12. PROLACTIN VALUE
AND DIAGNOSIS
Value of Prolactin often gives hint of the diagnosis
Value of 30-40 ng/dl - typically can be seen in PCOS
Again, 30-40 ng/dl- may be typically associated with Drugs
like Metoclopromide or Domperidone
Values of 70-80 ng/dl- May be drug induced due to
Levosulpiride
Values of >100 ng/dl- Thing of Pituitary tumors and ask for
an MRI
18. This is a case of a 61 year old female.
She was complaining of weakness and fatigue for a
long time.
Someone ordered a TSH, which was 6.3 ng/dl
19. What would you do next
?
a) Get a complete thyroid function- T3, T4 and TSH
b) Ask for Anti-TPO antibody
c) Both A and B
d) Neither A nor B
20. What would you do next
?
a) Get a complete thyroid function- T3, T4 and TSH
b) Ask for Anti-TPO antibody
c) Both A and B
d) Neither A nor B
21. We ordered a thyroid function which
shows
T3 and T4- Reduced
TSH- 6.3
Anti-TPO- negative
22. What does this suggest ?
a) Subclinical hypothyroidism
b) Overt Primary hypothyroidism
c) Possible central hypothyroidism
d) Normal thyroid function
23. What does this suggest ?
a) Subclinical hypothyroidism
b) Overt Primary hypothyroidism
c) Possible central hypothyroidism
d) Normal thyroid function
24. T3 and T4- Normal
TSH - elevated
Subclinical Hypothyroidism
25. T3 and T4- Low
TSH - Elevated- value >20 mIU/ml
Overt Primary hypothyroidism
26. T3 and T4- Low
TSH - Elevated- value <20 mIU/ml
(some use 10 as cut-off)
Think of Central hypothyroidism
27. T3 and T4- Low
TSH - Normal
Think of Central hypothyroidism
28. T3 and T4- Low
TSH - low
Think of Central hypothyroidism
29. We ordered test for anterior pituitary
function
S. Cortisol- low
FSH and LH - low
Prolactin - also low
31. On taking a detailed history, the patient revealed she
had a history of post-partum hemorrhage 23 years
back in her last delivery.
Following this she had amenorrhea and lactational
failure.
59. A 30 year old primigravida is referred
to me with following results on OGTT
Fasting- 81 (>92)
1 hr – 207 (>180)
2 hr- 186 (>153)
60. She has a strong family history of
Diabetes mellitus
Diagnosed to have GDM in last
pregnancy
61. She had previously undergone only
Fasting plasma glucose twice both
of which were normal.
62. Gestational diabetes is often missed
out when diagnosed using fasting
plasma glucose- OGTT is the
diagnostic test for GDM
63. We started her on Metformin + 1800
Kcal meal plan- followed her up with
CGMS
64.
65. Target values of Gestational
diabetes in pregnancy
Fasting <95 mg/dl
1 hr post meal <140 mg/dl
2 hr post meal <120 mg/dl
66.
67. Results 1
Metformin compared to insulin lowered the risk of neonatal
hypoglycaemia [risk ratio (RR) = 0.63; 95% confidence
interval (95% CI), 0.45 to 0.87]
large for gestational age babies (RR = 0.80; 95% CI, 0.64 to
0.99)
pregnancy-induced hypertension (RR = 0.56; 95% CI, 0.37
to 0.85)
total maternal pregnancy weight gain [mean difference (MD)
-2.07; 95% CI -2.88 to -1.27].
68. Results 2
Metformin compared to insulin did not increase
preterm delivery (RR = 1.18; 95% CI 0.67 to 2.07)
small for gestational age babies (RR = 1.20; 95% CI,
0.67 to 2.14)
perinatal mortality (RR = 0.82; 95% CI, 0.17 to 3.92)
Caesarean section (RR = 0.97; 95% CI, 0.80 to 1.19).
82. Newer ATA recommendation for
Hypothyroidism in Pregnancy do not
recommend the use of LT4 in when
with Subclinical hypothyroidism
having TSH 2.5-4.0 with anti-anti-TPO
negative.
83.
84. Join our WhatsApp Group
Endocrine Disorders in Women
+91 9871009021 for being added to the
group