Reference no: EM133901153

Case Scenario

Sarah is a 28-year-old female who presents to the clinic with concerns about irregular periods and recent weight gain. She reports that her menstrual cycles have been unpredictable since her teenage years, with cycles ranging from 35 to 90 days. Sarah has also noticed an increase in facial hair and acne over the past year. She and her partner have been trying to conceive for the last 12 months without success. Her past medical history is significant for obesity, and she has gained 20 pounds over the last year despite attempting diet changes. Sarah's family history includes type 2 diabetes in both her parents. She denies any history of thyroid disease or significant medical problems. On physical examination, Sarah has a BMI of 33 kg/m², acanthosis nigricans on her neck, and hirsutism on her chin and upper lip. Her pelvic examination is normal, and no ovarian masses are palpated. Initial lab work reveals the following: Luteinizing hormone (LH): 32 IU/L Follicle-stimulating hormone (FSH): 19.2 IU/mL Total testosterone: 80 ng/dL TSH: 2.1 µU/mL Prolactin: 300 ng/mL Fasting glucose: 110 mg/dL Fasting insulin: 18 µU/mL Imaging: An ultrasound of Sarah's ovaries shows multiple small cysts on both ovaries.