This document provides an overview of polycystic ovary syndrome (PCOS). It discusses the early descriptions and recognition of PCOS dating back to the 18th century. It outlines the diagnostic criteria for PCOS involving oligo-anovulation, clinical or biochemical signs of hyperandrogenism, and polycystic ovaries. The document also discusses the pathogenesis and genetic factors of PCOS, its association with insulin resistance and metabolic syndrome, and its clinical presentations and long term risks. Treatment involves lifestyle modification and insulin sensitizers to address the metabolic abnormalities and symptoms of PCOS.

1. PCOS
AN OVER VIEW
DR. RABI NARAYAN SATAPATHY
ASST.PROFESSOR
DEPT. OF OBST.& GYNAECOLOGY
SCB MEDICAL COLLEGE, CUTTACK
MOB-09861281510
EMAIL-drrabisatpathy@gmail.com

2. “ Young married peasant
woman, moderately obese
and infertile, with two larger
than normal ovaries, bumpy,
shiny and whitish, just like
pigeon eggs.”
- A. Vallisneri, 1721
Cited in Insler, V. and Lunenfeld, B.; Gynec. Endocrinology 4 (1990)
.

3. Nineteenth Century
Recognition and description of
sclero-cystic changes
in the ovary
Chereau A, 1844
.

4. 1935
Stein and Leventhal
First presented their paper
on seven women with
amenorrhoea, hirsutism and
enlarged ovaries with multiple cysts
and thickened tunica at
the Central Association of
Obstetricians and Gynecologists..

5. Most Common
Endocrine Disorder
in WOMEN
with
multi-system involvement
Homburg, R ; Human Reprodn. 11 : 1996
Kovacs, GT ; Polycystic ovary syndrome ( Cambridge Univ. Press ) : 2000
Marx, TL & Mehta, AE ; Cleveland Clinic J. of Medicine : January 2003

6. Diagnosis
Any two of the following
(i) Oligo- and/or anovulation
(ii) Clinical and/or biochemical signs of
Hyperandrogenism
(iii) Polycystic ovary morphology on USG scan
[defined as presence of 12 or more fiollicles
The Rotterdam ESHRE/ASRM - sponsored
PCOS Work shop Group 2004

7. PCOS
associated with
Metabolic
syndrome• Hypertension : 130/85 or higher
• TG Levels : 150 mg/dl Or higher
• HDL-C levels : Less than 50 mg/dl
• Abd. Obesity : Waist circumference > 35”
• Fasting Glucose : 110mg/dl or higher

8. Chronic anovulation
due to
spectrum of
etiologies
and
clinical manifestations
which now include
Insulin Resistance
and
Hyperinsulinemia
and

9. Pathogenesis
Combination of
genetic and environmental factors
contribute with potential etiological
factors including Insulin resistance,
Ovarian dysfunction,
Hyperandrogenism and
Hypothalamic-pituitary dysfunction.
It is multi-factorial.
.

10. Genetic disorder with Autosomal dominant
mode of inheritance
: Genes involved :
Steroid hormone synthesis, Carbohydrate
metabolism, Gonadotrophin action & Major
histocompatibility region
: Candidates :
CYP11A, CYP17, CYP21, Androgen receptor gene,
SHBG gene, Insulin gene, IR gene, IRS gene,
Capain10, FSH β -subunit gene, Dopamine
receptor gene & Follistatin gene
DR. RABI NARAYAN SATAPATHY
ASST.PROFESSOR
DEPT. OF OBST.& GYNAECOLOGY
SCB MEDICAL COLLEGE, CUTTACK
MOB-09861281510
EMAIL-drrabisatpathy@gmail.com

11. HYPERANDROGENISM
HYPOTHALAMUS
ADRENALS
PANCREAS
OVARIES
.
LH FSH
INSULIN
GnRH
DHEA-S, ANDROSTENEDION
TESTOSTERONE & ESTRONE
zPITUITARY
GENETIC ENVIRONMENT

12. HYPOTHALAMUS
PITUITARY
GENETIC
PREDISPOSITION
OVARY
Theca cell hyperplasia
Impaired folliculogenesis
INSULIN RESISTANCE
Compensatory hyperinsulinemia
OBESITY
LIVER
SHBG
IGFBP-I
LH GH
IGF-I
HYPERANDROGENISM
.

13. ‘diabete a femmes de barbe’
Achard & Thiers, 1921
[ Bull Acad. Natl. Med.( Paris ) ]
Kahn et al, 1976
[ N Engl J Med ]
There was description of several
women with insulin resistance ,
severe hyperandrogenism and
acanthosis nigrans; most of these
women were noted to have
bilaterally multicystic ovaries.

14. TODAY
Insulin Resistance and PCOS
Strong association both in obese and
non-obese
Central to
Pathophysiology relationship

15. South Asian Women
With PCOS more
likely
to suffer from
Insulin Resistance
and to have
Low
Wijeyaratne et al .; Clin. Endocrinol.. : 2002

16. IR With INSULIN
TYR-PO4 TYR-PO4
RAS
MAP Kinase
SHC
SOC
MITOGENESIS
METABOLIC ACTIONS
IRS-1/2
Inactive
PI-3
Kinase
Active
PI-3 Kinase
PIP PIP 3
GLUT-4
PDH
Glycogen
Synthase
DCI-IPG
G-Pr.

17. INSULIN RESISTANCE
HyperinsulinaemiaENDOCRINE
MANIFESTATIONS
Theca cell hyperplasia
Ovary
Liver Adrenal gland
Pituitary
LH FSH
IGFBP-I
IGF-I
SHBG
Hyperandrogenism
Anovulation
CLINICAL
PRESENTATION
Infertility Menstrual disorder Hirsuitism

18. Clinical Presentation
[ Wide variety of presentation]
Menstrual disturbances
Anovulation
Infertility
Recurrent miscarriage
Hirsutism Acne Alopecia

19. Long Term Risks
[ Abnormal GT and DM,
Dyslipidaemia,
Hypertension,
Coronary arterial disease and
Cancer of Endometrium / Breast / Ovary ]

20. AT PRESENT
NO
SIMPLE SOLUTION
TO A
COMPLEX PROBLEM

21. Treatment
Life style modification
Insulin sensitisers
Menstrual disorder
Anovulation/Infertility
Hirsutism

22. .