PCOS Forum

Research in Polycystic Ovary Syndrome Today and Tomorrow

Renato Pasquali; Elisabet Stener-Victorin; Bulent O. Yildiz; Antoni J. Duleba; Kathleen Hoeger; Helen Mason; Roy Homburg; Theresa Hickey; Steve Franks; Juha S. Tapanainen; Adam Balen; David H. Abbott; Evanthia Diamanti-Kandarakis; Richard S. Legro


Clin Endocrinol. 2011;74(4):424-433. 

In This Article


Hyperthecosis is the development of nests of luteinized thecal cells, usually diffusely, in the ovary with the subsequent production of androgens and presentation with signs of androgen excess. Unlike PCOS, there is not an abundance of antral follicles surrounded by theca, in fact it often develops in postmenopausal women devoid of follicles.[46] The cause of hyperthecosis is unknown. The phenotype in hyperthecosis can be more severe than PCOS, as women can present with markedly elevated testosterone levels and may develop frank signs of virilization. Hyperinsulinaemia is also frequently part of the phenotype.[47] Although this condition responds to GnRH agonist suppression,[48] the usual treatment is oophorectomy, especially in a postmenopausal woman. Because this condition is rare, most publications are case reports and case series; however, it offers an intriguing clinical model for hyperandrogenism and insulin resistance solely because of an ovarian factor. Hyperthecosis, especially as an acquired condition of sudden onset, lends itself to the possibility of an infectious and/or autoimmune response to an infection or some external antigen, a possibility discussed below in relation to PCOS.


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