<prompt> A lady presented with hirsutism, anovulation increased estrogen level, which of the other diagnostic investigation helps in diagnosisProlactin levelLH, T ESRFSH LH ratioTestosterone, epiandrostenedione  <response>: FSH LH ratio Estrogen level 102, 331-32 Shows 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 mlIULSequelae 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 kgcm2 Waist line 35 Oligo menorrhoea, Amenorrhoea Infertility 30. HirsutismE2 levelFSH H 10 IUml FSHLH ratio Androgen Testosterone, epiandrostenedione, dehydro epiandrosterone17a hydroxyl progesterone 800 ngdL 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 ngml fasting insulin 10ml IUL Prolactin Sex hormone binding globulin SHBGi E2oestrone E1 ratio F. glucose insulin ratio 4.5 Normal 2.4-4.5failure following surgery: Spongy appearance with central sunburst calcification is seen in- Serous cyst adenoma or microcystic adenoma 793- Sutton 7th 