-IBIS-1.5.0-
tx
reproductive system
ovarian cyst
diagnoses

definition and etiology

definition:
A cyst on an ovary. When associated with with other disorders of the hypothalamic-pituitary-ovarian axis, and many cysts are present, it is termed Polycystic Ovary Syndrome (aka Stein-Leventhal Syndrome).

etiology:
Ovarian cysts may be due to endometriosis, follicular or corpus luteum cysts, malignancy, or dermoid cysts.

In Polycystic Ovary Syndrome, follicular cysts develop as a result of pituitary overproduction of LH to try to initiate ovulation.

signs and symptoms

signs and symptoms: (non-polycystic)
• Often, these cysts are asymptomatic.
• Abdominal pressure, discomfort, pain with palpation, heaviness. There is rarely sharp sudden pain that would tend to indicate a different pathology such as rupture, hemorrhage, or ovarian torsion.
• Bleeding with ovulation.
• Metrorrhagia.

lab findings:
• Endometrial biopsy: in women over 35 years old.
• Laparoscopy.

signs and symptoms: (polycystic)
• Normal maturation of sexual development.
• Hirsutism: usually only on the face.
• Obesity.
• Anovulating periods.
• Irregular periods with extended periods of amenorrhea.
• Infertility.
• Ovaries are enlarged and polycystic.

lab findings:
• Increased serum LH and normal FSH.
• Serum testosterone: increased.
• Urine 17-KS: increased.
• Endometrial biopsy: in women over 35 years old.
• Serum androstenedione: increased.
• with luteal cysts, see increased pregnanediol in urine

course and prognosis

In non-polycystic cysts, treatment is only needed if the cyst becomes symptomatic (unless there is a malignancy). Conventional treatment is usually surgery.
In polycystic ovary syndrome, while the course is typically benign, achieving pregnancy may be problematic (usually fertility must be drug-induced). Otherwise, normal conventional treatment consists of suppressing the pituitary release of LH by giving low-dose estrogen BCPs.

differential diagnosis

• Ovarian adhesions.
• Uterine fibroid, cysts, adhesions.
• Investigate other endocrine abnormalities


footnotes