This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: PCOD, hirsutism and galactorrhea, Subject name: Gynaecology & Obstetrics
[{'content': 'The biochemical changes in established cases of stein Leventhal syndrome are as mentioned except : \nSelect and explain. \nA. Marked elevation of LH in contrast to FSH, B. Insulin resistance, C. Elevation of plasma testosterone, D. Elevation of sex hormone binding globulin (SHBG) level', 'role': 'user'}, {'content': 'Answer: D \nExplanation: PCOS: Excess androgen production by ovary /adrenals interferes with growth of ovarian follicles. Endocrinological changes are as follows: 1.Estrone/E2 level rises. 2.Increased testosterone,DHEA-S,Androstenedione 3.Increased estrogen causes positive feedback on LH which causes increased LH. FSH levels are not raised. LH/FSH >2.1 -----negative feedback on FSH---decreased FSH -----increased risk of Endometrial hyperplasia,Endometrial cancer. 4.Decreased Sex hormone binding globulin(SHBG) due to hyperandrogenism---increased free estradiol. 5.Fasting Blood Glucose/Fasting Insulin < 4.5 suggests Insulin Resistance 6.Triglycerides>150mg/dl, Hyperlipedemia, HDL < 50 mg/dl 7.Prolactin is mildly raised in 15% cases. 8.Fasting Insulin is more than 10mIU/L 9.Thyroid function tests may be abnormal(hypothyroidism) 10.17 alpha hydroxyprogesterone in the follicular phase >300ng/dl suggests adrenal hyperplasia due to 21-hydroxylase deficiency 11.Urinary coisol<50 micrograms/24hr Ref: Shaw Gynecology 17 e pg 314.', 'role': 'assistant'}]