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Pathology - Polycystic Ovarian Syndrome
While the etiology of this disorder is not well known, overproduction of androgens by the ovaries (and possibly by adrenal glands as well) occurs, creating hirsutism and interrupted menses.
The hyperandrogenic state is further fostered by reduction of sex hormone-binding globulin, which effectively increases the proportion of free circulating androgens. Abnormally high levels of LH develop due to increased frequency of GnRH pulses from the hypothalamus, also increasing androgen excess. This overly abnormal hormonal milieu likely contributes to inadequate follicular development, resulting in the “polycystic” appearance of the ovaries seen with pelvic ultrasound imaging. Insulin resistance is usually detected in these patients due to increased androgen presence and leads to compensatory insulin hypersecretion by the pancreas in order to maintain normoglycemia. Patients often appear with physical indications of these excesses — hirsutism, acne, impaired glucose metabolism, irregular menses, and obesity. Noted in the patient in the vignette is the dermatologic finding of acanthosis nigricans, a darkening of the skin noted most commonly in patients with impaired insulin metabolism.
While the etiology of this disorder is not well known, overproduction of androgens by the ovaries (and possibly by adrenal glands as well) occurs, creating hirsutism and interrupted menses.
The hyperandrogenic state is further fostered by reduction of sex hormone-binding globulin, which effectively increases the proportion of free circulating androgens. Abnormally high levels of LH develop due to increased frequency of GnRH pulses from the hypothalamus, also increasing androgen excess. This overly abnormal hormonal milieu likely contributes to inadequate follicular development, resulting in the “polycystic” appearance of the ovaries seen with pelvic ultrasound imaging. Insulin resistance is usually detected in these patients due to increased androgen presence and leads to compensatory insulin hypersecretion by the pancreas in order to maintain normoglycemia. Patients often appear with physical indications of these excesses — hirsutism, acne, impaired glucose metabolism, irregular menses, and obesity. Noted in the patient in the vignette is the dermatologic finding of acanthosis nigricans, a darkening of the skin noted most commonly in patients with impaired insulin metabolism.
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