Diagnosis

Polycystic ovary syndrome

Etiology

Cause [eht]

• Genetic factors

• Obesity (visceral adiposity)

• Insulin resistance

Pathofysiology [eht]

1. Elevated LH -> ovarian theca cells increase production of androgens -> elevated LH/FSH-ratio -> failure to aromatize the androgens to estrogens -> decreased estrogen levels and anovulation -> arrest in maturation -> ovarian cysts

2. Insulin resistance --> hyperinsulinemia

3. Dysfunction of the hypothalamic-pituitary-ovarian axis

   • Increased Antimullerian hormone and Luteinizing hormone (LH)

   • Ovarian steroidogenesis --> androgen excess

4. Increased risk for:

   • Infertility

   • Metabolic syndrome

   • Obesity

   • Diabetes type 2

   • Cardiovascular risk

   • Depression

   • Obstructive sleep apnea

   • Endometrial cancer

   • Metabolic dysfunction-associated steatotic liver disease (MASLD)

Risk factors [eht]

• Family history of PCOS

• Fetal androgen exposure

• Family history of metabolic syndrome

• Overweight or obese

Complications [eht]

• Infertility

• Miscarriage

• Endometrial cancer

• Metabolic Disease: BMI, hypertension, diabetes, hyperlipidemia

• Cardiovascular Disease

• Metabolic dysfunction-associated steatotic liver disease (MASLD)

• Depression

Epidemiology

Incidence per 100.000 [qnw][osw][oh6][ipi]

Prevalence per 100.000 [qnw][osw][oh6][ipi]

Approach

• Blood test: glucose tolerance, thyroid-levels, SHBG, androgens, prolactin levels, hCG,

• Pelvic exam

• Ultrasound pelvis

• Diagnostic laparoscopy

Rotterdam diagnostic criteria - presence of 2 of the following [ixu]

• Androgen excess

• Ovulatory dysfunction

• Polycystic ovaries

Treatment

1. Lifestyle modifications: [ixu]

   • Weight loss

   • Increased exercise

   • Change in diet

2. Menstrual abnormalities and hirsutism/acne --> hormonal contraceptives [ixu]

3. Metabolic/glycemic abnormalities --> Metformin and GLP-1 agonists [eht]

4. Infertility --> Clomiphene

5. Adrenal hyperandrogenism --> Prednisone, dexamethasone, spironolactone

6. Treat cardiovascular risk, diabetes, endometrial cancer, mood disorders, and obstructive sleep apnea

7. Bariatric surgery [eht]

Differential diagnoses

Acromegaly, Adrenal cortical adenoma, Adrenal cortical carcinoma, Anabolic steroids, Congenital adrenal hyperplasia, Cushings disease, Cushing syndrome, Diabetes mellitus, Drug side effects, Early menopause, Eating disorder, Familial hirsutism, Gigantism, Hyperprolactinemia, Hyperthyroidism, Hypothyroidism, Idiopathic hirsutism, Obesity, Ovarian cancer, Ovarian hyperthecosis, Pituitary adenoma