Enlarged ovaries with multiple cysts, irregular menstrual cycles, and hyperandrogenism are characteristic of polycystic ovarian syndrome (PCOS). Patients with PCOS are at increased risk of endometrial carcinoma.
While the exact cause of PCOS is unknown, patients have elevated luteinizing hormone (LH) levels that often lead to theca cell hyperplasia. An LH:FSH ratio > 2 is typical. Theca cells produce excess androgens which aromatase converts to estrogens in fat cells. Abnormally high estrogen levels stimulate endometrial hyperplasia, a precursor to endometrial carcinoma.
Radosh reviews drug treatments for PCOS. Insulin-sensitizing agents, oral contraceptives, and spironolactone are commonly used to treat hyperandrogenism. Metformin is the first-line treatment for insulin resistance.
de Franco Neta et al. review the pathogenesis of cancers that arise due to PCOS, including endometrial cancer. PCOS is associated with endometrial, ovarian and breast cancer. Endometrial and breast cancer likely arise due to increased estrogen production in PCOS patients.
Illustration A shows a polycystic ovary on ultrasound.
Answer 1: Hypothyroidism is most often due to iodine deficiency or autoimmune thyroiditis. It is not associated with PCOS.
Answer 3: Addison’s disease is an endocrine disorder in which the adrenal glands fail to produce sufficient steroid hormones. It is not associated with PCOS.
Answer 4: Wegener’s granulomatosis is a vasculitis that affects the nose, lungs, kidney, and other organs. It is not associated with PCOS.
Answer 5: Eclampsia is an emergent complication of pregnancy marked by seizures, pregnancy induced hypertension, and proteinuria. It is not associated with PCOS.
Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. 2009 Apr 15;79(8):671-6. Review.
PMID:19405411 (Link to Abstract)
de França Neto AH, Rogatto S, Do Amorim MM, Tamanaha S, Aoki T, Aldrighi JM. Oncological repercussions of polycystic ovary syndrome. Gynecol Endocrinol. 2010 Oct;26(10):708-11. Review
PMID:20528205 (Link to Abstract)
USMLE World Step 1 Qbank Question #258. Copyright © USMLEWorld, LLC 2012