ClinicoPathologic Conference January 12, 2011 Department of Medicine

Outline Subjective Objective Analysis: Primary Impression and Differential Diagnosis Correlation Plan of Action (Management)

Subjective Data Problem: Infertility – 34 year-old female – With changes in menstrual cycle since six years prior Blood flow Irregular day cycle Abdominal pain

Subjective Data Sought Gynecologic consult – Intramural uterine myoma Increasing in size since six years prior – From 1.1x0.8cm to 1.7x1.4cm Dosegestrel + Ethinylestradiol (Gracial) – Had regular menstrual cycle upon intake; irregular after stopping – Unilocular cyst at the left ovary 2.2x1.9cm

Subjective Data Other S/Sx: Proton pump inhibitor; antispasmodic – Abdominal discomfort – Constipation – Early satiety – Weight loss (3kg) – Blood streaked stools

Objective Data BMI: 19kg/m 2 Tenderness at the left abdomen External Hemorrhoid Laboratory Work-up – Decreased FSH – Increased Total Testosterone – Increased Serum Dehydroepiandrosterone Sulfate

Objective Data CT Scan of Abdomen – 6.4 x 6.8 soft tissue mass at the left suprarenal region