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Your next patient has hirsutism and evidence of androgen excess. Note the hair growth on the chin and the oily skin. Serum testosterone and cortisol should be tested in this patient. Your differential diagnosis includes:
| Patients with ovarian hyperandrogenism may have minimal evident changes on ultrasound studies and physical examination. (note the yellow lipid color of the ovarian stroma) |
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Polycystic ovary, high power view.
Prominent layer of theca interna cells with
extensive luteinization. Atretic follicles are
more abundant in the cortex.
Credits: Edward C. Klatt, M.D. |
Her testosterone level returns at 90 ug/dl (upper limits of normal) and she has a normal 24 hour urinary free cortisol level which rules out Cushing's syndrome. The following is the ultrasound appearance of her ovaries.
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Polycystic ovary-pearl necklace sign.
Underlying the bladder is the ovary with a
classical polycystic appearance often referred
to as a "pearl necklace
Credits: Paula Woodward, M.D. |
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