From emedicine.com http://www.emedicine.com/MED/topic1701.htm
Background: Polycystic ovarian disease or syndrome (PCOS) is a heterogenous disorder characterized by a disruption of the regular processes leading to ovulation. It is associated with hyperandrogenemia, normal or elevated estrogen levels, and elevated luteinizing hormone (LH) secretion, with a raised LH?to?follicle-stimulating hormone (FSH) ratio.
Pathophysiology: The underlying cause of PCOS is an abnormality of ovarian androgen production that results from dysregulation of key enzymes involved in theca cell androgen biosynthesis. Hyperandrogenemia in PCOS could be due simply to increased follicle number or theca cell hyperplasia. Both insulin and insulinlike growth factors have been demonstrated to potentiate the actions of LH on theca cell androgen production.
Body mass index (BMI) is positively correlated to serum insulin and testosterone levels and is inversely related to sex hormone?binding globulin (SHBG) levels.
Frequency:
In the US: PCOS affects about 6-10% of women. Incidence in women who are infertile is 30%.
Internationally: PCOS affects about 6-10% of women. Incidence in women who are infertile is 30%.
Mortality/Morbidity: PCOS is a treatable disease with good improvement in signs and symptoms.
Patients are prone to cardiovascular diseases because of hypertension and dyslipidemia.
Patients are at risk of type II diabetes because of insulin resistance.
The chances of endometrial carcinoma are increased.
Sex: PCOS is a disease that affects females. It is a familial condition, possibly autosomal dominant, with premature balding being the male phenotype. The gene (possibly more than 1 gene) involved in PCOS has not yet been identified.
Synonyms and related keywords: Stein-Leventhal syndrome, polycystic ovarian syndrome, PCOS, abnormality of ovarian androgen production, hirsutism, menstrual disorders, infertility, oligomenorrhea
History: Patients present with various symptoms, including the following:
Menstrual disorders (80%)
Oligomenorrhea (71.4%)
Amenorrhea (28.6%)
Infertility (74%) - Accounts for 30% of overall infertility
Recurrent pregnancy losses (common)
Hirsutism (69%)
Obesity (49%)
Acne vulgaris
Asymptomatic
Physical: PCOS is associated with obesity in women, as well as hirsutism.
Causes: PCOS is a familial condition, possibly autosomal dominant. However, the genetic components of PCOS have not yet been identified.
Lab Studies:
Increased androgen levels in blood (testosterone and androstenedione)
Increased LH levels, exaggerated surge
Serum LH-to-FSH ratio - Exceeds 2
Increased fasting insulin
Increased prolactin levels
Increased oestradiol and oestrone levels
Decreased SHBG levels
Imaging Studies:
Ultrasonography is the most sensitive diagnostic study. Ultrasonographic criteria for establishing the diagnosis of PCOS are 10 or more cysts that are 2-8 mm in diameter and are peripherally arranged around an echodense stroma.
Transabdominal ultrasonography
Transvaginal ultrasonographyFrom emedicine.com http://www.emedicine.com/MED/topic1701.htm
Background: Polycystic ovarian disease or syndrome (PCOS) is a heterogenous disorder characterized by a disruption of the regular processes leading to ovulation. It is associated with hyperandrogenemia, normal or elevated estrogen levels, and elevated luteinizing hormone (LH) secretion, with a raised LH?to?follicle-stimulating hormone (FSH) ratio.
Pathophysiology: The underlying cause of PCOS is an abnormality of ovarian androgen production that results from dysregulation of key enzymes involved in theca cell androgen biosynthesis. Hyperandrogenemia in PCOS could be due simply to increased follicle number or theca cell hyperplasia. Both insulin and insulinlike growth factors have been demonstrated to potentiate the actions of LH on theca cell androgen production.
Body mass index (BMI) is positively correlated to serum insulin and testosterone levels and is inversely related to sex hormone?binding globulin (SHBG) levels.
Frequency:
In the US: PCOS affects about 6-10% of women. Incidence in women who are infertile is 30%.
Internationally: PCOS affects about 6-10% of women. Incidence in women who are infertile is 30%.
Mortality/Morbidity: PCOS is a treatable disease with good improvement in signs and symptoms.
Patients are prone to cardiovascular diseases because of hypertension and dyslipidemia.
Patients are at risk of type II diabetes because of insulin resistance.
The chances of endometrial carcinoma are increased.
Sex: PCOS is a disease that affects females. It is a familial condition, possibly autosomal dominant, with premature balding being the male phenotype. The gene (possibly more than 1 gene) involved in PCOS has not yet been identified.
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Ovarian Polycystic Disease
Last Updated: September 6, 2002 Rate this Article
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Synonyms and related keywords: Stein-Leventhal syndrome, polycystic ovarian syndrome, PCOS, abnormality of ovarian androgen production, hirsutism, menstrual disorders, infertility, oligomenorrhea
AUTHOR INFORMATION Section 1 of 10
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography
Author: Nadia K Waheed, MD, Fellow, Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School
Coauthor(s): Khalida Waheed, MD, Chairperson, Professor, Department of Obstetrics and Gynecology, Rawalpindi Medical College, Rawalpindi, Pakistan
Nadia K Waheed, MD, is a member of the following medical societies: American Academy of Ophthalmology
Editor(s): Gerard S Letterie, MD, Medical Director of In-vitro Fertilization Lab, Associate Clinical Professor, Department of Obstetrics and Gynecology, Virginia Mason Medical Center, University of Washington; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, Pharmacy, eMedicine; Michel E Rivlin, MD, Coordinator, Quality Assurance/Quality Improvement, Associate Professor, Department of Obstetrics and Gynecology, University of Mississippi Medical Center; Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Lake Hospital; and Lee P Shulman, MD, Professor of Obstetrics and Gynecology, Head, Section of Reproductive Genetics, Feinberg School of Medicine, Northwestern University; Distinguished Physician, Department of Obstetrics and Gynecology, Northwestern Memorial Hospital
INTRODUCTION Section 2 of 10
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography
Background: Polycystic ovarian disease or syndrome (PCOS) is a heterogenous disorder characterized by a disruption of the regular processes leading to ovulation. It is associated with hyperandrogenemia, normal or elevated estrogen levels, and elevated luteinizing hormone (LH) secretion, with a raised LH?to?follicle-stimulating hormone (FSH) ratio.
Pathophysiology: The underlying cause of PCOS is an abnormality of ovarian androgen production that results from dysregulation of key enzymes involved in theca cell androgen biosynthesis. Hyperandrogenemia in PCOS could be due simply to increased follicle number or theca cell hyperplasia. Both insulin and insulinlike growth factors have been demonstrated to potentiate the actions of LH on theca cell androgen production.
Body mass index (BMI) is positively correlated to serum insulin and testosterone levels and is inversely related to sex hormone?binding globulin (SHBG) levels.
Frequency:
In the US: PCOS affects about 6-10% of women. Incidence in women who are infertile is 30%.
Internationally: PCOS affects about 6-10% of women. Incidence in women who are infertile is 30%.
Mortality/Morbidity: PCOS is a treatable disease with good improvement in signs and symptoms.
Patients are prone to cardiovascular diseases because of hypertension and dyslipidemia.
Patients are at risk of type II diabetes because of insulin resistance.
The chances of endometrial carcinoma are increased.
Sex: PCOS is a disease that affects females. It is a familial condition, possibly autosomal dominant, with premature balding being the male phenotype. The gene (possibly more than 1 gene) involved in PCOS has not yet been identified. CLINICAL Section 3 of 10
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography
History: Patients present with various symptoms, including the following:
Menstrual disorders (80%)
Oligomenorrhea (71.4%)
Amenorrhea (28.6%)
Infertility (74%) - Accounts for 30% of overall infertility
Recurrent pregnancy losses (common)
Hirsutism (69%)
Obesity (49%)
Acne vulgaris
Asymptomatic
Physical: PCOS is associated with obesity in women, as well as hirsutism.
Causes: PCOS is a familial condition, possibly autosomal dominant. However, the genetic components of PCOS have not yet been identified.
Lab Studies:
Increased androgen levels in blood (testosterone and androstenedione)
Increased LH levels, exaggerated surge
Serum LH-to-FSH ratio - Exceeds 2
Increased fasting insulin
Increased prolactin levels
Increased oestradiol and oestrone levels
Decreased SHBG levels
Imaging Studies:
Ultrasonography is the most sensitive diagnostic study. Ultrasonographic criteria for establishing the diagnosis of PCOS are 10 or more cysts that are 2-8 mm in diameter and are peripherally arranged around an echodense stroma.
Transabdominal ultrasonography
Transvaginal ultrasonography
