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Polycystic ovary syndrome


Step 1: View clinicals

A 23 year old nulliparous woman presents with amenorrhea associated with a weight gain of 12 kg, over a period of 6 months. She attained menarche at age 11, and her menstrual cycles have been irregular since then. She is sexually active and uses barrier methods for contraception. Her family history is significant for type 2 diabetes mellitus in both parents. A urine hCG test is found to be negative.

Step 2: Order all relevant investigations

Hormone profile

LH:FSH ratio: 3:1 S. Testosterone: 2.7 nmol/L (reference range <2.1 nmol/L) Low-dose dexamethasone suppression test: negative TSH, 17 hydroxyprogesterone, DHEAS, prolactin: normal


Fasting level: 115 mg/dL At 2 hours: 155 mg/dL

Ultrasound Pelvis

There are between 12 to 15 cysts of 3 to 6 mm in size in the periphery of each ovary. The endometrium is of normal thickness.

Lipid Profile

Total cholesterol: 184 mg/dL (optimal <200) LDL: 100 mg/dL (optimal <100) HDL: 60 mg/dL (optimal >60) Triglycerides: 120 mg/dL (normal <150)

Step 3: Select appropriate management

Combined OCPs
Uterine D&C
Finasteride stat

Score: ★★☆