POLYCYSTIC OVARY

SYNDROME Andrea Myers

KNH 411

CLIENT Gracie Moore 34 Female 5’5” 180lbs Graduate Student Graduate teaching assistant Married One adopted child, infant

COMPLAINT “I just keep gaining weight, no matter

what I do! The more weight I gain, the more hair shows up on my body. And I just found out I have sleep apnea and I have to use a CPAP at night!”

PATIENT HISTORY Stopped menstruating in college Placed on oral contraceptives Controlled her weight during her

undergraduate education through regular physical activity and eating a healthy diet. Maintained weight of 140lbs.

Since graduating, she has gained an average of 4lbs per year

PCOS symptoms grew worse as she gained weight

PATIENT HISTORY CONT’D Has had two miscarriages Adopted infant girl one year ago Stress of school, job and family have

exacerbated her symptoms further and caused her to seek further medical intervention

Has had nutrition education 6 years prior to current admission

DIAGNOSIS Diagnosed with Polycystic Ovary

Syndrome (PCOS) six years ago

PCOS is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels and physical appearance.

PCOS Only affects women Elevated level of androgens (male

hormones) Irregular or no menstrual cycle May cause many small cysts to develop

in the ovaries

The most common hormonal reproductive problem in women of childbearing age

PCOS

DIAGNOSTIC CRITERIA There is not a well-defined diagnostic

criteria for PCOS Criteria according to the Androgen

Excess Society (2006):hyperandrogenism (clinical or biochemical)ovarian dysfunction (oligomenorrhea or

anovulation and/or polycystic ovarian morphology)

exclusion of other androgen excess or related disorders

ETIOLOGY Cause of PCOS is unknown

Several factors seem to be linked to PCOSGeneticsBody’s ability to make insulin

SYMPTOMS Symptoms presented:

Cessation of menstruation Weight gain Sleep apnea Hirsutism Thinning hair Dandruff Acne Skin tags Acanthosis Nigricans High blood pressure High cholesterol

ABNORMAL LAB VALUES Bilirubin: 0.41mg/dL ALT: 42U/L HDL-C: 51mg/dL TG:184 mg/dL LDL:132 mg/dL

DIAGNOSTIC CRITERIA Complete blood count with:

Metabolic panelLipid panelThyroid panel with TSH Testosterone level

2 hour GTT

TREATMENT-MEDICATIONS YAZ 1 tablet PO Glucophage 850mg PO Aldactone 100mg/d PO Vaniqua

Nutrition consult requested

NUTRITION INTERVENTION Gracie’s weight= 180lbs/2.2= 82kg Gracie’s height= 65” x 2.54= 165cm=

1.65m

BMI: 82kg/1.65m^2 = 30 kg/m^2

NUTRITION INTERVENTION TEE: (10 x 140lbs + 6.25 x 65” – 5 x 34)

1.3 = 2,127 kcal/day

Range: 2,100-2,200 kcal/day

NUTRITION INTERVENTION Those with PCOS are encouraged to

follow a healthy, balanced diet in moderation. One with PCOS should take care to:Limit processed foods and foods containing

processed sugars Add more whole grains to their diet Add more fruits and vegetables to their dietadd more lean meats to their diet

24-HOUR RECALL Breakfast: 8oz. calcium-fortified orange

juice, 6 oz. black coffee Snack: 1 cup mixed nuts (salted), 10 oz.

unsweetened iced tea Lunch: Cheeseburger and small fries

from fast food restaurant, 18 oz. Diet Coke

Dinner: 1 ½ cup ham and beans, 2 corn muffins, 12 oz. Diet Coke

Snack: Skinny Cow ice cream sandwich

PES STATEMENTS Excessive energy intake related to

frequent consumption of high-fat, high kilocalorie foods as evidenced by 24-hour dietary recall and obese BMI of 30 kh/m^2.

Physical inactivity related to busy lifestyle and lack of access to facility as evidenced by undesired weight gain of 40 lbs over ten years.

GOALS Reduce weight and BMI to normal range

by reducing daily kilocalorie intake from 2,500kcal to 2,100-2,200kcal/day and eating balanced meals containing 50% CHO, 20% protein and 30% fat

Increase physical activity slowly, starting with 30 minutes 4 times/week and working up to recommended 1 hour/day. Encourage family physical activities, such as daily walks.

PROGNOSIS With treatment, women with PCOS are

usually able to lead normal lives and can become pregnant.

National Institute of Health

RESOURCES http://www.nlm.nih.gov/medlineplus/ency/

article/000369.htm Nutrition Therapy and Pathophysiology; pg. 501  http://www.nurse-practitioners-and-physician-

assistants.advanceweb.com http://www.womenshealth.gov/publications/our-

publications/fact-sheet/ polycystic-ovary-syndrome.cfm

. http://www.pharmacytimes.com/publications/issue/2004/2004-06/2004-06-7973

http://www.mckinley.illinois.edu/handouts/pcos.htm