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Polycystic Ovarian Syndrome

 Stein-Leventhal Ovaries

Submitted by Ryan Smith, MD

·         Polycystic ovarian syndrome (PCOS), also known as, Stein-Leventhal syndrome, includes

o       Polycystic ovaries

o       Obesity

o       Hirsutism

o       Infertility

·         Women with PCOS have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production

·         Elevated androgen levels can be of ovarian (eg, testosterone, androstenedione) or adrenal (dehydroepiandrosterone sulfate) origin

·         The luteinizing hormone level is elevated, with reversal of the LH/FSH ratio as LH becomes higher than FSH throughout the menstrual cycle

·         PCOS is also associated with peripheral insulin resistance

o       Approximately 10% of women who are obese and have PCOS also have type 2 diabetes mellitus by age 40 years

·         Imaging

o       Ultrasound is the imaging modality of choice 

o       Polycystic ovaries are enlarged and rounder than normal with increased stromal echogenicity

o       There are numerous small cysts, less than 5mm, that line up on the periphery, in a “string-of-pearls” appearance

o       Ultrasonographic criteria for establishing the diagnosis of PCOS are 10 or more cysts that are 2-8 mm in diameter and are peripherally arranged around an echodense stroma


Polycystic Ovarian Syndrome (Stein-Leventhal Ovaries). Both the right and left ovaries show numerous
cysts arranged around the periphery of the ovaries producing the "string-of-pearls" sign..
Click here for a larger view of this photo



·         The minimal criteria proposed for the diagnosis of PCOS include

o       Menstrual dysfunction

o       Evidence of hyperandrogenism, whether clinical (eg, hirsutism, acne, male pattern balding) or biochemical (elevated androgen level and other causes of hyperandrogenism must be excluded)