Case Scenario 122

Infertility and Polycystic Ovarian Disease: "String of Pearls" in a Bearded Lady

The special chemistry section received laboratory requests for the following hormones: total testosterone, free testosterone, FSH, midfollicular LH, mid-follicular prolactin, androstenedione, DHEAS, dihydrotestosterone, andro-standiol glucuronide, and sex hormone-binding globulin. Many of these laboratory tests were to be sent to a reference laboratory. The referral database was consulted so that the correct type of specimen was collected and proper storage and handling conditions were met prior to performing the tests at the reference laboratory. The patient was a 23-year-old African-American female with a preliminary diagnosis of hirsutism and infertility. Previous laboratory results showed a slightly elevated 8:00 a.m. plasma cortisol level but a low-dose dexamethasone test showed normal cortisol suppression. The following laboratory results were obtained initially from the special chemistry section:

Test Result Reference Range

Testosterone, total (ng/dL) 65 15-70

Estradiol, midcycle (pg/mL) 151 150-750

Prolactin (ng/mL) 14 <20 in nonpregnant women

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