Case 259

Medical History

A 40-year-old female patient, G3Pc3A0, sought gynecological care with complaintsof obesity and hirsutism for many years. Refers irregular menstrual cycles sincemenarche, occurring at 14 years. In use of losartan and hydrochlorothiazide forhypertension and carbamazepine for epilepsy. Physical examination: grade IIobesity, cervical acanthosis nigricans, genitalia and breasts without alterations.Laboratory exams were requested, which results were normal for testosterone,DHEA, cortisol after suppression with 2mg of dexamethasone, TSH, T4L and 17-OH progesterone, with only prolactin being elevated (29ng / mL - VR: up to 19ng /mL). Endovaginal ultrasonography was also performed.

Given the clinical history and the images presented, what is the main diagnostichypothesis?

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