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Polycystic Ovary Syndrome. Krishna B. Singh, MD Department of Obstetrics & Gynecology LSU Health Sciences Center Shreveport, LA. PCOS: Learning Objectives. After viewing this slide show, you’ll be able to understand that... -PCOS is a common endocrine disorder

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Polycystic ovary syndrome

Polycystic Ovary Syndrome

Krishna B. Singh, MD

Department of Obstetrics & Gynecology

LSU Health Sciences Center

Shreveport, LA

Pcos learning objectives
PCOS: Learning Objectives

After viewing this slide show, you’ll be able to understand that...

-PCOS is a common endocrine disorder

-Multifactorial, heterogeneous condition

-Clinical manifestations affect menses, fertility

-Multiple hormonal, biochemical changes

-Long-term implications are important

Pco syndrome topics
PCO Syndrome: Topics

  • Historical review

  • Incidence

  • Clinical features

  • Diagnosis

  • Management

  • Summary

Pcos literature review
PCOS: Literature Review

  • Sclerocystic ovaries were described by Chereau (1844); Pozzi (1894); Waldo (1895)

  • Stein/Leventhal first described seven cases of infertility associated with enlarged polycystic ovaries (1935)

  • The NIH Consensus Conference (1990)

  • The Rotterdam PCOS Consensus Group (2003)

Incidence pco syndrome
Incidence: PCO Syndrome

  • The incidence varies: 5-10% (~5% USA)

  • About 25% normal women may have PCO by ultrasound criteria (BMJ 1986)

  • Ultrasound findings don’t correlate with serum hormone levels

Features of pco syndrome
Features of PCO Syndrome

  • Symptoms present since puberty: Cyclic menses with luteal-phase progesterone deficiency; hirsutism; hyperandrogenemia; infertility; chronic anovulation/miscarriages

  • Irregular menses in 25-75% women

  • Obesity (60%); also non-obese women

  • Hirsutism and/or acne (virilization rare)

Polycystic ovarian disease
Polycystic Ovarian Disease

  • PCO disease can be seen in women with pituitary neoplasms, hypo- or hyperthyroidism, diabetes, adrenal and pelvic neoplasms

  • Rule out PCOD to diagnose PCO syndrome

  • Long-term care is important. Studies have shown increased incidence of hypertension, hyperlipidemia and diabetes. Risk for CVD increased

Pco syndrome facts correlates
PCO Syndrome: Facts/correlates

  • Genetic factors: autosomal or X-linked

  • Positivecorrelations of androgen and insulin levels in some studies

  • Ultrasound findings don’t correlate with serum hormone levels

Theories of pco syndrome
Theories of PCO Syndrome

  • PCO syndrome is a multifactorial disorder

  • Theories are based on data in selectedwomen

  • Brain and limbic system control the hypothalamus-pituitary-ovarian axis needed for reproductive cycle initiation and maintenance

  • Feedback CNS abnormality results in PCOS

Cns theories of pco
CNS theories of PCO

  • Beta-endorphin theory:Higherplasma levels are found in women with PCO syndrome

  • Progesterone deficiency/estrogen excess is the key component

  • Hyperandrogenism also important in PCO women

  • Hyperprolactinemiamay cause breast symptoms, diminish libido, and alter moods in some women

More pco theories
More PCO Theories...

  • Rat PCO model: Persistent-estrus syndrome

    • Constant-light exposure; androgenized rat model; hypothalamic lesions

    • Other methods (DHEAS model)

  • Monkey model: testosterone injections

  • Human model: transvestites given androgens

  • Diagnosis of pco syndrome
    Diagnosis of PCO Syndrome

    • History and physical examination important; selected laboratory and hormonal tests during several visits are needed for confirmation

    • Both structured and descriptive notes are evaluated by the physician

    • Follow-up visits arranged @ regular intervals

    Pcos differential diagnosis
    PCOS: Differential Diagnosis

    • Laboratory tests for confirmation: LH/FSH, T

    • Baseline values: Chem-22 @ morning

    • Baseline serum hormones @ morning

    • Pelvic ultrasound in some cases required

    • Consider PCOD versus PCO syndrome

    Pcos key to diagnosis
    PCOS: Key to Diagnosis

    • Rule out conditions which may require referral;focus on the presenting signs and symptoms

    • Beware of misdiagnosis “on the fly”

    • Beware of differential diagnosis

    • History and physical exam; selected tests

    • Know when to refer patients and where

    Pcos management options
    PCOS: Management Options

    • Principal components:Confirm diagnosis and identify category; identify and manage concurrent illness; identify and manage patient needs

    • There are numerous options for successful PCO management

    Pcos treatment options
    PCOS: Treatment Options

    • General measures:diet, exercise, relaxation for stress management

    • Contraception: OCP; DMPA

    • Hormones/drugs:Provera; Parlodel; Clomiphene; hMG/hCG; IVF in selected women

    • Newer drugs for treatment of obesity, hyperinsulinemia, hyperandogenemia and hirsutism

    Pco syndrome and infertility
    PCO Syndrome and Infertility

    • About 60% PCO patients will have ovulatory cycles and pregnancy on clomiphene alone

    • About 50% PCOpatients will respond to the combined clomiphene and dexamethasone within six months of treatment

    Pco syndrome summary
    PCO Syndrome: Summary

    • PCO syndrome remains an enigma despite many scientific studies done during the last three decades

    • Theories of PCO abound; terminology used may be confusing and definitions are not standardized

    • There are many treatment options

    What this means
    What This Means...

    • Polycystic ovary syndrome is a common disorder among reproductive age groupof women; these women generally have irregular menstrual cycles

    • PCO has many facets of clinical presentation

    • PCO can be successfully managed and treated by conventional means