Cases reported "Oligomenorrhea"

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1/30. Bilateral ovarian stromal hyperplasia concealing a nonhilar, pure stromal-Leydig cell tumor. A case report.

    BACKGROUND: Of ovarian stromal tumors containing leydig cells, nonhilar, pure stromal-leydig cell tumor is rare. CASE: An obese, diabetic, borderline hypertensive 41-year-old woman with a five-year history of oligomenorrhea and amenorrhea presented with complaints of masculinization. physical examination revealed hirsutism and an enlarged clitoris. The only abnormal serum marker was elevated testosterone. At laparotomy both ovaries were enlarged and suspected to have bilateral stromal hyperthecosis. histology revealed stromal hyperplasia along with a 1.5-cm, testosterone-producing pure stromal-leydig cell tumor of the right ovary. CONCLUSION: Bilateral ovarian enlargement secondary to stromal hyperplasia in patients with masculinizing signs can conceal a small, unilateral pure stromal-leydig cell tumor. ( info)

2/30. Clinical presentation of PCOS following development of an insulinoma: case report.

    A 24 year old woman presented with a prolonged clinical history of fasting and exertional hypoglycaemia, and was subsequently diagnosed with an insulinoma. Concurrent symptoms of oligomenorrhoea and hyperandrogenism of similar duration were noted. Biochemically, hyperinsulinaemia was observed in association with a raised serum luteinizing hormone (LH), raised testosterone and androstendione concentrations. Surgical removal of the insulinoma resulted in resolution of the clinical and biochemical features of the polycystic ovarian syndrome (PCOS) but minimal change was observed in the ovarian ultrasound appearances. This case demonstrates the role of insulin in mediating the hypersecretion of both LH and androgens in women with polycystic ovaries. We suggest that hyperinsulinaemia converted occult 'polycystic ovaries' to become clinically manifest as 'polycystic ovary syndrome'. This paradigm has clear implications for women with insulin dependent diabetes mellitus who presumably have systemic hyperinsulinaemia. ( info)

3/30. The spectrum and significance of primary hypophysitis.

    Hypophysitis can present clinically as a mass lesion of the sella turcica. Secondary hypophysitis occurs in cases where a definite etiologic agent or process inciting the inflammatory reaction can be identified. In contrast, primary hypophysitis refers to inflammation confined to the pituitary gland with no identifiable etiologic associations. We report three cases of primary hypophysitis to illustrate the spectrum of three clinicopathological entities that encompass this disease: lymphocytic hypophysitis, granulomatous hypophysitis, and xanthomatous hypophysitis. Our three patients underwent surgery, with variable response. However, conservative, supportive treatment with or without surgical decompression is generally favored over aggressive and extensive surgical resection that results in hypopituitarism. We conclude that the optimal management of patients with hyophysitis requires a high index of suspicion before extensive surgical resection. Histological confirmation of the diagnosis of hypophysitis can be obtained by performing a biopsy or by requesting an intraoperative frozen section consultation. ( info)

4/30. Familial prader-willi syndrome.

    Five cases of prader-willi syndrome were found in an inbred south louisiana family. pedigree data strongly support autosomal recessive inheritance of the syndrome in this family. ( info)

5/30. A rare case of lumbosacral meningioma: nondural attachment and possible enlargement by orally administered sex steroid.

    STUDY DESIGN: A case report is presented. OBJECTIVES: To present a very rare case of orally ingested sex hormone pills inducing nondurally attached meningioma in the lumbosacral region. SUMMARY OF BACKGROUND DATA: Meningiomas are known to enlarge in response to female sex hormones. At this writing, few cases of nondurally based intradural meningioma have been reported. Moreover, meningiomas in the lumbosacral region are very rare. Spinal meningiomas predominantly arise in the fourth to sixth decades of life and are more common in women. methods: The patient was a 20-year-old woman. She had undergone oral sex steroid therapy for long-term oligomenorrhea. The patient complained of intolerable lumbago and numbness in her buttocks. Nonopioid analgesics did not relieve her pain, and she was unable to walk without the aid of a walker. radiography disclosed a lumbosacral intradural tumor. RESULTS: Complete removal of the tumor was performed. The tumor was not adherent to the dura, and its appearance was that of a typical neurilemmoma. However, the pathologic diagnosis was meningioma. CONCLUSIONS: The tumor in the reported case may have enlarged in response to orally ingested sex steroid pills. Nondural attachment intradural meningiomas are quite uncommon. The gross appearance of the tumor during surgery was typical of neurilemmoma. All the cases reported so far, including the current case, have involved tumor located in the lumbosacral region. Care must be taken in the management of lumbosacral intradural tumors because tumors resembling neurilemmoma may in fact represent meningioma, some subtypes of which possess a high rate of recurrence. ( info)

6/30. Sclerosing stromal tumor of the ovary: a case report.

    Sclerozing stromal tumor of the ovary is an extremely rare neoplasm occurring predominantly in the second and third decades of life. Most patients have menstrual irregularities and pelvic pain. infertility and endometrial pathology have also been described. A 34-year-old woman presented with hirsutism and oligomenorrhea of three months duration. Ultrasound examination showed a heterogeneous right ovarian tumor consisting of predominantly solid tissue with several loculated cysts. On T2-weighted pelvic MR images, signal intensities of the cystic components were high and those of the solid components were heterogeneous, ranging from intermediate-high to high. Dynamic MRI marked early enhancement of solid components in the right ovary. The specimen obtained from endometrial curettage showed proliferative endometrium. Preoperative serum levels of tumor markers were in normal range: preoperative serum levels of testosterone (T) (2.42 ng/ml; normal for adult females 0.1-0.8 ng/ml) and dehydroepiandrosterone-sulphate (DHEA-S) (232.4 microg/dL; normal for adult female, 35-430 microg/dL) were measured and the T value was found increased. At laparotomy, a left ovarian mass was found attached to the right infundibulopelvic ligament and a left oophorectomy was performed. The mass was described as benign by frozen analysis. Definitive histopathological diagnosis was sclerozing stromal tumor of the ovary (SST). The histologic features included a pseudolobular pattern with focal areas of sclerosis and a two-cell population of spindled and polygonal cells. Immunohistochemical studies showed positive smooth muscle actin and negative cytokeratin, keratin, S100 and desmin. The T value decreased postoperatively (0.57 ng/ml). ( info)

7/30. Adrenal adenoma and normal androgen levels in a young woman with polycystic ovaries: a case of idiopathic hirsutism?

    A case of unusual combination of polycystic ovaries (PCO), adrenal non-functioning adenoma and severe hirsutism in a young woman from Southern italy is reported here. A 18-yr-old woman was referred to our Department because of oligomenhorrea, acne and severe hirsutism. During evaluation of the cause of her symptoms, PCO and small left adrenal adenoma were revealed. Although adrenal androgen excess has been shown to dysregulate the hypothalamic-pituitary-gonadal axis, causing PCO-like syndrome, normal circulating androgen values were found. androgens and cortisol levels were completely suppressed by low-dose dexamethasone test, excluding autonomous steroid secretion by the adrenal mass. Normal response of cortisol and adrenal androgens to corticotropin stimulation test permitted the exclusion of functional adrenal hyperandrogenism. Despite normal LH/FSH ratio, anovulatory cycles were revealed by persistently low progesterone values. Glucose and insulin response to oral glucose tolerance test did not differ from those of normal population. The patient showed an improvement of acne and hirsutism on therapy with estro-progestins (EP). In conclusion, despite normal pattern of serum androgens and LH/FSH ratio, this patient had anovulatory cycles and good response to the EP treatment. These findings suggest that ultrasonography evidence of PCO together with anovulatory cycles contributed to her clinical picture whereas adrenal adenoma seemed to have no relevant role. This case report underlines the need of cautious interpretation of imaging results and clinical signs of severe hirsutism, reminding one that the true cause of a medical problem may not be the most evident. ( info)

8/30. Type A insulin resistance syndrome revealing a novel lamin A mutation.

    Particular forms of polycystic ovary syndrome with severe hyperandrogenism, acanthosis nigricans, and marked insulin resistance, defining the type A insulin resistance syndrome, are due to insulin receptor gene mutations. However, the majority of affected individuals do not have such mutation, arguing for the genetic heterogeneity of this syndrome. The familial partial lipodystrophy of the Dunnigan type, one of the diseases due to mutations in the lamin A/C (LMNA) gene, is characterized by a lipodystrophic phenotype and shares some clinical and metabolic features with the type A syndrome. We describe here the case of a nonobese 24-year-old woman affected with type A syndrome without clinical lipodystrophy. We linked this phenotype to a novel heterozygous missense mutation in the LMNA, predicting a G602S amino acid substitution in lamin A. This mutation cosegregated with impaired glucose tolerance, insulin resistance, and acanthosis nigricans in the absence of clinical lipodystrophy in the family. The skin fibroblasts from the proband exhibited nuclear alterations similar to those described in other laminopathies, and showed several defects in the insulin transduction pathway. This study further extends the vast range of diseases linked to LMNA mutations and identifies another genetic cause for the type A insulin resistance syndrome. ( info)

9/30. gadolinium radiologic contrast is a useful alternative for hysterosalpingography in patients with iodine allergy.

    OBJECTIVE: To report the successful use of gadolinium radiologic contrast for hysterosalpingography. DESIGN: Case report. SETTING: Outpatient care in a private practice setting. PATIENT(S): One female patient entering and finishing study. INTERVENTION(S): Hysterosalpingogram. MAIN OUTCOME MEASURE(S): Interpretability of radiological imaging. RESULT(S): Visualization of a normal uterine cavity and fallopian tubes with bilateral patency was confirmed during the procedure. Radiologic films were created that document the results. The best visualization of the internal pelvic anatomy was noted during the actual procedure. There was a lighter image noted on the films taken from the use of gadolinium rather than the traditional iodinated contrast. CONCLUSION(S): gadolinium is a safe and useful alternative to iodinated contrast for hysterosalpingography in patients with iodine allergy. ( info)

10/30. Vitamin B12 deficiency and infertility: report of a case.

    An oligomenorrheic infertile patient with evidence of vitamin B12 (cobalamin) deficiency is described. Treatment consisted of clomiphene citrate, human chorionic gonadotropin (hCG), conjugated estrogens, dexamethasone, and ferrous sulfate. pregnancy occurred after 1,000 micrograms of vitamin B12 was added to the treatment regimen. We believe the patient's infertility was in part related to the megaloblastic anemia. A possible correlation between vitamin B12 deficiency and failure to ovulate is presented. ( info)
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