Figure II-12-7. Adrenal HyperplasiaPolycystic Ovarian Syndrome (PCOS): typically the onset has been gradual,
frequently with a positive family history. In addition, the history is positive for
irregular bleeding and infertility.
Examination. Physical examination usually reveals hirsutism, often with
obesity and increased acne. Bilaterally enlarged, smooth, mobile ovaries will
be palpated on pelvic examination. Acanthosis nigricans may be seen.
Laboratory tests. Testosterone level is mildly elevated. LH to FSH ratio is
elevated (3:1). Sex hormone binding globulin (SHBG) is decreased.
Imaging. Pelvic U/S will show bilaterally enlarged ovaries with multiple
subcapsular small follicles and increased stromal echogenicity.
Management. Combination OCPs, which will lower free testosterone levels
in two ways: by suppressing LH stimulation of the ovarian follicle theca cells