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Layered onto these genomic and signalling defects are epigenetic derangements that lock the ovary into a pathologic state

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Symptom-Triggered Testing Persistent severe abdominal pain: urgent evaluation, lipase testing, and appropriate imaging Right-upper-abdominal pain or jaundice: liver and biliary testing plus gallbladder imaging Persistent vomiting or diarrhea: kidney function and electrolyte testing Symptoms of hypoglycemia: immediate glucose evaluation Fatigue or signs of deficiency: CBC and selected nutritional tests Testing should not delay medical care for severe symptoms