Polycystic Ovary Syndrome: Characteristics and Clinical Controversies

Posted by e-Medical PPT Tuesday, August 16, 2011
Polycystic Ovarian Syndrome (PCOS) Overview
PCOS is a complex endocrine disorder affecting women of childbearing age characterized by increased androgen production and ovulatory dysfunction
PCOS is the leading cause of anovulatory infertility and hirsutism
Women with PCOS have an increased risk of miscarriage, insulin resistance, hyperlipidemia, type 2 diabetes, cardiovascular disease, and endometrial cancer

PCOS: National Institutes of Health Diagnostic Criteria
Presence of ovulatory dysfunction, polymenorrhea, oligomenorrhea, or amenorrhea
Clinical evidence of hyperandrogenism and/or hyperandrogenemia
Exclusion of other endocrinopathies (eg, Cushing syndrome, hypothyroidism, late-onset congenital adrenal hyperplasia
May appear at puberty with a delayed menarche followed by the onset of irregular periods or as the breakdown of a previously regular cycle
Anovulation is usually chronic and presents as oligomenorrhea or amenorrhea

Clinical Features of PCOS - Hyperandrogenism
Symptoms may include hirsutism, acne, male pattern balding, and/or male distribution of body hair

Common Endocrine Abnormalities in PCOS
Elevated luteinizing hormone (LH)
Increased LH/follicle-stimulating hormone (FSH) ratio
Elevated androgen levels
Decreased sex hormone binding globulin levels

Metabolic Abnormalities in PCOS
Hyperinsulinemia and insulin resistance
Insulin resistance may be independent of the effect of obesity
Decreased peripheral insulin sensitivity and consequent hyperinsulinemia may play an important role in the pathogenesis of PCOS

Lipid and Lipoprotein Abnormalities in PCOS
Elevated LDL cholesterol
Elevated triglycerides
Decreased HDL cholesterol
Decreased apolipoprotein A-I
Impaired fibrinolytic activity

Etiology of PCOS
PCOS may be caused by interactions between
Genetic factors (eg, autosomal dominant transmission)
Endocrine factors (eg, increased LH/FSH ratio, increased insulin and androgen concentrations)
Metabolic factors (eg, increased insulin resistance,  decreased SHBG)
Neurologic factors (eg, epileptic discharges)
Environmental factors (eg, anabolic steroids)

Developmental Origin of PCOS
During gestation, human chorionic gonadotrophin, LH, and genes regulating folliculogenesis and steroidogenesis may cause excess prenatal androgen
Postpubertally, hyperinsulinemia and LH hypersecretion augment ovarian steroidogenesis, leading to anovulation....

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