhea and high BMI. Irrespective of what the blood sugar or HbA1C results show, she needs to be treated with Metformin. No other hypoglycemic drug or regimen helps in PCOS. Moreover, metformin reduces cardiovascular risk.

  14. ~E.
    start metformin.

  15. how can you start treatment with metformin without a confirmed diagnosis, in PCOS increased insulin resistance should be tested with biochemical test first surely, with fasting glucose, adverse effects of starting metformin as well. Dr archer the answer??

  16. yea how can you start on treatment .without even her blood glucose level? i would do fasting…then with random or ogt maybe then only start treatment!

  17. e

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