rocky_Yersinia

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I have a patient with polycystic ovary syndrome (PCOS) .Now is the 4th year of her disease .She have menstrual irregularities , increasing dimension and number of follicules on echography , elevating testosterone level . She has been treated with oestrogens ( 1year ), metformine ( 2g/day for 1year )but have not much progression . Please help me to answer this : causes , complications , prognosis and treatment of this syndrome ! She's a doctor and she is very anxious actually ! Thanks a lot for your advices !
 

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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.

Back to: eMedicine Specialties > Medicine, Ob/Gyn, Psychiatry, and Surgery > Obstetrics/gynecology


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
 

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and the rest....

Medical Care:

Weight reduction is associated with normalization of hormonal disturbances and the resumption of regular ovulation. It also has a beneficial impact on the consequences of PCOS (eg, cardiovascular diseases, impaired glucose tolerance, hypertension, dyslipidemia).
Cigarette smoking should be stopped because it stimulates adrenal androgens.
Medical treatment of hirsutism includes antiandrogen, progestogen with nonandrogenic progesterone (combined pill), adrenal suppression by dexamethasone, 5-alpha reductase inhibitors, and cosmetic methods (eg, waxing, shaving [shaving does not increase hair growth, but it may make hair coarse], bleaching, electrolysis).
Medical treatment of infertility includes antiestrogens (clomiphene citrate), adrenal suppression by dexamethasone along with clomiphene, gonadotropin therapy, gonadotropin-releasing hormone (GnRH) analogue, and metformin therapy.
Surgical Care: Ovarian diathermy has replaced wedge resection, which can result in extensive ovarian, periovarian, and tubal adhesions. Only minimal damage to the ovary is required to stimulate ovulation. The method involves 4-point diathermy set at 40 W for 4 seconds at each point.

Diet: A low-calorie diet is recommended for patients with BMI greater than 25 kg/m or for patients with truncal obesity.

Activity: No restriction of activity is needed; encourage regular exercise. Aerobic exercise in patients who are overweight is recommended for weight loss.

Prognosis:


With proper diagnosis and treatment, most PCOS symptoms can be adequately controlled or eliminated.
Infertility can be corrected and pregnancy achieved in most patients. In some patients, hormonal disturbances and anovulation may recur.
Monitor patients for endometrial cancer.
Because of the high rate of hyperinsulinemia observed in PCOS, women with the disorder should have their glucose levels checked regularly to monitor for the development of diabetes.
Blood pressure and cholesterol screening are also needed because women with PCOS tend to have high levels of low-density lipoprotein (LDL) cholesterol and triglycerides, which puts them at risk for developing heart disease.
Patient Education:


No known way to prevent PCOS exists, but, if diagnosed and treated early, risks for complications, such as heart disease and diabetes, may be minimized.
Weight control through diet and exercise stabilizes hormones and lowers insulin levels.
 
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Global Disrobal

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hehe...yes, but I got some much needed review out of it aside from practicing my cut & paste techniques:laugh:
 

chanchalpari

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hi,
will a high testosterone level(91)..and no other abnormality be considered as pco..????all other report normal..no obesity,lots of hair or acne..
 

WillowRose

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VentdependenT said:
Lose weight and go on clomiphine. I think thats how you spell it. Too lazy to look it up.

God, I hope you don't say that to your patients!

I actually had a doctor say nearly that same thing to me ONCE. (And clomiphine when you don't have regular menstrual periods is NOT an easy routine).
 

doc05

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rocky_Yersinia said:
I have a patient with polycystic ovary syndrome (PCOS) .Now is the 4th year of her disease .She have menstrual irregularities , increasing dimension and number of follicules on echography , elevating testosterone level . She has been treated with oestrogens ( 1year ), metformine ( 2g/day for 1year )but have not much progression . Please help me to answer this : causes , complications , prognosis and treatment of this syndrome ! She's a doctor and she is very anxious actually ! Thanks a lot for your advices !

wow what a stupid question. If she is YOUR patient, then perhaps you should read on the disease yourself.

and what sort of practicioner are you that you don't know about PCOS?
 

KatieOConnor

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I have a question relating to this. I was diagnosed via ultrasound with PCOS (lots of little cysts were hanging out in my ovaries). It does run in my family, and the women who have it tend to be overweight. I'm not, but I do have an abnormal amount of facial hair. (I don't look like a guy or anything, but it's a lot of that coarse type of hair, and I'm of Northern European descent so women of my genetic heritage tend to be more on the hairless side)

Now, I switched doctors and I told the new doctor of my diagnsosis. She told me I do not have PCOS and said that cysts are perfectly normal and that my cysts probably come and go and that they are probably bigger than those associated with PCOS. I figured it doesn't really matter whether I have it or not because it has no effect on my life so I didn't bother to argue.

Is the second doctor right? Can she be? She didn't do an ultrasound. Is there something I'm missing? Can you really tell whether someone has this or not without doing an ultrasound?
 

MustafaMond

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doc05 said:
wow what a stupid question. If she is YOUR patient, then perhaps you should read on the disease yourself.
and what sort of practicioner are you that you don't know about PCOS?
Agreed.
OP is a prick. A troll too.
Global posted a lot of good info for you, and you dissed him.

Its called google...use it, fool.
 

deeq

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Yo Rocky_Yersinia,
Global gave you, like, two med. school lectures worth on PCOS. You'll seriously wow your attendings if you use even half of it. However, if you're still in a bind I would suggest Up To Date Online...if your hospital gives you access. Otherwise, as previously suggested, open a standard Ob/Gyn text....you'll find plenty....promise.....and of course, as again suggested, there's always good ol' google....
 

deeq

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wait....is this a resurrection of a thread? who's the original and what the heck did i just respond to? :confused:
 
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