Which is raised in polycystic ovarian syndrome:

Ans. C. Luteinizing hormonePolycystic ovarian syndrome (PCOS) OR disease (PCOD)/stein Leventhal syndromea. PCOS includes chronic non-ovulation and Hyperandrogenemia associated with normal or raised estrogen (E2), raised LH, and low FSH/LH ratio.b. Age -15-25 yearsFeaturesa. The raised E2 level causes negative feedback to pituitary resulting in diminished FSH but raised LH.b. The involvement of adrenal glands is seen in raised androstenedione, dehydroepiandrosterone, testosterone and 17-alpha-Hydroxy-progesterone.c. Much of the testosterone is secreted by the ovarian stroma.d. Macroscopicallye. OvariesBilateral Enlarged LobulatedFree of Adhesion"Necklace" appearance on ultrasoundClinical Featuresa. The women is young who complains of oligomenorrhea and often amenorrhea.b. Infertility occurs in 30%.c. Obesity and hirsutism.DiagnosisLaparoscopic evaluation is not only diagnostic, but also therapeutic.Treatment of PCOSa. Oestrogen suppresses androgen and adrenal production. It is best given with progestogen with no androgenic properties, cyclically as in oral contraceptives.b. Dexamethasone 0.5mg or prednisone 5mg at bedtime also reduces androgen production.c. Hirsutism is treated with cyproterone acetate or spironolactone.d. Infertility is treated with clomiphene.e. In clomiphene failed group, ovulation can be induced with FSH or GnRH analogues.Surgery is reserved for those in whom:a. Medical therapy failsb. Hyperstimulation occursc. Use of GnRH analogues is a cost constraint.d. Surgery comprises laparoscopic multiple punctures of the cysts with electrocautery or laser.