Hi everyone,
I’m posting about my girlfriend (30F) as we’re currently in the middle of an extensive medical workup, but still feel like we might be missing the bigger picture. Any medical insight would be greatly appreciated.
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Basic info:
- Female, 30 years old
- Height: 157 cm
- Weight: +20 kg over ~1.5 years to now 67KG
- Works as a kindergarten teacher (high exposure to infections)
- Lifestyle: balanced diet, physically active daily (often 10k steps, even more) but no regular exercises
→ The weight gain feels unexplained given her lifestyle. She never had weight issues prior to that.
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Main symptoms (progressive over ~2 years):
- Severe fatigue (sleeping a lot, never feeling rested, issues falling asleep and randomly waking up in the night)
- Brain fog, poor concentration
- Persistent low energy
- Hair shedding
- High thirst
- Frequent infections
- General decline in overall health and mental wellbeing
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Gastrointestinal issues:
- Chronic bloating (so severe that ultrasound imaging is sometimes difficult)
- IBS-like symptoms (frequent diarrhea)
- Known intolerances: fructose, lactose, sorbitol (no celiac)
- Ongoing GI discomfort
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Gynecological history:
- Endometriosis (surgery ~3 years ago, now recurrence suspected with ovarian cysts)
- Irregular or absent menstrual cycle
- Very thin endometrial lining on ultrasound
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Hormonal / endocrine history:
- Childhood growth hormone therapy with Genotropin (somatropin) until age 17 (as part of a study) because of her size as a child
- Recent labs:
- Low IGF-1
- AMH: 9.58 (high)
- Testosterone: normal
- Fatty liver (diagnosed October 2025)
- Chronically elevated CRP
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Medication / hormonal changes:
- Stopped sertraline: March 2024
- Stopped NuvaRing: September 2025
→ The significant weight gain seemed to accelerate after these changes
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Recent hospital evaluation (endocrinology):
- Oral glucose tolerance test:
- Normal 2h glucose (~120 mg/dl)
- Later hypoglycemia (~47 mg/dl)
- 3–4 day supervised fast:
- Repeated symptomatic hypoglycemia (~47–57 mg/dl)
- Symptoms: sweating, dizziness, cognitive impairment
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Current working diagnosis:
Doctors are leaning toward PCOS (based on high AMH, ovarian findings, irregular cycle) and suggested possibly starting metformin.
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Concerns:
PCOS seems plausible, but it does not fully explain:
- Severe fatigue / hypersomnia
- Hypoglycemia during fasting
- High thirst
- Low IGF-1 + prior GH therapy
- Chronic inflammation (CRP)
- infections
- Significant GI symptoms
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Questions:
- Could this be more consistent with a central (pituitary/hypothalamic) disorder rather than isolated PCOS?
- Has anyone seen a similar constellation of symptoms?
- Could prior GH therapy (Genotropin) have long-term endocrine effects?
- What further testing would you recommend beyond a standard PCOS workup?
We have scheduled further measures (including visiting her gynecologist, visiting a specific clinic for PCOs), but would really appreciate any guidance or thoughts on possible directions. It has been quite heavy years for her (and for me, too).
Thank you very much 🙏