Monday, March 4, 2013

PCOS and Type 2 DM

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 Gender: Female
 How tall are you (feet and inches)?: 5'8
 What is your weight in pounds?: 181
 How old are you?: 15
 How long has this been going on?: More than a year

 Check all symptoms you are currently experiencing:
 Fever
 Abdominal Pain

 Describe associated symptoms not listed above: tiredness most of the time.

What have you done so far to remedy this condition?

I am doing this fro my 15 yr old daughter. she has been recently diagnosed with type 2 diabetes and PCOS. However, my concern is the everyday abdominal pain with headaches and tiredness. Also frequent low grade fevers ranging from 99-100. She has only had an ultra sound for the stomace and it showed that she was constipated. She is also anemic, and they took her off of her iron pills. She has had h-pylori tests done , amalyse and other tests as well.

 No surgeries.

 Check all conditions present in your immediate family... : Diabetes
 Please list any medications you are currently taking (and dosage if known) :: she takes metformin xlr. was on reg metformin but caused stomach problems on top of the stomach problems she already has.
What could possibly causing this. What can reduce the pain and sleepiness. What other tests could be done. And does she need to be referred to a specialist?

_____________________________________________________________

First of all, if all she has had is an abdominal ultrasound that showed 'constipation', then it did not acheive the results intended, which were to visualize her ovaries. The fact that they said it showed 'constipation' means that the study was sub-optimal.

Unfortunately, PCOS is not in MY particular area of expertise.My gut reaction was that PCOS is poorly understood, and about this I was correct. I did not remember that Type 2 DM was associated with this disorder.

In fact, what I have linked HERE is a very good reference for you to print out and have at hand.

From what you are telling me she is getting a slow workup for her issues. With the H pylori esting and the focus on the stomach and abdomen they are looking for a source of blood loss which could cause her anemia. It sounds as if they have not found it yet.

As you can see from the link, increased or abnormal uterine bleeding uheavy menstrual cycles) can go with this syndrome and may be the source of the anemia. But if they took her off iron pills they are thinking that this is NOT an anemia based on iron deficiency... there ARE other causes.

I do not have any magic answers to her low grade fever, tiredness, and headaches, but would say the following.

If her thyroid function has not been checked it needs to be.

If she does not have a primary care manager that is WELL versed in treating PCOS then she either needs an endocrinologist or a family practitioaer with a concentration endocrine disorders.

The headaches may or may not be related to her PCOS, and doctors always look for a 'unifying diagnosis'... a single diagnosis that explains all symtoms. That being said, the headaches may need an evaluation by a neurologist.

And finally, as hard as this will be for her, she absolutely needs to become VERY aggressive in managing her weight and in maintaining her health. The habits she forms now will either see her thgough a long and healthy life or will set her up for failure.
 
As you can see from the reference, people with PCOS often develop 'metabolic syndrome', as of now a poorly understood cluster of medical problems (including DM) that make heart disease and heart attack a big risk, not now, and not in ten years, but as your daughter gets into her late thirties and onwwards.  
 
It is not clear from your question, but it would seem that things are moving along slowly. If you are not satisfied with the progress so far, do not hesitate to get a second opiniion. A pediatric endocrinologist might be a good place to go for a second opinion.
 
I hope this helps some. Again, this problem is complicated and poorly understood at present. Your daughter is being treated reasonably, but there are unanswered questions. I hope you will drop back by in the comment section and update us on her progress. The comment section is also where you can ask questions about this answer.
 
Thank you and good luck .

 

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