1. Andrea Myers KNH 411

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

3.  “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!”

4.  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

5.  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

6.  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.

7.  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

9.  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

10.  Cause of PCOS is unknown  Several factors seem to be linked to PCOS  Genetics  Body’s ability to make insulin

11.  Symptoms presented:  Cessation of menstruation  Weight gain  Sleep apnea  Hirsutism  Thinning hair  Dandruff  Acne  Skin tags  Acanthosis Nigricans  High blood pressure  High cholesterol

12.  Bilirubin: 0.41mg/dL  ALT: 42U/L  HDL-C: 51mg/dL  TG:184 mg/dL  LDL:132 mg/dL

13.  Complete blood count with:  Metabolic panel  Lipid panel  Thyroid panel with TSH  Testosterone level  2 hour GTT

14.  YAZ 1 tablet PO  Glucophage 850mg PO  Aldactone 100mg/d PO  Vaniqua  Nutrition consult requested

15.  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

16.  TEE: (10 x 140lbs + 6.25 x 65” – 5 x 34) 1.3 = 2,127 kcal/day Range: 2,100-2,200 kcal/day

17.  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 diet  add more lean meats to their diet

18.  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

19.  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.

20.  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.

21.  With treatment, women with PCOS are usually able to lead normal lives and can become pregnant. National Institute of Health

22.  http://www.nlm.nih.gov/medlineplus/ency/arti cle/000369.htm  Nutrition Therapy and Pathophysiology; pg. 501  http://www.nurse-practitioners-and-physician- assistants.advanceweb.com  http://www.womenshealth.gov/publications/ou r-publications/fact-sheet/ polycystic-ovary- syndrome.cfm . http://www.pharmacytimes.com/publications/is sue/2004/2004-06/2004-06-7973  http://www.mckinley.illinois.edu/handouts/pco s.htm