9/27/2022 Too Late Too Often!![]()
By Lucy Hallmark
Freshman, Biochemistry Major Mississippi State University ![]()
Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects 6â12% of women of reproductive age globally. Hormonal imbalance and ovarian dysfunction are two significant hallmarks of PCOS.
A recent study shows that women with PCOS are at a higher risk of developing infertility, cardiovascular diseases, diabetes, hypertension, and obesity. The lack of guidelines for accurate clinical identification and knowledge gaps among providers pose a challenge for PCOS diagnosis. Most women discover they have PCOS after experiencing infertility issues. September is PCOS Awareness month. Throughout this month, PCOS Challenge: The National Polycystic Ovary Syndrome Association sponsors and organizes events and provides resources and information regarding PCOS. A little history Polycystic ovary syndrome was initially described in 1721 by Italian physician Antonio Vallisneri. He reported the case of a peasant woman who was obese, infertile, and had enlarged ovaries, which were described as white and shiny. It wasnât until 1935, when Dr. Irving Stein and Dr. Michael Leventhal published a report entitled âAmenorrhea associated with polycystic ovaries,â that any progress in diagnosing the disease began. Leventhal and Stein defined three criteria that remain to this day vital in the diagnosis of PCOS. Theirs was the first report of patients suffering from polycystic ovaries and PCOS-related symptoms. They also were one of the first researchers to suggest that the abnormalities resulted from a hormonal imbalance. What are the symptoms of PCOS? Women affected by PCOS miss or have delayed irregular periods. Per Rotterdam criteria, PCOS has three key features: Anovulation, hyperandrogenism, and polycystic ovaries. You must display at least 2 of these criteria to be diagnosed with PCOS. Anovulation happens in women of childbearing age when an egg is not released during the menstrual cycle. The primary cause is excessive androgen production, also called functional ovarian hyperandrogenism leading to small pre-ovulatory follicles that fail to respond to normal concentrations of follicle-stimulating hormone. Small ovarian follicles preferentially metabolize androgens to make male hormones like testosterone. This is due to high levels of the enzyme steroid 5α-reductase found in small ovarian follicles that process hormones for male sexual development. In women of childbearing age, PCOS is detected in the late teens or early 20s when symptoms like excessive coarse hair growth on the face, chest, and back, acne, and irregular periods surface. Excessive hair growth is referred to as hirsutism. What are the causes of PCOS? Four schools of thought provide a hypothesis for the pathogenesis of PCOS. They are the top-down, bottom-up, androgen theory, and insulin schools of thought. The top-down school hypothesizes that PCOS results from the aberrant production of the luteinizing hormone, LH, which translates into inadequate follicular maturation. Increases in serum LH levels lead to enlargement of the ovarian theca cells, which causes the overproduction of ovarian androgens. The bottom-up school suggests that the root cause is the conversion of adrenal androgens such as D4 androstenedione or D4A into estrone or E1 in the peripheral adipose tissues. E1 sensitizes the pituitary gland resulting in the overproduction of LH. Excessive LH stimulates the thecal cells causing the overproduction of androgens. The school of androgen theory emphasizes that ovarian hyperandrogenism is the primary cause of PCOS. The insulin school links high androgen levels with hyperinsulinemia or overproduction of insulin. Excessive insulin accompanied by insulin resistance is a significant factor predisposing women to PCOS. High insulin levels reduce androgen clearance and enhance steroidogenesis in the adrenal glands and ovarian theca. Endocrine mechanisms that control PCOS are reviewed in detail here. PhysioPathoPharmaco 2020 [YouTube Channel] Polycystic Ovarian Syndrome (PCOS) - Pathophysiology, Symptoms, Treatment
Erin Tolar Fortenberry
10/4/2022 01:46:27 pm
Very interesting and informative! Comments are closed.
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