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Question #816

Mrs. O’Doole is a 34-year-old of Irish descent. She works as florist and is married with three children. She arrives at your clinic for her annual wellness exam. Her blood pressure is 130/84 mmHg, pulse 65, BMI 24 kg/m2 and her physical exam is notable for acne and mild hirsutism. Her only current medication is oral birth control pills. She recalls starting OCP, 15 years prior, due to irregular menses.

What clinical diagnosis would suggest screening Mrs. O'Doole for type 2 diabetes?

Correct

Answer:   C. Polycystic ovary syndrome

The ADA has developed criteria for testing asymptomatic adults for type 2 diabetes. In this case, while she normal weight, she has one or more additional risk factors and should be screened for type 2 diabetes. Mrs. O’Doole’s clinical picture (acne, hirsutism, overweight, irregular menses) is suggestive for polycystic ovary syndrome (PCOS), a significant risk factor for type 2 diabetes. While hirsutism/acne/menstrual irregularities can occur in Cushing syndrome, other physical findings are also usually present (abdominal striae/central fat/moon facies/hypertension). Signs of hyperandrogenism are absent in thyroid dysfunction and premature ovarian failure.
Wang et al (2011) examined data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to estimate whether women with PCOS (overweight and normal-weight) were at increased risk for the development of incident diabetes, dyslipidemia and hypertension. Study authors concluded that PCOS, independent of BMI, is associated with an increased risk of diabetes and dyslipidemia, but not hypertension. The risk of developing diabetes was three times higher in normal weight women with PCOS vs. normal weight women without PCOS.

Reference(s):

American Diabetes Association. Standards of medical care in Diabetes – 2013. Diabetes Care. January 2013; 36(Suppl. 1):S11-S66. Available at http://care.diabetesjournals.org/content/36/Supplement_1/S11.full. Accessed Jan. 11, 2013.

Wang E, Calderon-Margalit R, Cedars M, et al. Polycystic ovary syndrome and risk for long-term diabetes and dyslipidemia. Obstet Gynecol. 2011; 117:1:6-13. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060760/. Accessed Jan. 11, 2013.

Incorrect