04-14-2017, 12:36 PM
order pregnancy prolactin and thyroid..
why!? Patient had secondary amenhorrea and irregular bleeding. She used to have menstural regular periods and now she panics and realizes she didn't have periods for 3 months ! Then this horrendous bleeding.
Doctor: "don't worry we will figure this out, i am here to help you out. !"
Patient: Yes this is worrying me.
Doctor goes and orders pregnancy test, t3 t4 tsh and prolactin. Why? tsh? Hypothyroid can cause high TRH and stimulates prolactin. doctor checks the medications such as antipsych as well because this patient has a history of panic attacks!
Doctor: Everything is normal Melissa so we will need to figure out next steps. We will do a progesterone challenge test. Doctor gives the progesterone and the patient stops bleeding. After 2-5 days of not using patient bleeds. Ok since the patient bleeds that means it's a positive progesterone test! Postive progesterone test means low progesterone or high estrogen due to endometrial hyperplasia. This is diagnosed as anovulation.
Another scenario: Patient does not bleed in the progestetrone challenge test so it is negative. This is due to low estrogen or inadequate obstruction. Doctor orders another test estrogen progesterone challenge test. Patient bleeds so that means it is low estrogen. Order FSH after. Fsh low? Hypothalamic pituitary issue. FSH high? Ovarian failure early menopause.
Another scenario. Patient does not bleed in the estrogen progesterone challenge test? Then it is an obstruction issue. Order hysterosalpinogram!
why!? Patient had secondary amenhorrea and irregular bleeding. She used to have menstural regular periods and now she panics and realizes she didn't have periods for 3 months ! Then this horrendous bleeding.
Doctor: "don't worry we will figure this out, i am here to help you out. !"
Patient: Yes this is worrying me.
Doctor goes and orders pregnancy test, t3 t4 tsh and prolactin. Why? tsh? Hypothyroid can cause high TRH and stimulates prolactin. doctor checks the medications such as antipsych as well because this patient has a history of panic attacks!
Doctor: Everything is normal Melissa so we will need to figure out next steps. We will do a progesterone challenge test. Doctor gives the progesterone and the patient stops bleeding. After 2-5 days of not using patient bleeds. Ok since the patient bleeds that means it's a positive progesterone test! Postive progesterone test means low progesterone or high estrogen due to endometrial hyperplasia. This is diagnosed as anovulation.
Another scenario: Patient does not bleed in the progestetrone challenge test so it is negative. This is due to low estrogen or inadequate obstruction. Doctor orders another test estrogen progesterone challenge test. Patient bleeds so that means it is low estrogen. Order FSH after. Fsh low? Hypothalamic pituitary issue. FSH high? Ovarian failure early menopause.
Another scenario. Patient does not bleed in the estrogen progesterone challenge test? Then it is an obstruction issue. Order hysterosalpinogram!