Spot diagnosis

A 19-year-old female presents to her family physician with a six-month history of worsening acne, irregular menses and difficulty sleeping.

She mentions her last menstrual period was 45 days ago.

On examination, she is overweight, and excess hair is seen on her upper lip and chin.

Laboratory tests reveal normal follicle-stimulating hormone levels, elevated luteinising hormone levels and elevated testosterone levels.

An ultrasound demonstrates the findings seen here.

Based on this patient’s presentation, which of the following malignancies is she at greatest risk for as she ages? (answer below)

  • Ovarian
  • Thyroid
  • Endometrial
  • Breast

Answer:

Endometrial

This patient has polycystic ovarian syndrome (PCOS), a set of symptoms characterised by ovulatory dysfunction and excess androgen production.

Patients with PCOS are at an increased risk of endometrial carcinoma and hyperplasia due to prolonged unopposed oestrogen.

These women are also at increased risk of type 2 diabetes, metabolic syndrome and cardiovascular disease.

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