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Polycystic Ovary Syndrome and Hirsutism

Stein and Leventhal: first report of seven amenorrheic women with smooth, enlarged ovaries, who ovulated following wedge resection.

The advent of radioimmunoassay

Obesity: seen in at least 50% of women with polycystic ovary syndrome (PCO).

Upper body obesity is frequently characteristic

Oligomenorrhea or amenorrhea

Hirsutism 1. Not always present 2. Hirsutism is a function of both target tissue response and hyperandrogenism

Premenarchal onset of symptoms

Infertility

Acne

Biochemical Features

Increased free testosterone: if not present, the diagnosis is suspect; the most reliable biochemical indicator of the disorder

Decreased sex hormone-binding globulin polycystic ovary syndrome, hirsutism (SHBG): a consequence of both elevated androgen secretion and obesity

Increased luteinizing hormone (LH): not always present, and may vary from time to time polycystic ovary syndrome.

Normal follicle-stimulating hormone (FSH)

Prolactin occasionally elevated

Dehydroepiandrosterone sulfate often elevated: no longer viewed as evidence of intrinsic adrenal dysfunction

Insulin resistance

Seen even in lean subjects

Subsequent risk for type II diabetes mellitus may be increased

DIFFERENTIAL DIAGNOSIS

PATHOGENESIS

Treatment