Polycystic ovarian syndrome Stein-Leventhal syndrome

• Facts:
  Abnormal GnRH secretion, causes excessive LH
  Anovulation caused by LH/FSH imbalance and insulin resistance
• History / PE:
  Hirsuitism , obesity, acne
  Menstrual irregularities
  Hyperandrogenism
  Insulin-resistance
  Acanthosis nigricans
• Diagnosis:
  Glucose tolerance test (more sensitive than fasting glucose)
  U/S for ovarian cysts
  Increased LH/FSH ratio
  Elevated testosterone levels
• Treatment:
  Metformin (for patients with impaired glucose tolerance)
  Clomiphene (encourages ovulation )
• Complications:
  Unopposed estrogen because of the oligo-anovulatory state leads to increased risk for endometrial cancer
• Differential Diagnosis:
  Aromatase deficiency (ambiguous external genitalia)
  Congenital adrenal hyperplasia