A 28-year-old woman is evaluated for infeility and amenorrhea. She is obese and has significant facial hair in a male distribution. Laboratory studies reveal an increase in serum LH, as well as in total serum testosterone and in the testosterone metabolite dehydroepiandrosterone sulfate. A pelvic ultrasound examination would probably reveal which of the following findings?

**Core Concept**
The patient's presentation of amenorrhea, hirsutism, and elevated serum LH, testosterone, and dehydroepiandrosterone sulfate levels is suggestive of an androgen excess disorder, specifically polycystic ovary syndrome (PCOS). PCOS is a complex endocrine disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries.

**Why the Correct Answer is Right**
The presence of polycystic ovaries on pelvic ultrasound is a common finding in women with PCOS. This is due to the hormonal imbalance, particularly the high levels of androgens, which disrupt the normal ovarian follicular development and growth. The high LH levels stimulate the growth of multiple small follicles, leading to the formation of multiple small cysts on the ovaries.

**Why Each Wrong Option is Incorrect**
**Option A:** A normal pelvic ultrasound examination would not be expected in a woman with PCOS, as the disorder is characterized by polycystic ovaries.
**Option B:** A pelvic ultrasound examination would not typically reveal a tumor in a woman with PCOS, as the disorder is not typically associated with ovarian tumors.
**Option C:** A pelvic ultrasound examination would not typically reveal a congenital anomaly in a woman with PCOS, as the disorder is not typically associated with congenital anomalies.

**Clinical Pearl / High-Yield Fact**
It's essential to remember that PCOS is a diagnosis of exclusion, and the presence of polycystic ovaries on pelvic ultrasound is not diagnostic in itself. Other conditions, such as congenital adrenal hyperplasia, must be ruled out before making a diagnosis of PCOS.

**Correct Answer:** C. A pelvic ultrasound examination would probably reveal polycystic ovaries.

✓ Correct Answer: D. Multiple small follicular cysts on the ovary