The nuances of ovarian morphology have been reviewed in Chapter 16. It is important here to note that because polycystic ovarian morphology has become an integral part of the diagnosis of PCOS, patients suspected of having androgen excess should undergo transvaginal sonography when possible. Importantly, the definition of "polycystic-appearing" ovaries is relatively uniform and specific. It should also be understood that although virginal women and others who do not tolerate a transvaginal ultrasound probe can undergo transabdominal ultrasonography for ovarian examination, this latter method is considerably less sensitive than the transvaginal approach (26).
2.4. Predictive Value of the Clinical Features Observed in Patients With Possible Androgen Excess
Clinical experience has indicated that the majority of women with signs of virilization (i.e., mas-culinization of body muscular, severe or extreme male-pattern balding or hirsutism, clitoromegaly, etc.) will have androgen excess. Although rarely a sign of PCOS, virilization can be seen in patients with disorders of severe insulin resistance, androgen-secreting tumors, and androgenic substance abuse. Less clear is the predictive ability of less dramatic signs and symptoms. Although reviewed previously (see Chapter 14), it is still noteworthy to briefly summarize the predictive ability of the various historical and clinical features of androgen excess.
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