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Polycystic Ovarian Syndrome

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Topic updated on 06/21/16 2:48pm

Snap Shot
  • A G0 26-year-old presents for evaluation for infertility. Past medical history is notable for diabetes and body mass index is 30 kg/m^2. Physical examination reveals hirsutism and acne.
Introduction
  • Exact cause is unknown
    • underlying mechanism is a tonically ↑ LH level with ↓ FSH
    • leads to hyperproduction of androgens
    • excess androgens can be aromatized to estrogen by adipose tissue
    • ↑ estrogen inhibits FSH and stimulates LH release
    • results in the absence of normal menstrual hormone fluctuations
  • Affects woman from 15-25 years of age
  • Obesity and diabetes are risk factors
Presentation
  • Symptoms
    • amenorrhea
    • infertility
    • hirsutism
      • more commonly seen than virilization
    • acne
  • Physical exam
    • bimanual exam shows large palpable ovaries
Evaluation
  • Serology
    • serum LH/FSH > 2
    • serum androgens (testosterone and serum androstenedione)
    • estrogen
  • Ultrasound
    • shows bilateral enlarged ovaries with multiple large subcapsular cysts
Treatment
  • Conservative
    • weight reduction
  • Pharmacologic
    • OCPs
      • used to break feedback cycle and decrease LH
Complications
  • Infertility
  • Endometrial cancer 
    • due to unopposed estrogen stimulation 


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Qbank (1 Questions)

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(M1.RP.1) A 32-year-old female complains to her gynecologist that she has had irregular periods for several years. She has severe facial acne and dense black hairs on her upper lip, beneath her hairline anterior to her ears, and the back of her neck. Ultrasound reveals bilateral enlarged ovaries with multiple cysts. The patient is at increased risk of: Topic Review Topic

1. Hypothyroidism
2. Endometrial carcinoma
3. Addison’s disease
4. Wegener’s granulomatosus
5. Eclampsia

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