July 2010|Vol 7|Issue 7

July 2010 | Volume 7 | Issue 7



Case
 
A case of Endometrial Hyperplasia
 


 



Dr. Sundari Sembaruthi is a leading clinician serving the temple town in south India, Madurai. She had authored articles, presented papers, participated in public awareness programs. Here she presents a case of Endometrial Hyperplasia. She can be contacted at : MAC Homoeo Clinic, 202, Naicker New Street, Madurai: 625001, Ph: 0452-2630503, Mobile: 9443529494,
Email: sundari_dr@yahoo.co.in,


    A female aged 44 years presented the following complaints

    Past history
    Had Chicken pox when she was six years old.

    Family history
    He 67 years father had depression and Glaucoma and her 58 years old mother is known Diabetic. Maternal grand mother had Ca uterus, maternal grand father had Ca Oesophgus, and maternal grandfather’s sister had Ca cheek. Her younger sister was suffering from depressive disorder. Father’s brother has nervous weakness.

    Physical generals
    Appetite : Decreased; cannot tolerate hunger, feels tired, take sweets

    Thirst : 200ml/time, 1 litre/day

    Sleep : 10.00pm-5.15am, now good, before disturbed by dreams

    Stool : Regular

    Urine : Involuntary when coughing, sneezing

    Sweat : Since 1 yr, profuse all over.

    Desires : Warm/cold foods, must drink tea two cups/day, otherwise gets headache, Sour++ curry

    Intolerance : Cold foods, drinks<es headache

    Thermal : Hot cannot tolerate both heat ++ and cold
    In summer, pour water over her at night before sleep, wants 2 fans
    Desires fanning in summer and covering in winter

     

    Tight clothes aggravate, uneasiness, but adjust with it.
    Aversion crowded area+++ <; suffocation
    Before craves raw rice, now not.

    Menstrual history:
    Menarche : 13yrs
    Cycle : Irregular since 1 yr
    L.M.P : 04.07.08, persisted for 14 days
    Duration : Usually 4 days
    Flow : Profuse< walking, < slightest movement
    Colour : dark clots present
    Menses before : Backache, breast pain

    Obstetric history:
    1ST Four deliveries - Ftnd, died immediately due to deformed skull.
    5th child-son-FTND-alive
    6th-daughter-FTND-died 5 months after birth due to weak heart
    PPS done

    Lifespace :
    She is the eldest, has 2 siblings; father worked as mechanic in TVS. Father was very strict+++, military like; so adjusts to everyone but feels inside that they are doing like this. She studied 8th std; married at 15 yrs, consanguineous marriage, own maternal uncle. She is the eldest daughter-in-law. Even if she do so much work, others are not satisfied, so everyone always finds fault with her; so much stress for the past 1 yr; wants to satisfy everyone.

    Mind:
    · MINGLES WITH NEW PERSONS EASILY

    · Desires company always

    · Active; does all work even when she is sick. Wakes daily at 5.00A.M; must take bath in early morning hours daily, never skips that.

    · Don’t get anger easily; don’t fight with anybody.

    · Anxiety and weeps easily if she hears that anyone is sick or on hearing anyone in hospital. Weeps on seeing sad scenes in T.V disturbs for many days sometime don’t get sleep due to those thoughts.

    · Weeps++ even from slightest words; weeps easily in front of others, feels for a long time.

    · Don’t like anyone teasing her, starts weeping++.

    · If criticism is true, she corrects, otherwise wont.

    · She even cooks for 10 persons at a time; very active, does all work by herself.

    · Fastidious+++ wants everything to be very neat; things must be in place if any slight change in position, feels irritable.

    · Don’t like others touching her with dirty hands.

    · Disgust to everything. Often wash hands; cut her nails every week regularly.

    · Wash the legs before going to sleep;

    · Punctuality+++ arrives before the time, 1hr before if others are late, gets angry but don’t express out.

    · Think and decides by her own, once decided, won’t change it.

    · Spends money to need, wont go by auto, go by walk only.

    · Receives guests very well; treats them very well.

    · Forgetfulness: for placed things, until she gets it, she wont sleep,

    · Forgets what she has just come to say.

    · Dreams; unremembered, often that she is getting a female child, want to make her study, treat her like her daughter.

    · Has normal GOD faith. Don’t ask for this and that. Must do work properly that will itself benefit us.

    · Share her worries with others

    · Much responsibility as she is the eldest daughter-in-law; she does it well.

    · Likes old songs;

    · Face any problems courageously by herself

    · Finishes her work on time, don’t postpone it.

    · Does not like if any one talks without respect, gets angry, expects other to respect her.

    · Helps others, but does not expect help from other,

    · Avoids watching fight scene, does not like to watch.

    · Very adjustable.

    Investigations

    USG: IMPRESSION:
    Bulky Retroverted Uterus with altered Myometrial Echopattern – 8.6 x 4.5 cm
    Thickened endometrium 2.3 cm with hyperechogenicity and multiple tiny cystic spaces with in it – may suggestive of endometrial hyperplasia
    Kindly rule out endometrial carcinoma
    Refer Plate I & Plate II

    Problem Definition:
    Normal endometrium is seen as a thin layer on both sides of the anechoic endometrial cavity. During the normal menstrual cycle, the endometrium becomes progressively thicker and more echogenic. The endometrial thickness, measured as the double thickness of the echogenic layers, may reach up to 10 mm. After the menopause, or during ovulatory suppression, (e.g. oral contraceptive usage), the endometrium is inactive, and is seen as a thin layer of under 5 mm in thickness.
    In endometrial hyperplasia, the central endometrial echo complex is thickened, measuring over 10 mm. It does not demonstrate the normal variation in appearance during the menstrual cycle. In severe cases the endometrium may measure up to 5 cm in thickness. Endometrial hyperplasia involves the proliferation of endometrial glands that results in a greater than normal gland-to-stroma ratio. This results in varying degrees of architectural complexity and cytologic atypia. The clinical significance of this diagnosis is progression to or concurrent endometrioid endometrial adenocarcinoma.

    Rubrics:
    · Fastidious
    · Responsible
    · Anxiety for others.
    · Horrible things affect her profoundly

    Carcinosin and Aurum came after analysis
    Aurum is ruled out because it is thirstless and chilly and Aurum is also responsible but is more as a duty oriented but Carcinosin love to take up responsibility and fastidiousness more orderliness and time.Carcinosin is hot and thirstless

    First Prescription       19-08-08
    R/x
    CARCINOSIN 200 /1 DOSE

    Follow Up1      10-09-08
    · Had throat pain with mild fever for a day. Phlegm in chest and throat since a week.
    · Head ache once severe after ice cream, lasted a day
    · LMP: 3/09/2008 had menses for 4 days, Normal Flow
    R/x
    Placebo

    Follow Up 2      12-10-08

    LMP: 07/10/2010- Flow for 3days, 4th day scanty no pain or discomfort
    R/x
    Placebo

    Follow Up 3      14-11-08
    LMP: 05/11/2008, had flow for 3 days No complaints
    Rx: Placebo continued for 2 months

    Follow Up 4      11-02-09
    Menses was regular, No Headaches. Generally feels good.
    USG:
    Normal sized. Anteverted uterus measuring 7.5 x 4.2 cm.
    Endometrial thickness 4mm.
    Refer Plate III & Plate IV