STEIN-LEVENTHAL SYNDROME

also called Polycystic Ovary Syndrome, endocrine disorder in women that is characterized by an elevated level of male hormones (androgens) and an absence of ovulation (anovulation). It is one of the most common hormonal disorders and is responsible for a substantial proportion of cases of female infertility. Additional symptoms include hirsutism and acne, which result from high androgen levels. Anovulation may manifest as irregular or absent menses, excessive bleeding, and infertility. Another common feature is obesity. Usually, but not always, the ovaries are enlarged and contain many follicular cysts. The disease usually begins in puberty, but because symptoms can be mild the disease is often not diagnosed until a woman is unable to conceive. Affected individuals exhibit a wide variety of signs and symptoms, and for this reason some authorities think the syndrome is not one but several different syndromes. The term polycystic ovary syndrome is somewhat of a misnomer. When Irving F. Stein and Michael L. Leventhal originally described the disease in 1935, they considered the cyst-containing ovaries to be a distinguishing feature; however, anovulation and an elevated level of androgens, not ovarian cysts, are now considered essential for diagnosis of the condition. Excessive androgen secretion, which chronically stimulates estrogen production and disrupts the monthly menstrual cycle, is responsible for the development of the disease. The site of androgen overproduction may vary, but the ovaries are thought to be the main source of the hormones. The disease develops as excess androgens are converted to estrogen, which stimulates the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus and inhibits the secretion of follicle-stimulating hormone from the pituitary. GnRH also acts on the pituitary to produce lutenizing hormone, which stimulates the ovaries to produce more androgens, completing the cycle. The underlying cause of androgen overproduction by the ovaries is not fully understood. Treatment of the disease attempts to curtail excess androgen production. Hirsutism in women who do not wish to become pregnant can be treated with oral contraceptives. Infertility usually is treated with clomiphene citrate, which induces ovulation, but laparoscopic surgery is sometimes used.