Polycystic ovarian syndrome(PCOS).ppt

Polycystic ovarian syndrome(PCOS） Content OVERVIEW of PCOS PATHOPHYSIOLOGY SIGNS and SYMPTOMS DIAGNOSTIC CRITERIA TREATMENT OVERVIEW PCOS 1 st described by Stein and Leventhal as a triad of amenorrhea, obesity and hirsutism (1935) The symptoms and severity of the syndrome vary greatly among affected women It is one of the leading causes of female infertility Definition Abbreviations Definition :Polycystic ovarian syndrome is a common endocrine disfunction typified by oligo-ovulation or anovulation, signs of androgen excess, and multiple small ovarian cysts Abbreviations PCOS = Polycystic Ovarian Syndrome PCO= Polycystic Ovarian Incidence PCOS is the most common disorder of reproductive-aged women Affects approximately 4-12% PCOS appears to equally affect all races and nationalities Etiology Genetic basis Aggregation of the syndrome within families An increased prevalence has been noted between affected individuals and their sisters and mothers The first-degree male relatives of women with PCOS have significantly higher circulating DHEAS levels . Environment causes Life style Exercise Diet Androgen exposure, et. al Interaction of Genetics and environment PCOS may be a genetically determined ovarian disorder , the heterogeneity can be explained on the basis of interaction of the disorder with other genes and with the environment PATHOPHYSIOLOGY Pathopysiologyz:What we think we know Abnormal gonadotropin secretion Excess LH and low, tonic FSH Hypersecretion of androgens Disrupts follicle maturation Substrate for peripheral aromatization Negative feedback on pituitary Decreased FSH secreation Insulin resistance, Elevated insulin levels Disorder of H-P-O axis Increased GnRH from hypothalamus Excessive LH secretion relative to FSH by pituitary gland LH stimulates ovarian thecal cells to produce excessive androgen Ineffective suppression of the LH pulse frequency by estradiol and progesterone Androgen excess increases LH