Polycystic Ovary (Stein-Leventhal) Syndrome: Etiology, Complications, and Treatment

Karri Lynn Hoyt; Margaret C Schmidt

doi:10.29074/ascls.17.3.155

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Karri Lynn Hoyt, MS RD MHS PA-C
1. is a Physician Assistant, Intermountain Health Care Instacare, Logan UT
Margaret C Schmidt, EdD CLS⇑
1. is at Duke University, Durham NC

Address for correspondence: Dr Margaret C Schmidt, Duke University Physician Assistant Program, Hanes House RM 337, DUMC 3848, Durham NC 27710. (919) 684-3872, (919) 681-3371 (fax). schmi006{at}mc.duke.edu

Extract

Polycystic ovary syndrome (PCOS) occurs in approximately 3% to 5% of the female population and may be the leading cause of infertility in those of reproductive age. PCOS presents clinically with a variety of signs and symptoms; the most common being menstrual irregularities, hyper-androgenism, infertility, and obesity. The true pathophysiology has not been clearly elucidated; however, there is growing agreement that gonadotropin dynamic dysfunction, hyperandrogenism, and insulin resistance are key features. The diagnosing of PCOS involves radiologic and laboratory studies. Radiologic studies typically include pelvic ultrasound; laboratory data should be obtained regarding pertinent gonadotropins and other hormone levels. PCOS is not a benign condition. It may lead to complications involving glucose metabolism, dyslipidemias, cardiovascular disease, and cancer. The goals of treatment should focus on restoring menstrual regularity, decreasing androgen excesses, and decreasing insulin resistance.

CASE STUDY A 27-year-old female presents to her primary care provider with complaints of amenorrhea times 11 months. Patient's past medical history is significant for starting menses at age 14. Menses have never been regular and when they do occur they are light. The longest time without a menstrual cycle is 18 months. A prior provider initiated progesterone withdrawal as a treatment; however, patient only used treatment once. Patient indicates that she is not pregnant at this time. Family history is significant for a sister and several paternal cousins with menstrual irregularities.

On physical exam the patient is of normal weight for height; it is noted that patient has slightly darker hair above the upper lip,…

ABBREVIATIONS: AN = acanthosis nigricans; FSH = follicle stimulating hormone; GnRH = gonadotropin releasing hormone; HAIRAN = hyperandrogenic-insulin resistance-acanthosis nigricans; hCG = human chorionic gonadotropin; HDL = high-density lipoproteins; LDL = low-density lipoprotein; LH = luteinizing hormone; OCP = oral contraceptive pill; PCOS = polycystic ovary syndrome; SHBG = sex hormone binding globulin; TSH = thyroid stimulating hormone.