Figure 15a. Polycystic ovary in a 19-year-old woman with Cushing syndrome. The patient was markedly obese (height, 168.6 cm; weight, 106.9 kg; body mass index, 37.6) and had hirsutism. She had had secondary amenorrhea for 1 year. Results of an endocrinologic survey revealed increased levels of serum cortisol (26.9 µg/dL [742 nmol/L]; normal range, 6-18 µg/dL [166-497 nmol/L]) and corticotropin (88.7 pg/mL [20 pmol/L]; normal range, 7-54 pg/mL [1.5-12 pmol/L]). A slight increase in the serum testosterone level was also noted (63.0 ng/dL [2.2 nmol/L]). (a) Coronal fat-saturated T1-weighted MR image of the sella turcica reveals a pituitary adenoma (arrows), which has weaker enhancement than the normal pituitary gland (arrowheads). (b) Coronal T2-weighted MR image of the pelvis demonstrates a slightly enlarged ovary with an increased number of follicles (arrows). Although this is not a typical ovarian finding of PCOS, it is similar to one. Because it has been reported that the morphologic characteristics of ovaries in patients with Cushing syndrome and increased cortisol secretion are suggestive of PCOS, we speculate that the secondary amenorrhea in this patient was due to secondary PCOS.