<s>[INST] context: (|FSH /LH ratio & | Estrogen level) (102, 331-32 Show's 14th)* Among the following options - best answer is FSH /LH ratio* POLYCYSTIC OVARIAN SYNDROME or DISEASE (PCOD)- Points in favor for diagnosis -- Anovulation- Hirsutism, obesity- | estrogen (E2) level- | FSH / LH ratio- | Androgen AD. DHEA- Sex hormone binding globulin (SHBG)|- Fasting insulin level is more than 10 mlIU/LSequelae of PCOD - DM, CVS disorder, Lipidaemia, Hypertension, Endometrial cancer, Breast cancer, Premature ovarian failure following surgeryCauses of Hirsutism* Ovarian - PCOD, hyperthecosis, masculinizing ovarian tumour, eg arrhenoblastoma, hilus cell tumour* Adrenal - congenital adrenal hyperplasia, cushing syndrome, adrenal tumour* Drugs - Androgens; progestogens with androgenic effect viz 19 norsteroids and levonorgestrel anabolic steroids, phenytoin, danazol, minoxidil* Other - Obesity, hypothyroidism, anovulatory hypo- oestrogenism idiopathic - 15%, hyperprolactinaemiaHYPERPROLACTINEMIAWomen: oligomenorrhea, amenorrhea, galactorrhea, infertilityProlactin normally elevated during pregnancyMen - Hypogonadism, decreased libido, and erectile dysfunction infertilityCT or MRI - demonstrate - pituitary adenomaStein Leventhal Syndrome or PCOD or PCOSClinical featuresHormonalSequelae-* Young women* Central obesity* BMI > 30 kg/cm2 * Waist line > 35"* Oligo menorrhoea, Amenorrhoea* Infertility (30%).* Hirsutism|E2 level|FSH | H> 10 IU/ml| FSH/LH ratio| Androgen* Testosterone, epiandrostenedione, dehydro epiandrosterone*17a hydroxyl progesterone >800 ng/dL* DM (15%)* CVS disorder* Lipidaemia* Hypertension* Endometrial cancer* Breast cancer* Premature ovarian* Acanthosis nigra due to insulin resistance*** Thick pigmented skin over the nape of neck inner thigh and axillaUltrasound - Necklace appearance*** Testosterone >0.5 ng/ml* |fasting insulin > 10ml IU/L* Prolactin |* Sex hormone binding globulin (SHBG)i* |E2/oestrone (E1) ratio* F. glucose / insulin ratio > 4.5 (Normal 2.4-4.5)failure following surgery:* 'Spongy appearance' with central sunburst calcification is seen in- Serous cyst adenoma or microcystic adenoma (793- Sutton 7th) [/INST] question: A lady presented with hirsutism, anovulation increased estrogen level, which of the other diagnostic investigation helps in diagnosis | options: A: | Prolactin level B: | LH, T ESR C: | FSH /LH ratio D: | Testosterone, epiandrostenedione | answer: C </s>