A 42-year-dd obese nulligravida patient with polycystic ovary syndrome has had irregular vaginal bleeding since menarche She has used no medication to control her periods (see lab results and report).
Test Result Normal Values
Cortsol 8 a m. 335 138-635 nmol/L
Estrogen 630 90-550 pmol/L
Follide-stimulating hormone 38 5-20 IU/L
Testosterone 3.1 0.7-2 8 nmoVL
Prolactin 590 < 870 pmol/L
T3 (Total serum} 1 2 0 9-2.8 nmol/L
Thyroxine (T4 Total serum) 82 64-155 nmoi/L
Thyroid-Stimulating Hormone 4.5 0.4 - 5.0 pU/L
Endometrial Biopsy:
Adenomatous hyperplasia.
Which of the following is the most likely cause of the adenomatous hyperplasia?