An Unusual case of polycystic ovary syndrome

Abstract

A 19 year old girl with primary smenorrhoea presented with lower abdominal pain, deepening of voice, hirsutism and hyperpigmentation of skin for five years. She had undergone left sided oophorectomy and wedge biopsy of the right sided ovary five years back and histology had revealed multiple ovarian cysts of follicular origin. On examination she was found to have a normal body habitus, temporal recession of hairline, hirsutism and clitoromegaly. Breasts were of Tanner stage 4-An ultrasound scan of abdomen revealed a right adnexal cyst of approximately 7x7 cm size. Serum testoeterone was mildly elevated. Serum dehydroepiandrosterone sulphate and 17 hydroxy progesterone levels were normal. A laparotomy carried out on 10 May 2005 revealed a right ovarian cyst of 7x7 cm. Cut surface of the cyst showed a large unilocular cyst and peripherally displaced multiple cysts of 0.5x0.5 cm size in thinned out stroma. Right sided oophorectomy was performed. Histology revealed multiple follicular cysts which was suggestive of polycystic ovaries. One month after surgery there is already an improvement in the pigmentation of skin and hirsutism. She was started on oral contraceptive pills. She is awaiting results of androstenedione, follicle stimulating hormone, luteinizing hormone and karyotype. This is a rare presentation of polycystic ovary syndrome.