Describe the etiopathogenesis, clinical features and complications of polycystic ovarian syndrome

1. Objectives
• Describe the etiopathogenesis, clinical features
and complications of polycystic ovarian
syndrome.

2. Polycystic Ovarian Syndrome
Polycystic ovarian syndrome or Stein-Leventhal
syndrome is an endocrine disorder which reflects:
Excess secretion of androgenic hormones
Persistent anovulation
Ovaries containing many small subcapsular cysts

3. • Change in lifestyle & Stress
• Genetic factors
• Obesity
• Insulin resistance

4. Pathophysiology
Exact pathophysiology of PCOS is not clearly
understood.
i. Hypothalamic - pituitary compartment
abnormality.
ii. Androgen excess
iii. Anovulation
iv. Obesity and insulin resistance.

5. Hypothalamic-Pituitary Compartment Abnormality
Hypothalamus
Increased frequency of GnRH
Pituitary sensitivity of increased GnRH
Increased pulse frequency of L H (preferential) compared to FSH
Increased L H : Decreased FSH
Pituitary
Increased oestradiol
Increased androgen
Increased oestradiol
Increased inhibin
Increased LH Decreased FSH
(+) (-)

6. Androgen excess
T he principal sources of androgens are ovary, adrenal & peripheral tissues
Decreased
aromatization
Enzyme
P450C17
dysregulation
Increased
insulin
Increased
IGF-1 (insulin-
like growth
factor)Increased
androstenedione
& testosterone
Increased LH
stimulation
Ovary

7. Anovulation
Granulosa
Cells
T heca cell
stroma
Anovulation
Increased
androgen
Ovary
Increased
L H &
IGF-1
Decreased
FSH

8. Increased insulin
Increased insulin resistance
Liver
Decreased SHBG
Decreased IGFBP
Obesity
Ovary (theca
cells)
Increased
androgensIncreased
androgens
Obesity

9. Clinical features
• Hirsutism, Acne
• Oligomenorrhoea, Amenorrhoea
• Infertility
• Acanthosis nigricans
• Central obesity
• Insulin Resistance, Dyslipidemia

10. Complications
• Type 2 diabetes
• Cardiovascular diseases
• Endometrial hyperplasia and cancer
• Obstructive sleep apnea
• Non alcoholic fatty liver disease

11. References
• T he essential guide for the practice of obstetrics and
gyanecology, 3rd edition, page no. 570 and 571
• Rubin’s pathology clinicopathological foundation of
medicine, 6th edition, page no. 886 &887