Pathophysiology (N Engl J Med 2005;352:1223)
• Associated w/ ↑’d intra-ovarian androgens & often associated with insulin resistance
• Visceral adiposity assoc w/ hyperandrogenemia, insulin resistance, glucose intolerance, dyslipidemia
• Hyperinsulinemia is also central. Insulin ↑ thecal androgen production, ↓ sex-hormone–binding globulin, which ↑ fraction of free testosterone
Epidemiology (N Engl J Med 2005;352:1223)
• Affects ∼5–10% of women; 30–75% of women with PCOS are obese
• Currently considered a complex, multigenic disorder
Diagnosis (N Engl J Med 2005;352:1223)
• Rotterdam Criteria, 2003 (2 of 3): Oligo/amenorrhea; hyperandrogenism or hyper-androgenemia; radiographic evidence of polycystic ovaries OR
• Androgen Excess Society 2006 (all): Hyperandrogenism, ovarian dysfunction, exclude other androgen disorders/excess
• Polycystic ovaries are not necessary or sufficient to confirm dx (functional condition)
• Must r/o hyperprolactinemia, CAH, Cushing syndrome, acromegaly, androgen-secreting neoplasm
• Consider the following labs: HCG, prolactin, 17-OH P, DHEA, SHBG, LH/FSH, testosterone, fasting glucose, insulin, TFTs (“The Polycystic Ovary Syndrome: Current Concepts On Pathogenesis And Clinical Care. Legro, RS 2007)
• Symptoms of hyperandrogenism include hirsutism, acne, and male-pattern alopecia
• Often disordered uterine bleeding & infertility 2/2 anovulation, acanthosis nigricans 2/2 hyperinsulin
• ↑ LH or LH:FSH ratio (>2) less reliable, as levels vary throughout menstrual cycle
• Risk assessment for endometrial carcinoma, glucose intolerance (OGTT, random glucose, A1c), dyslipidemia (fasting lipids), obstructive sleep apnea
Treatment (N Engl J Med 2005;352:1223)
• Hyperandrogenism (hirsutism and acne)
• Combined estrogen–progestin contraceptives: Choose lowest androgen activity
• Antiandrogens: Spironolactone; reserve steroids for marked androgen excess
• Oligomenorrhea and amenorrhea
• Combined estrogen–progestin Rx or cyclic progestin administration may inhibit endometrial proliferation from chronic anovulation
• Weight loss and lowering insulin levels are shown to improve ovulatory function
• Insulin resistance and glucose intolerance: Weight reduction, metformin