Case #3 Marcy, a thirty-two year old teacher, is telling friends that she is fee

Question

Case #3 Marcy, a thirty-two year old teacher, is telling friends that she is feeling strange, but cannot specifically identify her condition with precision. She is unmarried, but enjoys a healthy relationship with her fiancé. About two months prior she had a Dexxa scan. Some osteopaenia with mild scores of osteoporosis especially in her lower spine has been noted. Her doctor wishes to pursue some investigational testing She has had one bout with kidney stones. She believes her mother might have had kidney stones as well, but was not sure. She has occasional abdominal pain, with concurrent joint and bone pain. Her appetite is OK, but sometimes off. She is occasionally depressed. Might any additional questions be asked of this patient? 24

Explanation / Answer

Possible diagnosis can be-

Menopause( Most likely these symptoms are associated with menopause since during menopause the levels of sex hormone estrogen declines, since estrogen is known to prevent bone loss. Decline in estrogen leads to Bone loss and ultimately leading to osteoporosis like symptoms and increased risk of fractures.

Osteoporosis

Osteopenia

Kidney stones

Endocrine disorder

Possible tests to check Endocrine disorders are

Bone density tests for evaluating osteoporosis (DEXA- X -ray absorptiometry)

Thyroxine(T4) tests and TSH(Thyroid stimulating hormone)Tests to check the activity of Thyroid glands

Tests for Estrogen levels and Estradiols

Tests to check activity of Pituitary gland (Hypopituitarism)

Primary cause of endocrine disorder may be due to Menopause since it is a natural process and estrogen levels declines during this at a very fast rate, low estrogen affects many cellular processes.

It affects bone density, Pelvic muscles, reduced mood(depressive symptoms) development of ovarian cysts

The secondary cause can be low levels of sex hormones and pituitary and thyroid gland functioning.

Treatments and drugs available for this disorder

Eating diets rich in estrogen( soya rich diets), flaxseeds, parsley

Increasing calcium uptake ( milk products)

Hormone replacement therapy

Estrogen containing pills

Calcium and multivitamin pills

Alendronate, Zoledronic acid for treating osteoporosis.

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