1/101. Catamenial hemoptysis--a case report. Thoracic endometriosis is rare. Its associated clinical syndromes should be considered in menstruating women with pneumothorax or hemoptysis. The availability of chest CT scanning and danazol provide new technique in diagnosis and therapy. ( info) |
2/101. Menstrual irregularities associated with athletics and exercise. For women and girls, and dangers of excessively rigorous exercise regimens can include disturbances in reproductive function and a negative impact on bone density. Assisting female patients in finding a balance between the benefits and potential dangers of exercise is an important role for health professionals. ( info) |
3/101. Weight problems in adolescence. Even the normal adolescent must incorporate into his body image radical changes in size, body proportions, and sexual characteristics. obesity and anorexia, which are commonplace, may be sensitive problems to deal with. ( info) |
4/101. Visualization of diaphragmatic fenestration associated with catamenial pneumothorax. Catamenial pneumothorax is a rare entity of unknown etiology characterized by recurrent accumulation of air in the thoracic space during or preceding menstruation. We documented the presence of a diaphragmatic fenestration during thoracoscopy, lending support for hypotheses involving diaphragmatic defects as possible avenues of air collection in the thorax. ( info) |
5/101. Ovarian hyperstimulation caused by gonadotroph adenoma secreting follicle-stimulating hormone in 28-year-old woman. Ovarian hyperstimulation caused by a gonadotroph adenoma in premenopausal women has been described only twice before this report. A 28-yr-old woman presented with menstrual disturbances and pelvic pains that began after stopping the use of contraceptive pills. Transvaginal ultrasound revealed enlarged ovaries with multiple cysts. The patient had elevated serum estradiol (up to 2900 pmol/L; normal, 80-300 pmol/L in the follicular phase) and inhibin (6.4 kU/L; normal, 0.5-2.5 kU/L) levels. serum LH was appropriately suppressed (0.6 IU/L), but serum FSH varied from 4.9-8.1 IU/L. Both gonadotropins as well as the free alpha-subunit showed a paradoxical response to the stimulus by TRH. A nuclear magnetic resonance study unraveled a pituitary tumor, 12-14 mm in diameter, extending up to the suprasellar cistern. After pituitary surgery, all hormone values normalized, and the patient resumed regular ovulatory cycles. In immunostaining, 20-30% of the cells of the tumor stained positively for FSHbeta. We conclude that a gonadotropin-producing adenoma must be considered in the differential diagnosis of a patient presenting with large multicystic ovaries and high estradiol levels in the absence of exogenous gonadotropins. ( info) |
| A 46-year-old woman had features of acute pulmonary edema soon after taking hydrochlorothiazide (HCTZ) for the first time. Although 31 cases of HCTZ-induced pulmonary edema have been reported in the world literature since it was first described in 1968, little is known about this clinical entity. Because its presence may be underestimated or underreported, it must be considered in the differential diagnosis in any case of pulmonary edema in a patient taking HCTZ. It is important to review the pathophysiology and management of this rare but potentially life-threatening idiosyncratic reaction to a commonly prescribed drug. ( info) |
7/101. Three cases of macroprolactinaemia. A woman with hirsutism but otherwise symptom-free was found to have a raised serum prolactin and a pituitary microadenoma. The hyperprolactinaemia persisted despite bromocriptine therapy and subsequent pituitary surgery, which yielded a non-functioning adenoma. After a further 15 years with persistent hyperprolactinaemia but no symptoms, macroprolactinaemia was diagnosed. Such cases might account for part of the failure rate of pituitary microsurgery for prolactinoma. Testing for macroprolactinaemia is advisable in a woman with hyperprolactinaemia, especially if her ovulatory cycle is normal. Two other cases are reported in which macroprolactinaemia was associated with menstrual disturbances and other hormonal effects: in these, treatment with dopamine agonists suppressed the hyperprolactinaemia and restored normal menstrual cycles. ( info) |
8/101. Hormonal side effects in women: typical versus atypical antipsychotic treatment. Neuroleptic-induced hyperprolactinemia can cause menstrual disorders, impaired fertility, galactorrhea, and sexual dysfunction, as well as hypoestrogenism secondary to disruption of the hypothalamic-pituitary-ovarian axis. The development of the prolactin-sparing atypical antipsychotic drugs offers prevention and resolution of these adverse reactions. Thus far, this property of the new medications has received insufficient clinical attention. The authors use case vignettes to discuss assessment and management of clinical situations that arise as a result of antipsychotic-induced endocrine changes. ( info) |
9/101. Valproate, hyperandrogenism, and polycystic ovaries: a report of 3 cases. BACKGROUND: Reproductive endocrine disorders characterized by menstrual disorders, polycystic ovaries, and hyperandrogenism seem to be common among women treated with sodium valproate for epilepsy. OBJECTIVE: To describe the development of valproate-related reproductive endocrine disorders in women with epilepsy. DESIGN: Case report. patients: Three patients developed a reproductive endocrine disorder during treatment with valproate. It was characterized by hyperandrogenism and polycystic ovaries in all cases, and it was associated with weight gain and menstrual disorders in 2 of the 3 women. RESULTS: Replacing valproate with lamotrigine resulted in a decrease in serum testosterone concentrations in all 3 women. The polycystic changes disappeared from the ovaries in 2 of the women after valproate therapy was discontinued, and the 2 women who had gained weight and developed amenorrhea while being treated with valproate lost weight and resumed menstruating after the change in medication. CONCLUSIONS: The 3 cases presented here illustrate the development of reproductive endocrine disorders after the initiation of valproate therapy in women with epilepsy. The disorders were characterized by hyperandrogenism and polycystic ovaries in all cases, and were associated with weight gain and menstrual disorders in 2 of the 3 women. An evaluation of ovarian structure and function should be considered in women of reproductive age being treated with valproate for epilepsy, especially if they develop menstrual cycle disturbances during treatment. ( info) |
10/101. Intermenstrual bleeding secondary to cesarean scar diverticuli: report of three cases. BACKGROUND: The differential diagnosis of intermenstrual bleeding includes structural lesions of the endometrium and cervix. CASES: Discrete diverticuli were noted in the endocervical canals of three women presenting with histories of multiple cesareans and chief complaints of intermenstrual bleeding. On ultrasound, diverticuli were diagnosed as cavities filled with heterogeneous material consistent with blood. In one case, the diverticulum was also visualized on hysterosalpingogram. hysterectomy specimens in two cases showed diverticuli lined with fibrous tissue in previous uterine scars; in one case, this also contained endometrium. CONCLUSION: Uterine scar diverticuli may cause intermenstrual bleeding in women with previous cesareans. When performing ultrasound in this clinical setting, physicians should look for these defects. ( info) |