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A 25-year old women presents with complaints of amenorrhea over the past six months. The woman is 5'5", obese, and exhibits excessive terminal hairs on the face, chest, back, and lower abdomen. Ultrasound shows that both ovaries are significantly enlarged. Serum LH concentration is increased compared to normal, while serum FSH concentration is decreased. Biopsy of an ovary from this patient would most likely show which of the following?
A. Atrophied theca cells
B. Dysgenesis with chromosomal mosaicism
C. Hyperplastic granulosa cells
D. Large numbers of cystic follicles
E. Seminiferous tubules
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DD policystic ovarian syndrome
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d is the ans
its pcod a.k.a pcos
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Guys you are all good.......
The correct answer is D. Polycystic ovary syndrome often results in amenorrhea because of excessive ovarian androgen production secondary to increased plasma LH. The initiating event in this disorder is not known, but could be due to excessive secretion of GnRH by the hypothalamus. The pituitary responds to the abnormal pattern of GnRH release by increasing LH secretion, but decreasing FSH secretion. The increased LH causes theca cell hyperplasia (not atrophy, choice A) and excessive androgen secretion. With low FSH levels, granulosa cells would be atrophied (not hyperplastic, choice C) and would have insufficient aromatase activity to convert the androgen to estrogen. The high local androgen concentration may be responsible for the formation of numerous small cystic follicles. One or both of the ovaries are often significantly enlarged. The hirsutism associated with polycystic ovarian syndrome is likely due to the increased ovarian secretion of androgen.
Ovarian dysgenesis with chromosomal mosaicism (choice B) is typical of Turner's syndrome. Individuals with the XO genotype typically have hypogonadism, in part, because of abnormal ovarian development. The ovary may contain multiple cell lines with varying chromosomal composition. Turner's syndrome is characterized by a constellation of physical abnormalities (short stature, webbed neck, shield chest) that are not present in this patient.
The presence of seminiferous tubules in the gonad (choice E) of a phenotypic female would suggest testicular feminization syndrome. In this syndrome, XY genotypic males are produced that lack androgen receptors. Although the individual exhibits female phenotypic external genitalia and secondary sex characteristics, a uterus is absent and menstrual cycles never begin. The absence of androgen receptors would also preclude the possibility of hirsutism.
