Poly-Cystic Ovarian Syndrome (PCOS)
Content
Poly-Cystic
Ovarian Syndrome
• Definition
• Criterion
• Pathophysiology
• Clinical Features
At the
end of this lecture, students will be able to –
• Define PCOS
• Explain the Pathophysiology of PCOS
• Describe the criterion and clinical features of PCOS
Polycystic Ovary Syndrome (PCOS)
Stein and Leventhal
First to recognize an
association between the presence of polycystic ovaries and signs of
hirsutism amenorrhea (oligomenorrhea, obesity)
Polycystic Ovarian Disease
After successful wedge
resection of the ovaries in women diagnosed with Stein-Leventhal syndrome, menstrual cycles become regular and the
patients were able to conceive (polycystic ovarian disease)
Polycystic ovarian syndrome
Biochemical, clinical
and endocrinological abnormalities have shown an array of underlying
abnormalities; hence condition known as polycystic ovarian syndrome( PCOS)
Syndrome ”O”
• Ovarian confusion
• Ovulation disruption
• Over‐nourishment
• Overproduction of insulin
Criteria of the PCO
• Presence of menstrual abnormalities and
anovulation
• Presence of clinical and/or biochemical
hyperandrogenaemia
• Ultrasound examination - peripheral cysts (10
or more) less than 10mm in size in an enlarged ovary with significant increase
in the central stroma
Ø Absence of hyperprolactinaemia or thyroid
disease
Ø Absence of late-onset congenital adrenal
hyperplasia
Ø Absence of Cushing’s syndrome
Etiology of PCOS
• Neuroendocrine derangement
– ↑LH relative to FSH
• Hyperinsulinemia
– Defect in insulin action or
secretion
• Androgen excess
– Ovarian and adrenal
Functional Hyperandrogenism
Pathways leading to Androgen excess in PCOS
Clinical Features of PCOS
• Menstrual abnormalities, Infertility
“anovulation”, Hirsutism, acne, aloplecia, Increased risk of atherosclerosis
& cardiovascular events
• Increased risk of diabetes mellitus in patients
with hyperinsulinemia
• Increased risk of endomentreal cancer &
Breast cancer
• Hyperlipidemia with its impact on
atherosclerotic changes
• Hypertension observed later in life
• Obesity 40% with health risks including
saphenous varicosities, hemorrhoids, hernias & osteoarthritis
• Several mental health problems, depression,
anxiety
Summary
• Biochemical, clinical and endocrinological
abnormalities have shown an array of underlying abnormalities; hence condition
known as polycystic ovarian syndrome
• Menstrual abnormalities, Infertility
“anovulation”, Hirsutism, acne, aloplecia, Increased risk of atherosclerosis
& cardiovascular events
• Neuroendocrine derangement -
↑LH relative to FSH
• Hyperinsulinemia- Defect in insulin action or
secretion
• Androgen excess -
Ovarian and adrenal
Criteria of
the PCO
• Presence of menstrual abnormalities and
anovulation
• Presence of clinical and/or biochemical
hyperandrogenaemia
• Ultrasound examination - peripheral cysts (10
or more) less than 10mm in size in an enlarged ovary with significant increase
in the central stroma
Ø Absence of hyperprolactinaemia or thyroid
disease
Ø Absence of late-onset congenital adrenal
hyperplasia
Ø Absence of Cushing’s syndrome
Etiology of PCOS
• Neuroendocrine derangement
– ↑LH relative to FSH
• Hyperinsulinemia
– Defect in insulin action or
secretion
• Androgen excess
– Ovarian and adrenal
Functional Hyperandrogenism
Pathways leading to
Androgen excess in PCOS
Clinical Features of PCOS
• Menstrual abnormalities, Infertility
“anovulation”, Hirsutism, acne, aloplecia, Increased risk of atherosclerosis
& cardiovascular events
• Increased risk of diabetes mellitus in patients
with hyperinsulinemia
• Increased risk of endomentreal cancer &
Breast cancer
• Hyperlipidemia with its impact on
atherosclerotic changes
• Hypertension observed later in life
• Obesity 40% with health risks including
saphenous varicosities, hemorrhoids, hernias & osteoarthritis
• Several mental health problems, depression,
anxiety
Summary
• Biochemical, clinical and endocrinological
abnormalities have shown an array of underlying abnormalities; hence condition
known as polycystic ovarian syndrome
• Menstrual abnormalities, Infertility
“anovulation”, Hirsutism, acne, aloplecia, Increased risk of atherosclerosis
& cardiovascular events
• Neuroendocrine derangement -
↑LH relative to FSH
• Hyperinsulinemia- Defect in insulin action or
secretion
• Androgen excess -
Ovarian and adrenal
Criteria of
the PCO
• Presence of menstrual abnormalities and
anovulation
• Presence of clinical and/or biochemical
hyperandrogenaemia
• Ultrasound examination - peripheral cysts (10
or more) less than 10mm in size in an enlarged ovary with significant increase
in the central stroma
Ø Absence of hyperprolactinaemia or thyroid
disease
Ø Absence of late-onset congenital adrenal
hyperplasia
Ø Absence of Cushing’s syndrome
Etiology of PCOS
• Neuroendocrine derangement
– ↑LH relative to FSH
• Hyperinsulinemia
– Defect in insulin action or
secretion
• Androgen excess
– Ovarian and adrenal
Functional Hyperandrogenism
Pathways leading to
Androgen excess in PCOS
Clinical Features of PCOS
• Menstrual abnormalities, Infertility
“anovulation”, Hirsutism, acne, aloplecia, Increased risk of atherosclerosis
& cardiovascular events
• Increased risk of diabetes mellitus in patients
with hyperinsulinemia
• Increased risk of endomentreal cancer &
Breast cancer
• Hyperlipidemia with its impact on
atherosclerotic changes
• Hypertension observed later in life
• Obesity 40% with health risks including
saphenous varicosities, hemorrhoids, hernias & osteoarthritis
• Several mental health problems, depression,
anxiety
Summary
• Biochemical, clinical and endocrinological
abnormalities have shown an array of underlying abnormalities; hence condition
known as polycystic ovarian syndrome
• Menstrual abnormalities, Infertility
“anovulation”, Hirsutism, acne, aloplecia, Increased risk of atherosclerosis
& cardiovascular events
• Neuroendocrine derangement -
↑LH relative to FSH
• Hyperinsulinemia- Defect in insulin action or
secretion
• Androgen excess -
Ovarian and adrenal
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