Female Case Histories

• Case Histories: Female, copyright 2024, by Pamela W. Smith, M.D., MPH, MS.
• AKH Inc., Advancing Knowledge in Healthcare provides CE credits.
• AKH Inc., Advancing Knowledge in Healthcare is jointly accredited by ACCME, ACPE, and ANCC.
• Physicians can claim a maximum of 24.0 AMA PRA Category 1 Credits for this activity.
• There is no commercial support for this activity.
• Cost to participate in this activity is $2,700.00.
• Certificates of completion are awarded after attending and completing evaluation, and the credit form available after the conference.
• The deadline to claim credit is December 17, 2024.

Objectives

• Case histories explore personalized medicine to improve hormone levels.
• Personalized medicine aims to improve overall health, thyroid function, blood sugar and cholesterol levels in females.

Disclosure

• AKH Inc. ensures independence, balance, objectivity, scientific rigor, and integrity in all continuing education.
• Authors must disclose relationships with ineligible companies whose products are mentioned
• Conflicts of interest are mitigated by AKH before accreditation.
• AKH planners and reviewers have no financial relationships to disclose.
• Pamela Smith, MD, MPH, MS (Speaker & Owner) has a relationship with Biotics Research, Doctors Data, Genova Diagnostics, MDLifespan PCCA and ZRT Laboratory.
• Dorothy Caputo, MA, BSN, RN - VP, Healthcare Continuing Education and Operations at AKH Inc., Advancing Knowledge in Healthcare has nothing to disclose.
• Michele Bielarski, RN (planner/reviewer) has nothing to disclose.
• AKH Inc Staff and Planners have nothing to disclose.
• Precision Medicine Consultants Staff and Planners have nothing to disclose.
• All relevant financial relationships have been mitigated.

Case #1

• A 45-year-old female with a history of ER+, PR+ breast cancer.
• She had a lumpectomy with axillary dissection in 2022, followed by a bilateral oophorectomy six months later.
• The patient owns a copy and experiences stress.
• Family history includes HTN, CAD, lung cancer (father), colon cancer (3 family members on the father's side, mother, and paternal grandfather), and DM.
• Allergies: Taxol.
• Current medications: Lisinopril, Anastrozole, and Zoledronic acid every 6 months for osteoporosis prevention.
• She takes Coenzyme Q-10, EPA/DHA, vitamin D (5,000 IU), a probiotic, and a multivitamin.
• She reports fatigue, brain fog, loss of muscle, decreased energy, and low sex drive.
• Lab results on 10/31/23 showed Estradiol <0.5 L, Progesterone 13, Ratio Pg/E2 N/A, Testosterone 32, DHEAS 13.4, Cortisol 5.4, Cortisol 2.4, Cortisol 1.0, Cortisol 0.9.
• Salivary Steroids Other Analytes (LC-MS/MS) results for Estradiol were 0.3 L, Estriol 0.9, Estrone 0.4 L, Ethinyl Estradiol <0.4, Pregnenolone Sulfate 31 H, Progesterone <5 L, Ratio Pg/E2 (Saliva LCMS) N/A, Allopregnanolone <15.0
• Salivary Steroids Other Analytes (LC-MS/MS) results for 17OH-Progesterone were 11, Androstenedione 66, Testosterone 6 L, DHT <7, DHEA 238, DHEAS 9.0 H, 7-keto DHEA 124, and Ratio: DHEA/7keto DHEA 1.9
• Results for 11-Deoxycortisol was 23, Cortisol 3.3, Cortisone 14.6, Corticosterone 38, Aldosterone 84 H, Melatonin 16, Anastrozole 8639 H, Finasteride <5, and Letrozole <5.
• Therapies on 10/31/2023 included: 1mg oral Anastrozole (aromatase Inhibitor), 3mg oral Naltrexone, Zoladex, 2.5mg sublingual Lisinopril, oral Multi Vitamins.
• The patients Therapies on 09/07/2023: 1mg oral Anastrozole (aromatase Inhibitor)

Case #2

• 55-year-old female complains of weight gain and inability to lose weight.
• She has a history of ductal breast cancer treated with lumpectomy 10 years prior.
• The patient works as a financial officer.
• Family history: father with CHF and type II diabetes, mother with type II diabetes and ductal carcinoma at age 60.
• She takes no medications.
• She takes the following nutrients Vitamin D3 5,000 IU, magnesium, zinc, EPA/DHA 1,000 mg.
• She has hot flashes, irritability, and mood swings.
• Lab results showed Estradiol was 1.4, Progesterone 15, Ratio Pg/E2 11 L, Testosterone 22, DHEAS 4.9, Cortisol 3.4 L, Cortisol 1.2, Cortisol 1.6, and Cortisol 0.8.
• Salivary Steroids Other Analytes (LC-MS/MS) result for Estriol was 0.9.
• Patients therapy included oral Vitamin D.

Case #3

• 52-year-old female complains of irregular cycles.
• PH: Right foot fracture two years ago skiing
• Works as a social worker.
• FH: Mother has a history of RA, father had history of hypertension, maternal grandmother + MS, maternal grandfather + DM, paternal grandparents unknown
• Takes Estradiol cream 2x week, progesterone PO, and testosterone cream 3x a week
• She is taking MVI and calcium.
• Symptoms include anxiety, irritability, mood swings, insomnia, and depression, which started in the last two years.
• Lab results for Cortisol were 11.0 H, Cortisol 3.9 H, Cortisol 1.7, and Cortisol 1.9 H.
• Salivary Steroids Other Analytes (LC-MS/MS) result for Estradiol 0.5 L, Estriol <0.9, Estrone 1.3 L, Progesterone 7 L, Ratio Pg/E2 (Saliva LCMS) 14 L, and Testosterone 22.
• Patients DHEAS cortisol level was 4.8 and 7.5 H.
• Therapies include: 0.1mg 2x/week topical Estradiol, 185mg oral Progesterone, and 3x/week topical Testosterone.

Case #4

• 74-year-old female wants to know if it is too late to start on hormones due to a friend's health.
• She has hypertension.
• She is a retired schoolteacher with five children.
• Family history: deceased parents, mother died of COVID-19, father died of uncontrolled hypertension.
• The patient is taking lisinopril 10 mg.
• Supplements include probiotics, calcium, and vitamin D3 1,000 IU.
• She has decreased memory, decreased energy, and an early cataract on the right.
• The lab results are: Estradiol were 0.5 L, Progesterone <5 L, Ratio Pg/E2 N/A, Testosterone 11 L, DHEAS <1.0 L, Cortisol 2.0 L, Cortisol 2.4, Cortisol 1.8, Cortisol 0.9.
• The lab results also contain Salivary Steroids & Other Analytes (LC-MS/MS) where Estriol is 0.9
• Urinary Toxic & Essential Elements for Iodine and Urinary Creatinine were not tested but the patients Creatinine result was 1.11
• Indicated Therapies was none

Case #5

• 49-year-old female with regular cycles after starting progesterone was referred from a retired practitioner.
• The patient has migraine headaches just before cycles.
• She owns a consulting firm, is married, and has one daughter.
• Family history: both parents are alive and healthy, daughter has ADD.
• Patient takes: Progesterone 200 mg E4M (days 14-25), testosterone 4.0 mg cream, keto DHEA 15 mg E4M.
• She has developed facial hair since starting testosterone.
• The lab results were: Estradiol 1.7, Progesterone 12100, Ratio Pg/E2 71 L, Testosterone 188 H, DHEAS 2.1, Cortisol 7.5, Cortisol 2.8, Cortisol 1.1, Cortisol 0.6.
• Salivary Steroids & Other Analytes (LC-MS/MS) Test for Estriol is 0.9.
• Some Therapies included: oral Progesterone,topical Testosterone , oral DHEA-7 Keto, oral NP Thyroid and oral Vitamin D3.

Case #6

• 63-year-old female reenters practice after time at a medical spa for chronic Lyme disease.
• She has seasonal allergies, hypothyroidism, asthma, ptosis repair, and depression.
• Employed as an interior decorator.
• Mother had hormonally related breast cancer, father and brother have eczema.
• She takes biest, progesterone, testosterone, DHEA, and pregnenolone in one cream, plus Synthroid, Armour thyroid, and Zoloft.
• Takes a variety of Nutrients that included Quercetin, grape seed extract, magnesium, nattokinase, glutathione, and collagen complex.
• The patient has decreased sexual interest, anxiety, and irritability and enjoys hiking, biking, and yoga.
• Resulted lab values were were: Estradiol 2.100, Progesterone 31 L, Ratio Pg/E2 15 L, Testosterone 28, DHEAS 3.9, cortisol levels ranged from 1.2 to 4.8 H.
• Other analytes were tested where Results included Estriol 3.610 L.

Case #7

• 57-year-old female returns for follow-up wanting to work on her immune system.
• She was lost to follow-up for two years while seeing endocrinology for thyroid cancer, and writing her own HRT prescriptions.
• She has osteopenia and had a thyroidectomy secondary to thyroid cancer.
• Was an ER physician for many years and has worked for an HMO in the last three years.
• FH: Mother history of hypothyroidism and Father history of heart disease, died two years ago of CVA.
• Allergy: sulfa
• The patient is taking: synthroid, biest cream, progesterone, DHEA, and pregnenolone
• She takes calcium, vitamin D, and magnesium as nutrients.
• ROS: unremarkable -Indicated lab results were: Estradiol were 1.9(1), Progesterone 279(11), Ratio,Pg/E2 147,Testosterone 28 and DHEAS 13.0
• Other Salivary Steroids with other Analytes lab results included: Estriol 26.3(1).

Case #8

• A 52-year-old female presents for a follow-up visit and has recently left a long-term relationship and moved states.
• PH: Breast implants removed at the providers suggestion and had leep procedure.
• She is a physician now out of the stressful realtionship.
• Mother is healthy, the Father died due to hypertension-caused crisis, maternal great aunt had Breast Cancer
• Biest Cream,Progesterone, Testosterone Cream, DHEA ,Pregnenolone.
• Nutrients: Lipoic Acid, Coenzyme a-10, Liposomal glutathione, Rhodiola, MVI, Probiotics,EPA/DHA 3,000MG , Vitamin D Ps 300Mg

Case #9

• 52-year-old female,chief complaint fatigue and insomnia.
• The patient has surgery to the right foot.
• Mother has Grace, father was healthy
• Works as a school teacher and has lots of stress
• Takes ProgeSterone300 mg SR day 14-25Lmp was 12 days age, cycles are regular on progeaterone.
• Proboitic , vitamin D32000L.
• Normal limits patient always very tired
• Sample 1 Result; Estrone (E1): 9.4 , Estradiol (E2) :(pmol/L) :5.8, Estriol (E3) 70pmol/L), Progesterone :(pmol/L).1043
• Normal Range : 4.7/18.9 3.7 - 9.4 pmol/L,133.163-669.
• Average Estradiol = 5.1 : Average: Testroerous NR: Average : (Average Estrone5.3 ,83. (DHEACortosol Ratio/(: Average: Progesterone1.5)

Case #10

• 20-year-old female patient complains of not having regular periods.
• The patient has an unremarkable medical history.
• The only remarkable thing she could state, other than that she did not get regular periods is that the maternal grandmother died due lupus.
• The patient is college student and run track and field -Two has and exercised seven and work had no medications.
• The results of Estadidal & progesterone activity plus result was 0.0
• and the test for DHA was 0.0

Problem #11

• 70-year-old female with chief complaint that she feels great however,
• daughter wants her to come because she believes she should take DHEA.
• FH both parents died 80.
• Mother in chf, father died of acutemi: patient never worked outside of house ,goes to chruch 3 times .

Case #12

• 67 yr old complains Insomnia.She dosent want start on hormones.
• Has Ostioprosis
• She has 6 kids & Numerous grand kids
• F +CHD, both parenst died od MI, brother ad Sten
• Fosmax/ Baby ASA

Case #13

• The patient was 55 and with here HRT with no complaints for a recheck
• The patient as well as negetive the patient Loves SkI as recently became an empty and has worked. The result for hormne and all hormone suppermate are here
• Family has che diahberes father
  • Both patient medication for e4m,dhra, . Nutriente with mvi vitamin d and epa DHA are shown too. Th patient state has + headaches. Had Foggy Thinking and fatigue Vitamin . The thyroid as well as a few more symptoms

Case #14

• A 67 female is seen Pulmonologist for COPD and she has he hormones was checked from this visit. PH: Osteopenia
• FH: Breast Cancer , Sister uternie.Has Retired recent year.
• Medication is Inhaler Bies Cream
• Nutrrin: Garlic . MVI,PS, proabitiic Her stress was with with recent retiremebnt she canot exerse it Her Horemonre is been listed down the results Estradiol is level in Dha it is being reported

Case #15

• The patient is a 59 Year a Internationally Known to be as Expert.
• She Has been in this Fied With . Extreme insomnie
• The is a travel alot a work 80hour for work and in a dance comppiont .Patient Dries was it on every night Her Medication from Metromin. Vitamin D/ lodine / All this and and weoghtt 97 pond and dizzy spells and Urinary Leakage When I Lough or Cough
• Has 60%

Case #16

• 54 - The Raynauds Mvi,DHA, and all her family history and symptoms. With are
• FH mother brestca , fatherHtnCdh,
• The medciation ad nuternt, was Dilitiza + Prosac /Mvi her Result showed To help Do a tiver to lower Estradial and to help start progessione . To help and the Egh test to Discnitue and calming .