Polycystic Ovarian Syndrome & Hirsutism

Posted by e-Medical PPT Thursday, August 2, 2012
Polycystic Ovarian Syndrome
Formerly called Stein Leventhal Syndrome
Characterized by:
 anovulatory bleeding/amenorrhea
 hirsutism,
 obesity,
 hyperinsulinemia/insulin resistance,
 bilateral ovarian enlargement & multiple cysts
 Infertility
 Hyperandrogenemia & Hyperestrogenemia (due to peripheral conversion)

Pathophysiology
Incompletely understood
Abnormally elevated LH levels
Loss of mid cycle LH surge
Excessive androgen production
Atresia of ovarian follicles
Ratio of LH:FSH markedly  increased

Affects 5% of reproductive age women
Represents a leading cause of chronic anovulatory bleeding
disorder of hypothalamic rhythmicity
excessive LH production without mid cycle surge
leads to overproduction of testosterone & Androstenedione
Androgens converted to estrone which causes endometrial proliferation that results in irregular periods
Serum concentrations of both estrogen and testosterone rise
Insulin resistance once believed to be due to ovarian androgen overproduction
Current theory is that Hyperinsulinism causes ovarian androgen overproduction
Consequence of androgen overproduction
hirsutism
frank virilization
Chronic unopposed estrogen stimulation leads to endometrial Hyperplasia, cellular atypia, and endometrial carcinoma
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