Achieve Mastery of Medical Concepts

Study for medical school and boards with Lecturio

Ovarian Cysts

Ovarian cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change are defined as collections of fluid or semiliquid material, often walled off by a membrane, located in the ovary. These cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change are broadly categorized as either functional or neoplastic. Neoplastic ovarian cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change are subcategorized as either benign Benign Fibroadenoma or malignant. When the cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change occur as a result of normal physiologic processes, they are called functional, whereas if there is abnormal growth of ovarian cells, the cyst is referred to as neoplastic. In women of reproductive age, neoplastic ovarian cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change are typically benign Benign Fibroadenoma; however, the risk of malignancy Malignancy Hemothorax increases in the postmenopausal period. While most ovarian cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change do not cause symptoms, some women report vague symptoms such as lower abdominal pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways or abdominal fullness. Complications of functional cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change include torsion and rupture. Neoplastic cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change may be either benign Benign Fibroadenoma or cancerous. A diagnosis of ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer requires consultation with a specialist because treatment involves coordination Coordination Cerebellar Disorders of surgery and chemotherapy Chemotherapy Osteosarcoma. Treatment is dependent on the etiology of the ovarian cyst and may range from surgical intervention to supportive care only.

Last updated: 19 Apr, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Benign Cysts

Epidemiology and etiology

  • Follicular cyst
    • Most common ovarian mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast in women of reproductive age
    • Unruptured graafian follicle Graafian follicle Ovaries: Anatomy that continues to grow
    • Characteristics:
      • Multiple
      • Variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables size (normal follicles < 3 cm; pathologic follicular cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change are typically < 10 cm)
      • Lined with granulosa and theca cells Theca cells The flattened stroma cells forming a sheath or theca outside the basal lamina lining the mature ovarian follicle. Thecal interstitial or stromal cells are steroidogenic, and produce primarily androgens which serve as precursors of estrogens in the granulosa cells. Puberty
    • Associated with endometrial hyperplasia Endometrial Hyperplasia Benign proliferation of the endometrium in the uterus. Endometrial hyperplasia is classified by its cytology and glandular tissue. There are simple, complex (adenomatous without atypia), and atypical hyperplasia representing also the ascending risk of becoming malignant. Endometrial Hyperplasia and Endometrial Cancer and hyperestrogenism Hyperestrogenism Cirrhosis
  • Corpus luteal cyst 
    • Following ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle, follicles become corpus luteal cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change.
    • Secrete progesterone Progesterone The major progestational steroid that is secreted primarily by the corpus luteum and the placenta. Progesterone acts on the uterus, the mammary glands and the brain. It is required in embryo implantation; pregnancy maintenance, and the development of mammary tissue for milk production. Progesterone, converted from pregnenolone, also serves as an intermediate in the biosynthesis of gonadal steroid hormones and adrenal corticosteroids. Gonadal Hormones
    • Normal, physiologic structures in the second half of the menstrual cycle Menstrual cycle The menstrual cycle is the cyclic pattern of hormonal and tissular activity that prepares a suitable uterine environment for the fertilization and implantation of an ovum. The menstrual cycle involves both an endometrial and ovarian cycle that are dependent on one another for proper functioning. There are 2 phases of the ovarian cycle and 3 phases of the endometrial cycle. Menstrual Cycle and 1st trimester of pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care
    • Secrete progesterone Progesterone The major progestational steroid that is secreted primarily by the corpus luteum and the placenta. Progesterone acts on the uterus, the mammary glands and the brain. It is required in embryo implantation; pregnancy maintenance, and the development of mammary tissue for milk production. Progesterone, converted from pregnenolone, also serves as an intermediate in the biosynthesis of gonadal steroid hormones and adrenal corticosteroids. Gonadal Hormones required to maintain the endometrium Endometrium The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo. Embryoblast and Trophoblast Development in pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care
    • Characteristics:
      • Unilateral
      • Typically, 2‒3 cm size (but can be up to 8 cm)
      • Uniloculated cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change, which can contain some internal debris.
  • Endometriomas 
    • Also called chocolate cysts Chocolate Cysts Endometriosis
    • Arise from ectopic growth of endometrial tissue Endometrial tissue The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo. Endometriosis on the ovary 
    • A form of endometriosis Endometriosis Endometriosis is a common disease in which patients have endometrial tissue implanted outside of the uterus. Endometrial implants can occur anywhere in the pelvis, including the ovaries, the broad and uterosacral ligaments, the pelvic peritoneum, and the urinary and gastrointestinal tracts. Endometriosis

Clinical features

  • Usually asymptomatic if < 6 cm
  • Symptoms may include:
    • Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Peritoneal irritation
    • Delayed menses Menses The periodic shedding of the endometrium and associated menstrual bleeding in the menstrual cycle of humans and primates. Menstruation is due to the decline in circulating progesterone, and occurs at the late luteal phase when luteolysis of the corpus luteum takes place. Menstrual Cycle 
    • Vaginal bleeding
  • Follicular and corpus luteal cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change are rarely symptomatic if small and unruptured.
  • Endometriomas are much more likely to be symptomatic, regardless of size, typically presenting with:
    • Dysmenorrhea
    • Dyspareunia Dyspareunia Recurrent genital pain occurring during, before, or after sexual intercourse in either the male or the female. Primary Ovarian Insufficiency
    • Infertility Infertility Infertility is the inability to conceive in the context of regular intercourse. The most common causes of infertility in women are related to ovulatory dysfunction or tubal obstruction, whereas, in men, abnormal sperm is a common cause. Infertility

Diagnosis

  • History and exam
    • Consistent clinical symptoms
    • Palpable adnexal mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast on pelvic examination
  • Imaging
    • Ultrasonography:
      • Smooth, thin-walled
      • Anechoic Anechoic A structure that produces no echo at all (looks completely black) Ultrasound (Sonography)
      • Large cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change with reticular echoes might represent hemorrhage within a corpus luteal cyst, which should be followed with a repeat ultrasound in 2‒3 months.
    • MRI:
  • Cancer antigen Antigen Substances that are recognized by the immune system and induce an immune reaction. Vaccination 125 ( CA-125 CA-125 A carbohydrate antigen that occurs in tumors of the ovary as well as in breast, kidney, and gastrointestinal tract tumors and normal tissue. While it is tumor-associated, it is not tumor-specific and may have a protective function against particles and infectious agents at mucosal surfaces. Serum Tumor Markers) blood test:
    • Only for postmenopausal women
    • Complex cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change and high CA-125 CA-125 A carbohydrate antigen that occurs in tumors of the ovary as well as in breast, kidney, and gastrointestinal tract tumors and normal tissue. While it is tumor-associated, it is not tumor-specific and may have a protective function against particles and infectious agents at mucosal surfaces. Serum Tumor Markers associated with increased risk of malignancy Malignancy Hemothorax

Management

  • Typically no treatment required unless complications occur:
    • Follicular cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change usually resolve spontaneously within 1–2 menstrual cycles.
    • Resolution occurs after cyst fluid resorption or spontaneous rupture.
    • Cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change that do not resolve require further investigation.
  • Use of oral contraceptives has not proved to be helpful.
  • Transvaginal ultrasonography may be required to monitor cyst changes.
  • Surgical removal (oophorectomy):
    • Indications:
      • Suspected ovarian torsion Ovarian torsion Ovarian torsion is a clinical emergency in which the ovaries (with or without the fallopian tubes) twist along their axis, leading to partial or complete obstruction of their blood supply. Ovarian torsion is also called adnexal or tubo-ovarian torsion, especially if a fallopian tube is also involved. Ovarian Torsion
      • Persistent adnexal mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast
      • Suspected malignancy Malignancy Hemothorax

Related videos

Neoplastic Cysts

Classification

Neoplastic masses are classified according to their cell of origin: epithelial cells, germ cells Germ Cells The reproductive cells in multicellular organisms at various stages during gametogenesis. Gametogenesis, and sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria cord-stromal cells. Each has multiple histologic subtypes. Each subtype can be either benign Benign Fibroadenoma or malignant.

  • Epithelial cell tumors
    • Most common type of malignant ovarian tumor
    • Histologic subtypes include:
      • Serous tumors
      • Mucinous tumors
      • Clear cell tumors
      • Endometrioid tumors
      • Undifferentiated tumors
    • Histology, rather than radiographic appearance, determines if tumor is benign, borderline, or malignant.
    • Typically affect middle-aged and elderly women
  • Germ cell tumors: teratomas
    • Arise from germ cells
    • Common in children and adolescents
    • Usually asymptomatic and discovered incidentally on pelvic exam
    • Called “dermoid cysts” because they often contain ectodermal components, such as teeth Teeth Normally, an adult has 32 teeth: 16 maxillary and 16 mandibular. These teeth are divided into 4 quadrants with 8 teeth each. Each quadrant consists of 2 incisors (dentes incisivi), 1 canine (dens caninus), 2 premolars (dentes premolares), and 3 molars (dentes molares). Teeth are composed of enamel, dentin, and dental cement. Teeth: Anatomy and hair
    • High risk of ovarian torsion Ovarian torsion Ovarian torsion is a clinical emergency in which the ovaries (with or without the fallopian tubes) twist along their axis, leading to partial or complete obstruction of their blood supply. Ovarian torsion is also called adnexal or tubo-ovarian torsion, especially if a fallopian tube is also involved. Ovarian Torsion
  • Benign Benign Fibroadenoma sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria cord-stromal tumors
    • Histologic subtypes:
      • Fibroma
      • Thecoma
      • Fibrothecoma
    • Arise from the stroma of the ovary
    • Common in middle-aged women
    • Associated with ascites Ascites Ascites is the pathologic accumulation of fluid within the peritoneal cavity that occurs due to an osmotic and/or hydrostatic pressure imbalance secondary to portal hypertension (cirrhosis, heart failure) or non-portal hypertension (hypoalbuminemia, malignancy, infection). Ascites and pleural effusions
  • Metastatic tumors
    • Endometrium Endometrium The mucous membrane lining of the uterine cavity that is hormonally responsive during the menstrual cycle and pregnancy. The endometrium undergoes cyclic changes that characterize menstruation. After successful fertilization, it serves to sustain the developing embryo. Embryoblast and Trophoblast Development
    • Breast
    • Colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy
    • Cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy

Clinical features

  • Lower abdominal pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways: acute-onset pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways associated with ovarian rupture, torsion, or bleeding
  • Pelvic pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
  • Abdominal distention Abdominal distention Megacolon
  • Abdominal fullness, bloating Bloating Constipation
  • Indigestion
  • Heartburn Heartburn Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. Gastroesophageal Reflux Disease (GERD)
  • Early satiety Early Satiety Bariatric Surgery
  • Painful intercourse
  • Irregular periods
  • Abnormal vaginal bleeding
  • Urinary frequency
  • Constipation Constipation Constipation is common and may be due to a variety of causes. Constipation is generally defined as bowel movement frequency < 3 times per week. Patients who are constipated often strain to pass hard stools. The condition is classified as primary (also known as idiopathic or functional constipation) or secondary, and as acute or chronic. Constipation
  • Leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy swelling Swelling Inflammation
  • Weight loss Weight loss Decrease in existing body weight. Bariatric Surgery

Diagnosis

  • Ultrasonography used to determine malignancy Malignancy Hemothorax risk index:
    • Malignant tumors:
      • Bilateral
      • Multinodular
      • Presence of papillary projections
      • Solid areas within the tumor Tumor Inflammation
      • Presence of ascites Ascites Ascites is the pathologic accumulation of fluid within the peritoneal cavity that occurs due to an osmotic and/or hydrostatic pressure imbalance secondary to portal hypertension (cirrhosis, heart failure) or non-portal hypertension (hypoalbuminemia, malignancy, infection). Ascites
      • Abdominal involvement
  • Risk of malignancy Malignancy Hemothorax index (RMI): 
    • Clinical tool used to determine risk of cancer for ovarian tumors and to guide management
    • Considers 3 features:  menopausal status, ultrasound score, and presence of CA-125 CA-125 A carbohydrate antigen that occurs in tumors of the ovary as well as in breast, kidney, and gastrointestinal tract tumors and normal tissue. While it is tumor-associated, it is not tumor-specific and may have a protective function against particles and infectious agents at mucosal surfaces. Serum Tumor Markers in serum
    • Higher RMI correlates with increased risk of malignancy Malignancy Hemothorax.
  • MRI and CT scan features:
    • Heterogeneity
    • Faster contrast enhancement
    • Calcification
    • Multilocular cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change
Multiplanar ct demonstrating an ovarian cancer

Multiplanar CT demonstrating ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer

Image: “Multiplanar computed tomography scan demonstrating an ovarian cancer Ovarian cancer Ovarian cancer is a malignant tumor arising from the ovarian tissue and is classified according to the type of tissue from which it originates. The 3 major types of ovarian cancer are epithelial ovarian carcinomas (EOCs), ovarian germ cell tumors (OGCTs), and sex cord-stromal tumors (SCSTs). Ovarian Cancer” by Subapriya Suppiah. License: CC BY 3.0

Management

Complications

Ovarian torsion Ovarian torsion Ovarian torsion is a clinical emergency in which the ovaries (with or without the fallopian tubes) twist along their axis, leading to partial or complete obstruction of their blood supply. Ovarian torsion is also called adnexal or tubo-ovarian torsion, especially if a fallopian tube is also involved. Ovarian Torsion

  • Definition: twisting of the ovary and fallopian tube Fallopian Tube A pair of highly specialized canals extending from the uterus to its corresponding ovary. They provide the means for ovum transport from the ovaries and they are the site of the ovum’s final maturation and fertilization. The fallopian tube consists of an interstitium, an isthmus, an ampulla, an infundibulum, and fimbriae. Its wall consists of three layers: serous, muscular, and an internal mucosal layer lined with both ciliated and secretory cells. Uterus, Cervix, and Fallopian Tubes: Anatomy
  • Epidemiology:
    • Correlated with larger ovaries Ovaries Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes). Ovaries: Anatomy (> 5 cm)
    • Occur more often in women of reproductive age because of menstrual cycle Menstrual cycle The menstrual cycle is the cyclic pattern of hormonal and tissular activity that prepares a suitable uterine environment for the fertilization and implantation of an ovum. The menstrual cycle involves both an endometrial and ovarian cycle that are dependent on one another for proper functioning. There are 2 phases of the ovarian cycle and 3 phases of the endometrial cycle. Menstrual Cycle and formation of corpus luteal cyst
    • More common on the right side because the left adnexa is stabilized by the sigmoid colon Sigmoid colon A segment of the colon between the rectum and the descending colon. Colon, Cecum, and Appendix: Anatomy
  • Pathophysiology:
    • Twisting initially causes venous and lymphatic obstruction, leading to ovarian congestion and swelling Swelling Inflammation 
    • Evolves to arterial blockage
    • Results in ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage and infarction 
    • Final stage is local hemorrhage and tissue necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage
  • Clinical features: 
    • Pelvic mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast
    • Nausea Nausea An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. Antiemetics
    • Severe acute pelvic pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever
    • Abnormal bleeding
  • Diagnosis:
    • Laparoscopy Laparoscopy Laparoscopy is surgical exploration and interventions performed through small incisions with a camera and long instruments. Laparotomy and Laparoscopy (gold standard)
    • Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care test
    • Ultrasonography: most common finding is asymmetric enlarged ovary
    • CT scan
  • Treatment: detorsion via laparoscopic surgery
Twisted right ovarian cyst

Right ovarian torsion Ovarian torsion Ovarian torsion is a clinical emergency in which the ovaries (with or without the fallopian tubes) twist along their axis, leading to partial or complete obstruction of their blood supply. Ovarian torsion is also called adnexal or tubo-ovarian torsion, especially if a fallopian tube is also involved. Ovarian Torsion demonstrated by twisted pedicle and swollen ovary

Image: “Twisted right ovarian cyst” by Department of Pediatric Surgery, Division of Pediatric Urology, Cukurova University, Faculty of Medicine, Adana, Turkey. License: CC BY 3.0

Ruptured ovarian cyst

  • Clinical features: 
    • Unilateral lower abdominal pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Onset of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is acute and of moderate to severe intensity.
  • Diagnosis:
  • Treatment: laparoscopic surgery

Clinical Relevance

  • Polycystic ovarian syndrome Polycystic ovarian syndrome Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women, affecting nearly 5%-10% of women in the age group. It is characterized by hyperandrogenism, chronic anovulation leading to oligomenorrhea (or amenorrhea), and metabolic dysfunction. Polycystic Ovarian Syndrome: heterogeneous multisystem endocrinopathy Endocrinopathy IPEX Syndrome that is characterized by hyperandrogenism Hyperandrogenism A condition caused by the excessive secretion of androgens from the adrenal cortex; the ovaries; or the testes. The clinical significance in males is negligible. In women, the common manifestations are hirsutism and virilism as seen in patients with polycystic ovary syndrome and adrenocortical hyperfunction. Potassium-sparing Diuretics, ovarian dysfunction, and multiple cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change in the ovaries Ovaries Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes). Ovaries: Anatomy. The condition is also associated with metabolic syndrome Metabolic syndrome Metabolic syndrome is a cluster of conditions that significantly increases the risk for several secondary diseases, notably cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver. In general, it is agreed that hypertension, insulin resistance/hyperglycemia, and hyperlipidemia, along with central obesity, are components of the metabolic syndrome. Metabolic Syndrome, hyperinsulinemia Hyperinsulinemia Diabetes Mellitus, and insulin Insulin Insulin is a peptide hormone that is produced by the beta cells of the pancreas. Insulin plays a role in metabolic functions such as glucose uptake, glycolysis, glycogenesis, lipogenesis, and protein synthesis. Exogenous insulin may be needed for individuals with diabetes mellitus, in whom there is a deficiency in endogenous insulin or increased insulin resistance. Insulin resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing. Diagnosis is one of exclusion, so other causes of abnormal uterine bleeding Abnormal Uterine Bleeding Abnormal uterine bleeding is the medical term for abnormalities in the frequency, volume, duration, and regularity of the menstrual cycle. Abnormal uterine bleeding is classified using the acronym PALM-COEIN, with PALM representing the structural causes and COEIN indicating the non-structural causes. Abnormal Uterine Bleeding and hirsutism Hirsutism A condition observed in women and children when there is excess coarse body hair of an adult male distribution pattern, such as facial and chest areas. It is the result of elevated androgens from the ovaries, the adrenal glands, or exogenous sources. The concept does not include hypertrichosis, which is an androgen-independent excessive hair growth. Polycystic Ovarian Syndrome should be ruled out. Management includes attempting to restore normal ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle through weight loss Weight loss Decrease in existing body weight. Bariatric Surgery, oral contraceptive Oral contraceptive Compounds, usually hormonal, taken orally in order to block ovulation and prevent the occurrence of pregnancy. The hormones are generally estrogen or progesterone or both. Benign Liver Tumors pills, and assistance with fertility.
  • Ovarian tumors: Sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria-cord stromal tumors arising from the theca or granulosa cells within the ovary may secrete androgens Androgens Androgens are naturally occurring steroid hormones responsible for development and maintenance of the male sex characteristics, including penile, scrotal, and clitoral growth, development of sexual hair, deepening of the voice, and musculoskeletal growth. Androgens and Antiandrogens or estrogens, respectively. Individuals may have signs of virilization, irregular menstrual cycles, or abnormal uterine bleeding Abnormal Uterine Bleeding Abnormal uterine bleeding is the medical term for abnormalities in the frequency, volume, duration, and regularity of the menstrual cycle. Abnormal uterine bleeding is classified using the acronym PALM-COEIN, with PALM representing the structural causes and COEIN indicating the non-structural causes. Abnormal Uterine Bleeding. Initial treatment is surgical and based on the stage (if malignant).

References

  1. Miranda, A., MD, FACOG, Vasquez de Bracamonte, D., MD et al. (2016). Ovarian cysts: functional or neoplastic, benign or malignant? Retrieved June 17, 2021, from https://reference.medscape.com/features/slideshow/ovarian-cysts#page=1
  2. Horlen, C. (2010). Ovarian cysts: a review U.S. Pharmacist 35(7):1–4. Retrieved June 17, 2021, from https://www.medscape.com/viewarticle/726031_3
  3. Moolthiya, W., Yuenyao, P. (2009). The risk of malignancy index (RMI) in diagnosis of ovarian malignancy. Asian Pac J Cancer Prev 10:865–868. https://pubmed.ncbi.nlm.nih.gov/20162854/
  4. Mayo Clinic. Polycystic ovarian syndrome (PCOS). Retrieved June 18, 2021, from https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). None of the trademark holders are endorsed by nor affiliated with Lecturio.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

User Reviews

¡Hola!

Esta página está disponible en Español.

🍪 Lecturio is using cookies to improve your user experience. By continuing use of our service you agree upon our Data Privacy Statement.

Details