صفحه 1:
polycystic ovary
syndrome ( PCOS )
صفحه 2:
Etiology
» Etiology of this disorder is unknown
Some cases appear to result from:
» Genetic predisposition
» Obesity (the common factor: seen in 50% of patients )
* LH excess
صفحه 3:
Symptoms
* Oligomenorrhea or amenorrhea
* Acne
٠ Hirsutism
» Infertility
characterized by:
anovulation or extended periods of infrequent ovulation (oligo-
ovulation)
صفحه 4:
Diagnostic criteria
The patient should have two of the following criteria:
+ Oligo-ovulation or anovulation usually marked by irregular menstrual
cycles
» Biochemical or clinical evidence of hyperandrogenism
Hyperandrogenism can generally be established on the basis of
clinical findings (e.g., hirsutism, acne, or serum hormone
measurement)
٠ Polycystic-appearing ovaries on ultrasonography
Characteristic appearance: string-of-pearls
rule out other endocrine disorders that can mimic PCOS (CAH,
Cushing syndrome, and hyperprolactinemia)
صفحه 5:
Ultrasound
of
polycystic
ovary
showing
the
characteris
tic “string-
of-pearls”
appearanc
e of the
cysts
Lone tt ov]
صفحه 6:
Obesity
The common factor (seen in 50% of patients)
Stein-Leventhal syndrome:
women with hirsutism, irregular cycles, and obesity
صفحه 7:
Ovarian androgen & estrogen
production
LH FSH
242000 2460170 240170
(CvPttat) (CYPI7At) (CYPI7At) 17BHSD
‘Ta-hydroxy-
> DHEA —> Androstenedio!
pregnenolone
Cholesterol —> Pregnenolone —>
geHso | senso | gHso | geHs0 |
2450207
امس (CYPI9A1)
progesterone
450170 450170 178HSD t
‘P450arom 17/650
(cver7at) (cvPr7at) a
Progesterone —> > Androstenedione —> Testosterone Estradiol
Estrone
Theca cell Basement Granulosacell
Membrane
صفحه 8:
Estrogen سس
Pituitary pulsatile
LH release Ae
Circulating
LH level
Ovarian stroma
stimulation
Estrogen production Production of
from conversion of androstenedione
androstenedione in
adipocytes
Increased
conversio
n of
androsten
edione to
estrone in
obese
patients
صفحه 9:
Insulin
et 00
a ی a توس pase
Eire crt
» Insulin may also have direct hypothalamic effects, such as abnormal
appetite stimulation and gonadotropin secretion.
HAIR-AN syndrome (hyperandrogenism, insulin resistance, and
acanthosis nigricans):
٠ a defined subgroup of patients with PCOS.
+ Administration of the insulin-sensi g agent metformin in these
patients also reduces androgen and insulin levels.
صفحه 10:
Hormonal studies
Increased LH:FSH (follicle-stimulating hormone) ratio
* estrone in greater concentration than estradiol
- androstenedione at the upper limits of normal or increased
» testosterone at the upper limits of normal or slightly increased
+ The unopposed long-term elevated estrogen levels that
characterize PCOS increase the risk of:
* abnormal uterine bleeding
+ endometrial hyperplasia
» in some cases, the development of endometrial carcinoma.
صفحه 11:
Hyperthecosis
Severe form of PCOS
testosterone reaches concentrations that cause virilization
Symptoms:
* temporal balding
+ clitoral enlargement
» deepening of the voice
* remodeling at the limb-shoulder girdle
Hyperthecosis is often refractory to oral contraceptive
suppression
صفحه 12:
صفحه 13:
Metabolic Syndrome
Is defined by the presence of at least three of the following
components:
» Waist circumference 35 inches or greater
+ Triglyceride level 150 mg/dL or higher
» High-density lipoprotein cholesterol <50 mg/dL
۰ Blood pressure 130/85 mm Hg or higher
» Fasting glucose level 100 mg/dL or higher
These patients should be screened for diabetes
صفحه 14:
Treatment
The most common therapy for PCOS:
» administration of combination oral contraceptives, which
suppresses pituitary LH production
Suppressing LH causes:
* Acne clears
+ new hair growth is prevented
» there is decreased androgenic stimulation of existing hair follicles
* prevent endometrial hyperplasia
* women have cyclic, predictable, withdrawal bleeding episodes
صفحه 15:
Patient wishes to conceive
Oral contraceptive therapy is not a suitable choice
First-line intervention:
+ weight reduction
With body weight reduction alone, many women resume regular ovulatory cycles
and conceive spontaneously.
In some women, ovulation induction with clomiphene citrate is needed and is
facilitated by weight reduction.
second-line intervention:
+ exogenous gonadotropins or laparoscopic ovarian surgery
+ Aromatase inhibitors (letrozole and anastrozole) (as both primary and
secondary treatment for ovulation induction )
صفحه 16:
Thank you
Thanks for your attention