Polycystic Kidney Disease Associated with Polycystic Ovarian Syndrome

M. Segasothy, Department of Medicine, Faculty of Medicine, University Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur (Malaysia) Dear Sir, Autosomal dominant polycystic kidney disease (ADPKD) is commonly associated with other systemic manifestations such as cardiac valvular lesions, intracranial aneu-rysms, hepatic cysts and diverticula [1]. Rarely, ovarian cysts have been associated with ADPKD [1]. Polycystic Ovarian Syndrome (PCOS) has, however, not been documented in patients with ADPKD. We report a patient with PCOS and ADPKD. A 30-year-old female presented to the Obstetrics and Gynecology Department with hirsutism of 2 years’ duration and amenor-rhea and weight gain of 6 months’ duration. On examination, she was found to be overweight (weight 65 kg, height 160 cm) with gross hirsutism. There was male distribution of body hair. The breasts and genitalia were normal. There were no masses palpable on abdominal examination. Pelvic examination revealed normal findings. Blood pressure was 140/90 mm Hg. Cardiovascular examination revealed no murmurs or abnormal heart sounds. There was no neurologic deficit. Investigations revealed elevated serum testosterone (5.5 nmol/l; normal range: 0.9-2.8), raised luteinizing hormone/follicle-stimulating hormone ratio 10.7:5.2 (normal range: < 2) and low serum estradiol (216 pmol/l; normal range: 588-1,397 pmol/l). Serum prolactin (190 mU/1; normal range: 117^68), dehydroepiandrosterone (3.5 μmol/l; normal range: 1.1-10.7) and dexamethasone suppression test were normal. Vaginal probe ultrasound demonstrated the classic ‘necklace’-like arrangement of cysts in both ovaries (fig. 1). The adnexa were normal. Ultrasonography and computed tomography of the abdomen revealed multiple cysts of The patient was treated with oral cypro-terone acetate and premarin for her PCOS and was referred to the nephrology unit for evaluation and management of her ADPKD. By this time, the patient developed hypertension, the blood pressure being 190/110 mm Hg, and symptoms of renal colic. Investiga08*02.81 M4 15.OZ.41 t Fδ.ü D 18.♦HH 21.2HH JAB. OβSTCTRIK & CINEKOLOGI.UKM Í»J^EBU NEESft 21761 POt‚¥C¥STIC■ OVẀR¥ ‚ ‚, m»m í *