Question

Ms. Dalisay is 19 years old, single from the province. She came to Manila and sought consultation because of irregular menstruation sometimes only after 3 months or 4 months. She is a chubby individual with a weight of 180 lbs. She was initially given pills and eventually additional laboratory work-up was done which included an ultrasound which revealed cystic structures in he ovaries. Impression on ultrasound is Polycystic Ovarian Syndrome. Based on your knowledge learned in the reproductive system.

1. What specific area of that part of the reproductive system is affected?

2. What specific histological structures are involved or affected in the problem?

3. What is the main cause of the problem?

4. Describe those parts or structures of the reproductive system that are affected.

5. Explain briefly menstrual cycle until the point where the problem started.

Answer 1

Answer 1:

The ovaries of the female reproductive system is specifically affected.

Answer 2

The histological structures affected are :

• Theca cells of the ovarian follicles
• The endometrium of the uterus.
• The Granulosa cells of the ovarian follicle

Answer 3

Main cause of the problem is as following:

1. Excess secretion of luteinizing hormone from the anterior pituitary gland.
2. This stimulates the thecal cells to produce androgen ( testosterone, androstenedione)
3. There is relative low level of follicle stimulating hormone
4. Due to lack of FSH, the granulosa cells are unable to convert the androgen to estrogen
5. This in turn leads to anovulatory cycle.
6. Due absence of ovulation, the corpus luteum formation there is lack of progresterone.

Answer 4 :

1. The ovaries are enlarged bilaterally
2. The Ovarian capsule is thick and smooth and avascular
3. Cut section shows - subcapsular follicles in various stages of atresia.
4. Hyperplasia of the theca stromal cells surrounding the follicle

Answer 5:

• The Gonadotropin releasing hormone is not secreted in the normal cyclic manner.
• It is secreted in excessive amount throughout the day.
• This causes excessive secretion of the Luteinizing hormone compared to follicle stimulating hormone.
• This stimulates the thecal cells to secrete excess of androgen.
• Due to lack of FSH, the granulosa cells are unable to convert these androgens to estrogen.
• This leads to failure of ovulation.
• Therefore there is menstrual irregularity.
• The cycles are irregular and long