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
start metformin(E)
fasting glucose ( A )
C) Hemoglobin A1C – more reliable for measuring her insulin resistant status before starting metformin
D oral glucose tolerance test
c
d,,,,,,,,,,,,
Oral glucose tolerance test
Oral Glucose Tolerance Test
a
start metffomin for polycystic ovaries
D- Reference up to date
http://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics
obviuos clinical hx start metformin. She has PCOD written in her forehead
A should be done ist then OGT then metformin.
Metformin because pcos considered insulin resistance
What is the answer for question #421
D) Oral Glucose Tolerance Test – is the recommended test to screen for insulin resistance in patients with PCOS