Pcos

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Pcos

  1. 1. Non tumorous dysfunction of ovary Affecting 5 to 10 % of all reproductive age group in women
  2. 2. Hyperandrogenism Untimely secretion of LH LH : FSH > 2 - 3 : 1(50 % of cases) Oligomenorrhoea Anovulatory infertility Hirsutism Hyperinsulunemia Hyper prolactinemia Obesity C.V.D. Diabetes
  3. 3. Signs / Symptoms Frequency in PCOS Patients (%) Infertility 55 – 75 Oligomenorrhea 50 – 90 Amenorrhea 26 – 51 Abnormal uterine bleeding 30 Normal Menstrual Pattern 22 Hirsutism 60 – 90 Acne 24 – 27 Virilization 0 – 28 Obesity 40 – 60 Polycystic Ovaries on USG 50 – 75
  4. 4. Hyperandrogenism Ovary
  5. 5. pathogenesis Hypothalamus and Pituitary FSH New follicular growth continous LH Defective follicular maturtion Atretic follicle Chronic anovulation ⇑ Andorgens by Thea cells
  6. 6. pathogenesis Large 20 – 100 cystic follicles Surface area doubled Volume ⇑ 2–8 times Stroma thickness Tunica thickened
  7. 7. pathogenesis Insulin Resistance [IR] Hyperinsulinemia [HI] Genetic ⇑ Serine phosphorylation Insulin Receptor ⇓ Tyrosin acetophosphorylation Reduced glucose transport Hyperinsulinemia
  8. 8. ADRENAL CORTEX 25% 50% Testosteron e Almost 100% 90% 50% Androstenedion e DHEA 50% 10% 25% OVARY DHEAS
  9. 9. PCOS - Important cause of Hirsutism GnRH ESTROGEN PERIPHERAL FAT DECREASED SHBG PITUITARY INCREASED LH ANDROGEN 5α reductase INCREASED DHT INCREASED FREE TESTOSTERONE HIRSUTISM
  10. 10. Insulin Resistance and Hyperinsulinaemia ↓ SHBG Insulin with IGF 1 Receptors Hyperestrogeneamia Altered Pulsatile LH release ↑ Free Estrogens ↑ Free Testosterone ↑ Ovarian Androgens HYPERANDROGENISM HIRSUTISM ↑ Serum LH
  11. 11. Excessive growth of androgen dependent sexual hair HIRSUTISM Upper Lip Chin Ear Cheek Lower Abdomen Periareolor region
  12. 12. Genetic • Number of pilosebaceous units Amount of androgen production • Racial and ethnic factors 5α – reductase level and activity Sensitivity of pilosebaceous unit to DHT VELLUS HAIR – Short, fine , less pigmented TERMINAL HAIR => (1) Anagen (2) Catagen (3) Telagen
  13. 13. Day 2 1 LH : FSH > 2 – 3 : 1 2 Serum testesterone – twice the upper normal (Normal 20 – 80 ng / dl) 3 SHBG ⇓ 4 Prolactin – mild elevation < 50 ng / dl 5 Serum Insulin ⇑ 6 (normal fasting 20 – 24 µIU / ml) Fasting glucose : Insulin ratio < 4.5 7 USG – 10 – 15 cysts of 2 to 10 mm
  14. 14. Bharati Hospital Jan 2003 – Dec 2004 Total worked up cases 154 PCOS 20 Hirsutism 29 PCOS + Hirsutism 7
  15. 15. Anovulation Hyperandrogenis m
  16. 16. Therapy Mechanism of Action OCPs Medroxyprogesterone acetate Gn RH – analogues Hormonal suppression Glucocorticoids Spirinolactone Cryproterone Acetate Anti androgens Flutamide Ketoconazole Finasteride Enzyme inhibitors Depilatory creams Electrolysis Laser hair removal Mechanical methods
  17. 17. Desogestrel + E2 (0.15mg + 20 µgm) Levonorgestrel + E2 (0.1mg + 20 µgm) Cyprotene acetate + E2 Dianette (2 + 35 µgm)
  18. 18. Clomiphene citrate Gonadotropins
  19. 19. Metformin – 500 mg twice / thrice a day Metformin + Clomiphene citrate Troglitazone 400 mg daily Not used – hepatic dysfunction

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