Polycystic ovarian syndrome or Stein Leventhal syndrome (PCOS)

Millions of women suffer from PCOS due to hormones cause.
It is a common cause for infertility in women.
Male hormones testosterone causes hyperandrogenism in women with heaving PCOS.
It is characterised by an abnormaly evevated serum concentrations of androgen.
Cause....
   
  PCOS is multifactorial and polygenic.
     Excessive productions of androgen from ovaries.
    The elevated androgen interfere with reproductive, endocrine and metabolic functions.
Pathology.......
Hyperinsulinemina is found which is associated with insulin resistance and increase.
Insulin resistance=serum fasting blood sugar/serum fasting insulin<405.
Clinical features......
Obesity
Menstrual irregularities.. oligomenorrhea, amenorrhea or DUB
Infertility
Hirsutism
Acne
Physical finding present in women with PCOS.......
Weight gain.. Android obesity assess of (waist:hip ratio >0.85).
Hirsutism
Virilisations
Hypertrichosis
Acanthosis nigrican
USG.....
 Enlarged ovaries found due to presence of cyst in` sting ' of pearls like appearance.
Biochemical analysis..,..
 Increased. ....
  Androgen (testosterone,Androstenedione,Dihydroepiandrostenedion )
 LH
Estrogens (estrone>estradiol)
Insulin ( >10mIU/L)
Prolactin
LDL and triglycerides
Decreased....
  FSH 
  Progesterone
Sex hormones
HDL and Apropritein A-1
Sex hormones binding globulin
 Diagnosis...
Rotterdam criteria would be helpful to diagnose the patient with PCOS
Oligomenorrhea and amenorrhea
Hyperinsulinemina (serum testosterone=70-150Hg/dl )with hirsutism
USG scanning. 
   Ovarian volume increase (10cm3)
   Multiple follicular cyst (12)
  Size of cyst is 2 to 9mm.

Complications..
Consequences of PCOS are increased risk of CVD,DM Type 2, Breast and ovarian Ca, Metabolic syndrome , depressive illness,mood disorder and sleep apnea.
Treatment....
 Women with PCOS treated as per complain.....
Irregular period -Treated with OCP or GnRH agonist.
Insulin resistance -Treated with Metformin
Obesity -Life style modification,spironolactone, weight loss by exercise and food habits (BMI<25)
Infertility.....
  Weight loss
  Clomiphene/Tamoxifen
  Gonadotropin
Hirsutism 
  Treated with OCP with cyproterone acetract 
Medicated cream or Lesser treatment for extra hair....

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