OVARIAN HYPERTHECOSIS
In ovarian hyperthecosis, nests of luteinized theca cells are scattered in the
ovarian stroma, rather than being confined to areas around cystic follicles (as in
PCOS). Large amounts of androgens are produced, leading to increased
peripheral estrone production and markedly increased risk of endometrial
hyperplasia and carcinoma.
The clinical features are similar to those of PCOS; however, hirsutism is more
severe and virilization is frequent.
Management. Treatment is similar to that for hirsutism. Use oral contraceptive
pills both to suppress androgen production (by reducing LH stimulation of the
theca cells) and to decrease free androgens (by stimulating sex hormone-binding
globulin).
Patients present with anovulation, amenorrhea, or oligomenorrhea. Most
patients will have severe insulin-resistance, with type 2 diabetes mellitus and
cardiovascular disease.
Unlike PCOS, which occurs only during the reproductive years, hyperthecosis
of the ovaries can occur in postmenopausal women.