Wednesday, January 2, 2008

Eggs in One Basket

A 30 year old woman presents to your fertility clinic because she is having difficulty getting pregnant. As you take a focused history, you find that she began having periods at age 14 but her cycles have always been irregular, infrequent, and unpredictable. She had severe acne when she was young and has had an abnormal amount of hair on the upper lip, chin, around the nipples, and along the linea alba of the lower abdomen. When you take an ultrasound of her ovaries, you see this:

Challenge: What is your diagnosis?

Related Questions:
1. What is the hair finding called?
2. What is seen on the image?

Image shown under Fair Use.


Alex said...

1. hirsutism
2. i see some sort of mass. I think it is most likely polycystic ovarian disease because the mass is bilateral, and because it is associated with hirsutism.

If it was unilateral, have to figure out whether it's surface-derived or a germ cell tumor. If the former, ddx includes benign or malignant (cystadenoma versus cystadenocarcinoma) serous vs. mucinous, or a Brenner's tumor. If germ-cell derived, could be a terratoma, yolk sac tumor, or dysgerminoma.

Craig said...

Eggs in One Basket

This is polycystic ovarian syndrome (PCOS) with the key features of oligo- or anovulation and hyperandrogenism. This is one of the most common endocrinopathies among women (6.5-8% prevalence). The menstrual dysfunction is characterized by oligo- or amenorrhea and infertility. The hyperandrogenism manifests as hirsutism, acne, and male pattern balding. The ultrasound shows numerous small cysts on the periphery making a “string-of-pearls” appearance. PCOS is associated with obesity and peripheral insulin resistance.

Sources: UpToDate, LearningRadiology.