1. Endocrinology Dr. Onyemere Prudhvi Karumanchi, PGY-3 Ellaine Alcaraz, PGY-3 May 20, 2009

2. Case introduction 30 year old white female CC: Excessive facial hair and weight gain x 2 years HPI: Excessive hair growth on face, chest and back. She has to shave her face twice a day. She had weight gain – Over 100 lbs in 9 yrs. PMH: HTN x 1 yr – on HCTZ 25 mg daily. PSH: carpal tunnel surgery Family hx: Parents have HTN. Excessive hair growth in female relatives.

3. History ROS: –Positive for mild fatigue, headaches, and acne. –Negative for changes in skin color. Gyn hx: LMP was 9 days ago. Irregular menses x 9 yrs. Periods are spaced 4-5 months. Each period lasts 2 days to one month. Menarche – 13 years. Regular periods until age 18 when she was started on OC pills for 2 years. Social hx: Home-maker. No smoking. Occasional alcohol. No exercise. Has 9 yr old who is healthy.

4. Physical Exam VS: PULSE: 70/minute. BLOOD PRESSURE: 138/96. GENERAL: Patient sitting on examination table, not in acute distress. Oriented to time, place and person. No pallor. No icterus. No cyanosis. No clubbing. No edema. No lymphadenopathy. Patient is morbidly obese. Acanthosis nigricans around her neck seen. HEENT: Head, ENT within normal limits. CHEST: Bilaterally clear. No crepitation, wheezes. CVS: S1, S2, no murmurs appreciable. SKIN: Excessive hair growth over her back and face visible, which are terminal, black in color with thickening of skin. No appreciable violaceous striae on her abdomen seen.

5. Labs

6. Lipid Panel

7. Prolactin/DHEAS

8. CMP

9. Testosterone

10. IMAGING

11. Questions