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Hypothyroidism
10%
27/271
Endometrial carcinoma
77%
209/271
Addison disease
7%
19/271
Wegener granulomatosus
1%
3/271
Eclampsia
2%
5/271
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Enlarged ovaries with multiple cysts, irregular menstrual cycles, and hyperandrogenism are characteristic of polycystic ovarian syndrome (PCOS). Patients with PCOS are at increased risk of endometrial carcinoma. While the exact cause of PCOS is unknown, patients have elevated luteinizing hormone (LH) levels that often lead to theca cell hyperplasia. An LH:FSH ratio > 2 is typical. Theca cells produce excess androgens which aromatase converts to estrogens in fat cells. Abnormally high estrogen levels stimulate endometrial hyperplasia, a precursor to endometrial carcinoma. Illustration A shows a polycystic ovary on ultrasound. Incorrect Answers: Answer 1: Hypothyroidism is most often due to iodine deficiency or autoimmune thyroiditis. Though patients with PCOS often have other endocrine abnormalities, this patient is most at risk for developing endometrial carcinoma. Answer 3: Addison disease is an endocrine disorder in which the adrenal glands fail to produce sufficient steroid hormones. It is not associated with PCOS. Answer 4: Wegener granulomatosis is a vasculitis that affects the nose, lungs, kidney, and other organs. It is not associated with PCOS. Answer 5: Eclampsia is an emergent complication of pregnancy marked by seizures, pregnancy induced hypertension, and proteinuria. It is not associated with PCOS.
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