AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 32 CASE REPORT African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | Polycystic Ovary Syndrome: An update from the 2023 international guideline and 3 girls). There was no family history of disorders of sexual differentiation, genetic, endocrine or other chronic medical disease, or consanguinity. Her mother did not recall using any medications during her pregnancy and did not manifest any clinical features consistent with hyperandrogenism, adrenal or ovarian tumours. On examination, shewas short, with a height and bodymass index of 154cm and 26.56kg/m 2 respectively. Blood pressure was normal (127/67mmHg). There was mild temporal and occipital balding and sparse hair on the chin. Examination of the thyroid gland, cardio-respiratory and neurological systems were normal. Her breasts were assessed as Tanner stage 1 and she was masculine with broad shoulders, prominent calves and narrow hips. The abdominal examination was normal. She had Tanner stage 5 pubic hair development. On genital exam, the clitoris was prominent with large crura felt beneath the skin, altogether 2x4cm. There was a scar at the apex of the clitoris. The labia majora were almost fused posteriorly with loose creased skin. The labia minora were elongated beyond the majora. There was a single perineal orifice located posterior to the clitoris. Prader Stage 3 (Figure 1). Gonads were not clinically palpable. Figure1: Image of theVulva Baseline blood samples were collected at 08.10am and were registered in the laboratory within 30 minutes of collection. Serum androgen levels were elevated: testosterone 13.4nmol/L, dehydroepiandrosterone sulphate (DHEAS) 18.2umol/L. However, 17α-hydroxyprogesterone (17-OHP) was low normal at 1.6nmol/L. Reference intervalss in Table 1. Other hormones were normal: anti-mullerian hormone 1.63ng/ml, estradiol 396pmol/L, thyroid stimulating hormone 1.99mIU/L and follicle stimulating hormone 3.1 IU/L. Serum electrolytes were normal with sodium 142mmol/L, potassium 4.2mmol/L and fasting blood sugar 5.1mmol/L. Magnetic Resonance Imaging of the pelvis revealed bilateral polycystic ovaries, a bicornuate uterus and upper vagina. The lower vagina was not clear (Figure 2). Figure 2: MRI of the Pelvis