Description, Causes and Risk Factors:
Ovarian hyperthecosis refers to the presence of luteinized thecal cells within the ovarian stroma, separate from the follicles, and is accompanied by at least a moderate degree of stromal hyperplasia. The luteinized thecal cells may occur as single cells, small nests, or occasionally nodules. In contrast to the stromal location of luteinized thecal cells in SH, the luteinized thecal cells in PCOS occur around the periphery of the follicle. There is sometimes overlap in the morphologic features between SH and PCOS, however, it has been suggested that SH and PCOS are manifestations of the same heterogeneous disturbance of androgen metabolism.
Ovarian hyperthecosis is a tumorlike lesion considered a rare cause of hyperandrogenemia, possibly associated with virilization, in which ovarian involvement is almost invariably bilateral. Thus, it may be surprising that in the article by Brown et al, it was reported that at least 6 of 14 patients showed only unilateral involvement. They also reported an increased frequency of ovarian fibrothecomas in patients with hyperthecosis that has not been previously described. However, in their study, case selection was made from a computerized search of their institution's pathology and imaging databases, which identified patients with histologically proven hyperthecosis who had pelvic sonography before surgery. They also stated that histologic hyperthecosis can be an incidental pathologic finding with no biological or clinical consequences.
The cause of ovarian hyperthecosis is unknown. But most experts think that several factors, including genetics, could play a role. In women with ovarian hyperthecosis, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.
Researchers also think insulin may be linked to ovarian hyperthecosis. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with ovarian hyperthecosis have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen.
These are some of the symptoms of ovarian hyperthecosis
- Ovarian cysts.
- Infrequent menstrual periods, no menstrual periods, and/or irregular bleeding.
- Infertility because of not ovulating.
- Increased hair growth on the face, chest, stomach, back, thumbs, or toes.
- Weight gain or obesity, usually carrying extra weight around the waist.
- Patches of thickened and dark brown or black skin on the neck, arm, breasts, and thighs.
- Skin tags, or tiny excess flaps of skin in the armpits or neck area.
- Pelvic pain.
- Insulin resistance or type 2 diabetes mellitus.
- High cholesterol.
- High blood pressure.
- Male-pattern baldness or thinning hair.
- Anxiety or depression due to appearance and/or infertility.
- Sleep apnea, excessive snoring.
There is no single test to diagnose ovarian hyperthecosis. Your doctor will take a medical history, perform a physical exam, and possibly take some tests to rule out other causes of your symptoms. During the physical examination, the doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check out the areas of increased hair growth, so try to allow the natural hair growth for a few days before the visit. Your doctor might want to do a pelvic exam to see if your ovaries are enlarged or swollen by the increased number of small cysts. A vaginal ultrasound also might be used to examine the ovaries for cysts and check out the endometrium, the lining of the uterus. The uterine lining may become thicker if your periods are not regular. You also might have blood taken to check your hormone levels and toe measure glucose levels.
Ovarian hyperthecosis is a complex condition in women with manifestations across the lifespan and reflects a major health and economic burden in many countries. Therapy should target both short and long-term reproductive, metabolic and psychological aspects. Given the etiological role of insulin resistance and the impact of obesity on both hyperinsulinemia and hyperandrogenism, multidisciplinary lifestyle improvement aimed at normalizing insulin resistance, improving androgen status and aiding weight management is recognized as a critical initial treatment strategy. The loss in body weight of about 5% to 10% has been shown to improve many of the symptoms of ovarian hyperthecosis. Management of ovarian hyperthecosis should focus on medical therapy along with support, education, addressing psychological needs and encouraging a healthy lifestyle. Monitoring and management of long-term metabolic complications is also an important part of routine clinical care. Screening high-risk family members for metabolic disorders should also be made a priority. More research efforts are needed to tackle this complex problem.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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