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Characterized by amenorrhea, infertility, hirsutism,
and enlarged polycystic ovaries.
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Polycystic Ovary Syndrome (PCOS); Sclerocystic Disease of
the Ovaries.
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Stein and Leventhal first described this entity in
1935.
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Most authors agree that it is present in 3 to 7% of
women worldwide. Approximately 75% of women with irregular menses and/or
infertility may have polycystic ovaries. Based on ultrasonographic studies,
50% of women with regular menstrual cycles had polycystic ovaries.
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Unknown. Believed to be autosomal dominant.
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In Stein-Leventhal syndrome patients, the
preovulatory follicle in the ovary does not develop. As a result, multiple
subcapsular follicles develop. This creates an androgenic ovary, which is
usually anovulatory.
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The National Institutes of Health has defined PCOS as a
state of hyperandrogenism and chronic anovulation in the absence of other
causes, for example, congenital adrenal hyperplasia, hyperprolactinemia, and
Cushing syndrome. The diagnosis is made on clinical grounds, in addition to
the presence of bilateral polycystic ovaries in 90% of patients.
Increased plasma levels of luteinizing hormone but normal or reduced levels
of follicle-stimulating hormone. Other biochemical tests are done to exclude
other causes.
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Stein-Leventhal Syndrome is a condition that is
usually diagnosed after the expected onset of menstruation. Symptoms can
include amenorrhea or menstrual irregularity, hirsutism in
androgen-dependent regions (face, chest, lower abdomen), upper body obesity
(in 50% of patients), and infertility in patients of childbearing age.
Associated with the obesity, patients frequently have insulin resistance
resulting in adult-onset diabetes. Treatment may include progestins, oral
contraceptives, antiandrogens (including spironolactone), weight reduction,
ovulation-inducing medication, and surgery (laparoscopic ovarian cautery or
laser vaporization).
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Fasting blood sugar in older
patients (particularly obese patients). Ensure other conditions have been
excluded, for example, Cushing Syndrome.
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Consider implications of obesity and
glucose intolerance, if present.
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There are no known implications with
this condition.
Goudas V, Dumesic D: Polycystic ovary syndrome. Endocrinol Metab Clin North Am 26;4:893-911, 1997.
Legro R: The genetics of polycystic ovary syndrome. Am J Med 98(suppl 1A):9S,
1995.