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STEIN- LEVENTHAL SYNDROME
BY –Dr VIJETA
 IT IS THE MOST COMMON ENDOCRINE
DISORDERS IN FEMALES OF REPRODUCTIVE
AGE.
 FAMILIAL INHERITANCE IS PRESENT.
 Reduced glucose uptake response to a given
amount of insulin.
 Hyperinsulinemia causes hyperandrogenism
in 2 ways-
1. Stimulates synthesis of androgens from
ovaries.
2. Decreases sex-hormone binding globulin.
 Insulin resistance can be detected by –
Serum fasting blood sugar
Serum fasting insulin
<4.5
 Acanthosis nigricans – hyper-pigmented
velvety patches of skin in neck, axilla,below
breast ,thigh.
 2 hour OGTT is recommened by ACOG after
75gm of glucose in all pcos pts as imparied
glucose tolerance and diabetes may be
present in them.
 Excessive androgen production in pcos is due
to excessive synthesis by ovaries.
 Hirsuitism, acne ,alopecia.
 Grading of hirsuitism by MODIFIED FERRIMAN
GALLWEY SCORE = 9 sites are seen for
hirsutism.
max. score – 36
If score >8 (mild hirsuitism)
If score >15 (moderate /severe hirsuitism)
 CAUSES:
1. Inappropriate gonadotropin secretion
(absent LH SURGE and presence of LH from
the beginning of cycle).
2. Insulin resistance
3. Large number of antral follicles with
increased ovarian androgens.
This is the reason why laproscopic drilling is
done in PCOD as theca cells are destroyed so
there less androgen production.
 Amenorhoea
 Oligoamenorrhea
 menometrorrhagia
 Hyper-androgenism
 Insulin resistance
 Acanthosis nigricans
 Any 3 of the following 5
1. Abdominal obesity
2. Trigycerides > 150 mg/dl
3. HDL-cholesterol < 50 mg/dl
4. Bp :130/85 mmHg
5. Fasting blood sugar: 110-126 mg/dl
2 hr post-prandial : 140-199 mg/dl
1. Ovulatory dysfunction
2. Clinical ( hirsuitism ,acne ,alopecia) /
biochemical evidence of hyperandrogenism(
serum testosterone 70-150 ng/dl) if >200
ng/dl ,it is due to testosterone secreting
ovarian tumour not pcos.
3. USG – presence of 12 or more cyst(size 2-
9mm) in any one ovary or both with enlarged
ovaries (>10 ml).
 LIFE STYLE CHANGES
 Treatment of oligo and anovulation-
combination oral contraceptive pills.
it induces regular menstrual cycles, lower
androgen levels .
 For insulin resistance – METFORMIN 1500-
2000 mg in divided doses daily with meals.
 For hirsuitism – DOC- OC PILLS
GIVEN for 6months .if response does not
come then add spironolactone 50-100mg
daily
 Short term- hirsuitism, irregular menses,
INFERTILITY.
 Long term –cvs diseases,
diabetes,endometerial ,breast ,ovarian cancer
, depression ,mood disorder , metabolic X
syndrome.
 THANKYOU

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Pcos -polycystic ovarian syndrome

  • 2.
  • 3.  IT IS THE MOST COMMON ENDOCRINE DISORDERS IN FEMALES OF REPRODUCTIVE AGE.
  • 5.
  • 6.
  • 7.  Reduced glucose uptake response to a given amount of insulin.  Hyperinsulinemia causes hyperandrogenism in 2 ways- 1. Stimulates synthesis of androgens from ovaries. 2. Decreases sex-hormone binding globulin.
  • 8.  Insulin resistance can be detected by – Serum fasting blood sugar Serum fasting insulin <4.5  Acanthosis nigricans – hyper-pigmented velvety patches of skin in neck, axilla,below breast ,thigh.
  • 9.
  • 10.
  • 11.  2 hour OGTT is recommened by ACOG after 75gm of glucose in all pcos pts as imparied glucose tolerance and diabetes may be present in them.
  • 12.  Excessive androgen production in pcos is due to excessive synthesis by ovaries.  Hirsuitism, acne ,alopecia.  Grading of hirsuitism by MODIFIED FERRIMAN GALLWEY SCORE = 9 sites are seen for hirsutism. max. score – 36 If score >8 (mild hirsuitism) If score >15 (moderate /severe hirsuitism)
  • 13.
  • 14.  CAUSES: 1. Inappropriate gonadotropin secretion (absent LH SURGE and presence of LH from the beginning of cycle). 2. Insulin resistance 3. Large number of antral follicles with increased ovarian androgens. This is the reason why laproscopic drilling is done in PCOD as theca cells are destroyed so there less androgen production.
  • 15.
  • 17.  Hyper-androgenism  Insulin resistance  Acanthosis nigricans
  • 18.  Any 3 of the following 5 1. Abdominal obesity 2. Trigycerides > 150 mg/dl 3. HDL-cholesterol < 50 mg/dl 4. Bp :130/85 mmHg 5. Fasting blood sugar: 110-126 mg/dl 2 hr post-prandial : 140-199 mg/dl
  • 19. 1. Ovulatory dysfunction 2. Clinical ( hirsuitism ,acne ,alopecia) / biochemical evidence of hyperandrogenism( serum testosterone 70-150 ng/dl) if >200 ng/dl ,it is due to testosterone secreting ovarian tumour not pcos. 3. USG – presence of 12 or more cyst(size 2- 9mm) in any one ovary or both with enlarged ovaries (>10 ml).
  • 20.  LIFE STYLE CHANGES  Treatment of oligo and anovulation- combination oral contraceptive pills. it induces regular menstrual cycles, lower androgen levels .  For insulin resistance – METFORMIN 1500- 2000 mg in divided doses daily with meals.  For hirsuitism – DOC- OC PILLS GIVEN for 6months .if response does not come then add spironolactone 50-100mg daily
  • 21.  Short term- hirsuitism, irregular menses, INFERTILITY.  Long term –cvs diseases, diabetes,endometerial ,breast ,ovarian cancer , depression ,mood disorder , metabolic X syndrome.