Presenting Complaints

• 14-year-old female patient presents with a 6-month history of progressive weight gain.

History of Presenting Complaint

• The patient reports that she has gained approximately 10 kg over the past 6 months, despite no significant changes in her diet or physical activity level.
• She also notes that she has been experiencing irregular menstrual cycles, with her periods occurring every 2-3 months.
• The patient denies any other associated symptoms such as fatigue, hair loss, or changes in skin/hair texture.

Significant Positives & Negatives For Differentials

Polycystic Ovarian Syndrome (PCOS)

Positives:

• Progressive weight gain over 6 months
• Irregular menstrual cycles

Negatives:

• No history of infertility or hirsutism
• No evidence of polycystic ovaries on imaging

Hypothyroidism

Positives:

• Progressive weight gain
• Irregular menstrual cycles

Negatives:

• No other typical hypothyroid symptoms like fatigue, cold intolerance, constipation
• No history of thyroid disease in the family

Cushing's Syndrome

Positives:

• Progressive weight gain

Negatives:

• No other typical Cushing's symptoms like facial rounding, easy bruising, muscle weakness
• No history of glucocorticoid use

Growth Hormone Disorders

Positives:

• Progressive weight gain

Negatives:

• No other typical growth hormone disorder symptoms like acromegaly features or growth abnormalities
• No family history of growth hormone disorders

Past Medical History

• No significant past medical history.
• No history of any chronic medical conditions.
• No previous hospitalizations or surgeries.

Drug/Medication History

• The patient is not taking any medications, including oral contraceptives.

Social History

• The patient lives with her parents and younger sibling in Singapore.
• She is a high school student and denies any significant stress or changes in her daily routine.
• The patient denies any history of substance abuse.

Family History

• The patient's mother has a history of type 2 diabetes.
• No other significant family history of endocrine disorders or obesity.

Systems Review

• Positive for irregular menstrual cycles and weight gain.
• Negative for fatigue, hair loss, changes in skin/hair texture, headaches, or vision changes.

Ideas, Concerns & Expectations

• The patient is concerned about her weight gain and irregular periods, and would like to understand the underlying cause.

Case Presentation

Based on the patient's history and the analysis of the key positives and negatives for the differential diagnoses, Polycystic Ovarian Syndrome (PCOS) appears to be the most likely diagnosis. The progressive weight gain, irregular menstrual cycles, and lack of other associated symptoms are highly suggestive of PCOS. While hypothyroidism, Cushing's syndrome, and growth hormone disorders can also present with weight gain, the patient's history does not fit these diagnoses as closely.