Hyperandrogenism

Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility. The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily correlated with PCOS. more...

Nomenclature

Other names for this disorder include:

• Polycystic ovary disease (although this is not correct, as PCOS is characterised as a syndrome rather than a disease)
• Functional ovarian hyperandrogenism
• Hyperandrogenic chronic anovulation
• Ovarian dysmetabolic syndrome

Definition

There are two definitions that are commonly used:

1. In 1990 a consensus workshop sponsored by the NIH/NICHD suggested that a patient has PCOS if she has (1) signs of androgen excess (clinical or biochemical), (2) oligoovulation, and (3) other entities are excluded that would cause polycystic ovaries.
2. In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if 2 out of 3 criteria are met: (1) oligoovulation and/or anovulation, (2) excess androgen activity, (3) polycystic ovaries (by gynecologic ultrasonography), and other causes of PCOS are excluded.

The Rotterdam definition is wider, including many more patients, notably patients without androgen excess, while in the NIH/NICHD definiton androgen excess is a prerequisite. Critics maintain that findings obtained from the study of patients with androgen excess cannot be necessarily extrapolated to patients without androgen excess.

Signs and symptoms

Common symptoms of PCOS include:

• Oligomenorrhea, amenorrhea - irregular/few, or absent, menstrual periods; cycles that do occur may comprise heavy bleeding (check with a gynaecologist, since heavy bleeding is also an early warning sign of endometrial cancer, for which women with PCOS are at higher risk)
• Infertility, generally resulting from chronic anovulation (lack of ovulation)
• Elevated serum (blood) levels of androgens (male hormones), specifically testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS), causing hirsutism and occasionally masculinization
• Central obesity - "apple-shaped" obesity centered around the lower half of the torso
• Androgenic alopecia (male-pattern baldness)
• Acne / oily skin / seborrhea
• Acanthosis nigricans (dark patches of skin, tan to dark brown/black)
• Acrochordons (skin tags) - tiny flaps of skin
• Prolonged periods of PMS-like symptoms (bloating, mood swings, pelvic pain, backaches)
• Sleep apnea

Signs are:

• Multiple cysts on the ovaries. Sonographycally they may present as a "string of pearls".
• Enlarged ovaries, generally 1.5 to 3 times larger than normal, resulting from multiple cysts
• Thickened, smooth, pearl-white outer surface of ovary
• Chronic pelvic pain, possibly due to pelvic crowding from enlarged ovaries; however, the actual cause is not yet known
• The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone) is 2:1 or more, particularly in the early phase of the menstrual cycle.
• Increased levels of testosterone.
• Decreased levels of sex hormone binding globulin.
• Hyperinsulinemia.

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