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DEFINITION |
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2003 ESHRE/ASRM consensus: PCOD
should meet two of the three criteria:
1. Oligoovulation or anovulation;
2. Excess androgen activity;
3. Polycystic ovaries (by gynecologic
ultrasound), and other endocrine disorders are excluded.
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GENERAL FEATURES |
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Also known as Stein-Leventhal
syndrome.
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Most common hormonal disorder among
women of reproductive age, affects 3-10%, leading cause of
infertility.
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Key components of PCOD:
hyperandrogenism (especially testosterone), sustained LH levels
(LH/FSH > 1:1), and hyperinsulinemia.-
Common symptoms of
PCOD
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Oligomenorrhea,
amenorrhea: irregular, few, or absent menstrual
periods.
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Infertility:
chronic anovulation.
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Obesity: one of
two women with PCOD are obese.
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Hirsutism:
excessive and increased body hair, typically in a male
pattern affecting face, chest and legs.
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Hair loss
appearing as thinning hair on the top of the head
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Acne, oily skin,
seborrhea.
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Insulin
resistance.
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Depression.
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Risk of women with
PCOD:
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PATHOGENESIS |
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Increases GnRH pulse frequency;
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Excessive and more frequent release of LH
by the anterior pituitary gland, and hyperinsulinemia;
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Excessive production
of androgens by ovarian theca cell, and excessive production of
estrone by ovarian granulosa cells;
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Decrease of
follicular maturation and SHBG binding;
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Development of PCOD,
and endometrial hyperplasia.
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GROSS FINDINGS |
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Enlarged ovaries with thickened and smooth outer
surface; multiple blue, translucent subsurface cortical cysts;
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On cut surface, multiple cysts are
typically arranged in a radial fashion along the cortex with
1-2mm intervening dense fibrotic stroma.
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MICROSCOPIC FINDINGS |
- Enlarged ovarian size (2-fold),
including thickness of cortical and subcortical stroma;
- Thickened collagenized tunia;
- Normal number of primordial
follicles;
- Twice the number of ripening
and atretic follicles;
- Multiple follicular cysts
(1-2mm) with luteinized theca layer (theca-lutein hyperplasia);
- Minimal evidence of ovulation
with rare or no recent or degenerating corpora lutea, increased
numbers of hilus cells.
- Often stromal hyperplasia with
luteinized stromal cells (hyperthecosis).
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TREATMENT |
- Lowering of
insulin levels: weight loss, metformin.
- Restoration of fertility: diet modification,
weight loss, and treatment with metformin and
clomiphene citrate.
- Treatment of hirsutism or acne:
contraceptive pill, spironolactone.
- Restoration of regular menstruation, and
prevention of endometrial hyperplasia and
endometrial cancer.
- Wedge resection.
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REFERENCES |
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