Gynecology Book

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Polycystic Ovary Disease

Aka: Polycystic Ovary Disease, Stein-Leventhal Syndrome, Polycystic Ovary Syndrome, Polycystic Ovaries, Functional Ovarian Hyperandrogenism, PCO Disease, PCOS
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  1. See Also
    1. Hyperandrogenism
    2. Insulin Resistance Syndrome
    3. Dysfunctional Uterine Bleeding
  2. History
    1. First described by Stein and Leventhal in 1935
  3. Pathophysiology
    1. Contributing Factors
      1. Obesity and hyperinsulinemia
      2. Increased adrenal function
    2. Androgen Excess (Hyperandrogenism)
      1. Androstenedione increased
      2. Testosterone increased
      3. Free Testosterone increased
        1. Occurs with decreased Sex Hormone Binding Globulin
    3. Ovarian enlargement with Hyperthecosis
      1. Luteinization of theca interna
      2. Reduction of granulosa cells
  4. Symptoms
    1. Menstrual Disorders (80% of PCOS patients)
      1. Anovulatory Bleeding (<6 Menses per year)
      2. Delayed menstrual regularity
    2. Infertility (74%) and Recurrent Miscarriage
    3. Androgenic features
      1. See Hyperandrogenism
      2. Acne Vulgaris
      3. Hirsutism (69%)
      4. Male sweat changes
      5. Clitoris swelling
    4. Central Obesity (49% of PCOS patients)
      1. Weight gain starts in teens and twenties
      2. BMI over 27 (65% of PCOS patients)
    5. Mood disturbance (e.g. Major Depression, Anxiety)
  5. Signs
    1. Hirsutism
    2. Bilateral ovary enlargement
    3. Hypertension
  6. Differential Diagnosis (See Hyperandrogenism)
    1. Cushing's Syndrome and other endocrinopathies
    2. Adrenal Hyperplasia
    3. HAIR-AN Syndrome
  7. Radiology: Transvaginal Ultrasound
    1. General features
      1. Multiple small follicles in various stages
      2. Thick ovarian capsule
      3. String of pearls appearance
    2. Criteria: Multiple Ovarian Cysts (seen in 80% of cases)
      1. Ten or more cysts in a single plane
      2. Each cyst <10 mm in diameter
      3. Dense stroma
    3. Interpretation
      1. Polycystic appearance is seen in up to 33% of women
      2. Polycystic appearance does not diagnose PCOS
      3. PCOS clinical features must be present for diagnosis
      4. Hassan (2003) Fertil Steril 80:966-75
  8. Labs: Approach
    1. Screening for PCOS (if history suggests)
      1. Glucose to Insulin Ratio < 4.5
    2. Exclude other diagnoses
      1. Thyroid Stimulating Hormone
      2. Morning 17a-hydroxyprogesterone (adrenal hyperplasia)
      3. Serum DHEAS > 700 ng/dl (Androgen secreting tumor)
      4. Serum Total Testosterone >20 ng/dl (Androgen tumor)
    3. Evaluate comorbid disease
      1. Fasting Glucose
      2. Fasting Lipid Panel
  9. Labs: Review of laboratory changes in PCOS
    1. Insulin Resistance Syndrome (70% of PCOS patients)
      1. Glucose to Insulin Ratio < 4.5
        1. Sensitive marker of Insulin Resistance in PCOS
      2. Insulin increased (C-Peptide increased)
      3. Fasting Serum Glucose increased
      4. Two hour Glucose Tolerance Test abnormal
    2. Gonadotropin increases
      1. Luteinizing hormone (LH) exaggerated surge
      2. Serum LH to Serum FSH ratio exceeds 3.0 (30%)
      3. Serum Testosterone >20 ng/dl
      4. Serum Free Testosterone >2.57 pg/ml
      5. Androstenedione >2.7 ng/ml
    3. Associated endocrine abnormality testing
      1. Thyroid Stimulating Hormone (TSH)
      2. Serum Prolactin
      3. Consider adrenal function testing
    4. Associated dyslipidemia
      1. Total Cholesterol increased
      2. LDL Cholesterol increased
      3. HDL Cholesterol decreased
      4. Triglycerides increased
  10. Management: General
    1. Weight loss of 10% in Overweight patients
      1. Insulin Resistance decreases with weight loss
        1. Kiddy (1992) Clin Endocrinol 36:105-11
      2. Results in 75% conception rate in PCOS
        1. Bates (1982) Fertil Steril 38:406-9
  11. Management: Unopposed Estrogen Management
    1. Provera 10 mg PO qd for 7 days repeated q3 months or
    2. Oral Contraceptive with low Androgenic Activity
      1. Ortho Tri-Cyclen
      2. Ortho-Cept or Desogen
      3. Modicon
      4. Ortho-Cyclen
      5. Yasmin
  12. Management: Ovulatory Dysfunction interfering with fertility
    1. Clomiphene (Clomid)
    2. Letrozole (Femara)
  13. Management: Hyperandrogenism (e.g. Hirsutism, Acne)
    1. See HAIR-AN Syndrome
    2. See Hirsutism
    3. First-Line Agents
      1. Spironolactone (Aldactone) 50 mg PO twice daily
      2. Eflornithine (Vaniqa) 13.9% applied to face daily
    4. Second-Line Agents
      1. Finasteride (Propecia)
      2. Flutamide (Eulexin)
  14. Management: Insulin Resistance
    1. Metformin (Glucophage)
      1. Start at 500 mg PO daily and advance to 1500-2000 mg daily divided bid
      2. Effect not seen until dose >1000 mg/day
      3. Induces Ovulation in up to 46% of PCOS cases
      4. Barbieri (2003) Obstet Gynecol 101:785-93
      5. Lord (2003) BMJ 327:951-6
    2. Glitazones
      1. Pioglitazone (Actos) 30 mg orally daily
        1. Ortega-Gonzalez (2005) J Clin Endocrinol Metab 90(3): 1360-5
      2. Rosiglitazone (Avandia) 2-8 mg orally daily (best effect with higher doses)
        1. Cataldo (2006) Hum Reprod 21(1): 109-20
  15. Management: Advanced
    1. Gonadotropins (e.g. Metrodin, Pergonal)
      1. Risk of Ovarian Hyperstimulation Syndrome (OHSS)
    2. FSH with hCG
    3. Glucocorticoids (Prednisone, Dexamethasone)
      1. Indicated in adrenocortical hyperplasia
    4. GnRH-agonist
      1. Indicated prior to Ovulation induction
  16. Management: Surgical
    1. Ovarian wedge resection
      1. Normal cycles resume in 80% of patients
      2. Conception occurs in 63%
      3. Risk of peritubular and ovarian adhesions
    2. Laparoscopic ovarian drilling
      1. Similar results to ovarian wedge resection
      2. Minimally invasive
  17. Complications
    1. Infertility
    2. Increased Breast Cancer risk
    3. Increased Endometrial Cancer risk
      1. Associated with Unopposed Estrogen
    4. Increased cardiovascular disease risk
  18. References
    1. Acien (1999) Fertil Steril 72:32-40
    2. Chang (1999) Endocrinol Metab Clin North Am 28:397-408
    3. Futterweit (1999) Obstet Gynecol Surv 54:403-13
    4. Pasquali (1999) Clin Endocrinol 50:517-27
    5. Richardson (2003) Am Fam Physician 68(4):697-704
    6. Taylor (1998) Endocrinol Metab Clin North Am 27:877-902

Polycystic Ovary Syndrome (C0032460)

Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (CHV) a health problem that can affect a woman's menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance
Definition (NCI) A condition marked by infertility, enlarged ovaries, menstrual problems, high levels of male hormones, excess hair on the face and body, acne, and obesity. Women with PCOS have an increased risk of diabetes, high blood pressure, heart disease, and endometrial cancer.
Definition (NCI) A disorder that manifests as multiple cysts on the ovaries. It results in hormonal imbalances and leads to irregular and abnormal menstrual periods, excess growth of hair, acne eruptions and obesity.
Definition (MSH) A complex disorder characterized by infertility, HIRSUTISM; OBESITY; and various menstrual disturbances such as OLIGOMENORRHEA; AMENORRHEA; ANOVULATION. Polycystic ovary syndrome is usually associated with bilateral enlarged ovaries studded with atretic follicles, not with cysts. The term, polycystic ovary, is misleading.
Definition (CSP) clinical symptom complex characterized by presence of multiple cysts on the ovaries, oligomenorrhea or amenorrhea, anovulation and regularly associated with excessive amounts of body hair (hirsuitism), excessive body weight, infertility and insulin resistance.
Concepts Disease or Syndrome (T047)
MSH D011085
ICD9 256.4
ICD10 E28.2
SnomedCT 237055002, 154714009, 237792009, 271199009, 69878008, 190549002
English STEIN LEVENTHAL SYNDROME, Ovary Syndrome, Polycystic, Stein-Leventhal Syndrome, Syndrome, Polycystic Ovary, Syndrome, Stein-Leventhal, BILATERAL POLYCYSTIC OVARIAN SYNDROME, HYPERTHECOSIS, OVARIAN, POLYCYSTIC OVARIAN SYNDROME, POLYCYSTIC OVARY DISEASE, POYCYSTIC OVARIAN SYNDROME, SCLEROCYSTIC OVARIAN DISEASE, Stein Leventhal Syndrome, Cystic disease of ovary, PCOD - Polycystic ov disease, PCOS - Polycystic ov syndrome, PCOS, STEIN-LEVENTHAL SYNDROME, PCO1, PCO, Stein-Leventhal ovaries, PCOS1, POLYCYSTIC OVARY SYNDROME 1, polycystic ovaries, Polycystic ovary syndrome (disorder), (Polycystic ovaries) or (Stein-Leventhal syndrome) (disorder), Multicystic ovaries (disorder), Stein Leventhal syndrome (diagnosis), polycystic ovarian syndrome, PCOS (polycystic ovarian syndrome), Stein Leventhal syndrome, polycystic ovary, polycystic ovary (stein leventhal syndrome), Polycystic ovary, OVARIAN POLYCYSTIC DISEASE, Polycystic Ovarian Disease, Polycystic Ovary Syndrome [Disease/Finding], Polycystic Ovarian Syndrome, Ovarian Syndromes, Polycystic, Ovarian Syndrome, Polycystic, ovaries polycystic, polycystic ovarian disease, ovary polycystic, ovarian polycystic disease, sclerocystic ovarian disease, stein-leventhal syndrome, polycystic ovary syndrome (PCOS), diseases ovary polycystic, stein leventhal syndrome, disease ovary polycystic, multicystic ovaries, ovary polycystics syndrome, disease ovarian polycystic, ovarian hyperthecosis, Stein Lenventhal syndrome, polycystic ovary disease, polycystic ovary disorder, polycystic ovary syndrome, Ovarian Degeneration, Sclerocystic, Sclerocystic Ovarian Degeneration, Sclerocystic Ovary Syndrome, Polycystic ovaries, Polycystic ovary syndrome, Stein-Leventhal syndrome, Cystic disease of ovaries, Polycystic ovarian disease, Multicystic ovaries, PCOD - Polycystic ovarian disease, PCOS - Polycystic ovarian syndrome, Sclerocystic ovary syndrome, PCO - Polycystic ovaries, Polycystic ovaries (disorder), bilateral polycystic ovarian; syndrome, disease (or disorder); ovary, polycystic, disease (or disorder); polycystic, ovary, Stein-Leventhal, ovary; polycystic (syndrome), ovary; sclerocystic, syndrome, ovary; syndrome, polycystic, ovary; syndrome, sclerocystic, polycystic; disease, ovary, polycystic; ovary, sclerocystic ovary syndrome, syndrome; bilateral polycystic ovarian, syndrome; ovary, polycystic, syndrome; ovary, sclerocystic, syndrome; polycystic ovarium, syndrome; sclerocystic ovary, Stein - Leventhal syndrome, (Polycystic ovaries) or (Stein-Leventhal syndrome), Stein-Leventhal synd., Polycystic ovarian syndrome, Polycystic Ovary Syndrome
Dutch polycysteus ovarium-syndroom, polycystische ovaria, aandoening; ovarium, polycysteus, aandoening; polycysteus, ovarium, dubbelzijdig polycysteus ovarium; syndroom, ovarium; polycysteus (syndroom), ovarium; sclerocysteus, syndroom, ovarium; syndroom, polycysteus, ovarium; syndroom, sclerocysteus, polycysteus; aandoening, ovarium, polycysteus; ovarium, syndroom; dubbelzijdig polycysteus ovarium, syndroom; ovarium, polycysteus, syndroom; ovarium, sclerocysteus, syndroom; polycysteus ovarium, syndroom; sclerocysteus ovarium, polycysteuze eierstokken, Polycysteus-ovariumsyndroom, Stein-Leventhal-syndroom, Syndroom, polycysteus-ovarium-
French Ovaire polykystique, Syndrome des ovaires micropolykystiques, OPK (Ovaires Polykystiques), Ovaires polykystiques, MPO (MicroPolykystose Ovarienne), Micropolykystose ovarienne, SOMPK, Dystrophie ovarienne, SOPK, Syndrome de Stein-Leventhal, Syndrome des ovaires polykystiques, Polykystose ovarienne, SOPK (Syndrome des Ovaires PolyKystiques)
German polyzystischer Eierstock, Stein-Leventhal Syndrom, polyzystisches Ovarialsyndrom, Syndrom polyzystischer Ovarien, polyzystische Eierstoecke, Polyzystisches ovarielles Syndrom, Stein-Leventhal-Syndrom
Italian Ovaio policistico, Sindrome ovarica policistica, PCO, Malattia sclerocistica dell'ovaio, Sindrome di Stein-Leventhal, Policistosi ovarica, Sindrome dell'ovaio policistico
Portuguese Síndrome de ovário poliquístico, Ovário poliquístico, Ovários poliquísticos, Síndrome de Stein-Leventhal, Síndrome do Ovário Policístico
Spanish Ovario poliquístico, Síndrome ovárico poliquístico, Stein - Leventhal syndrome, Polycystic ovaries, (Polycystic ovaries) or (Stein-Leventhal syndrome), Stein-Leventhal synd., Multicystic ovaries, Polycystic ovary syndrome, enfermedad quística de los ovarios, ovarios poliquísticos, poliquistosis ovárica (trastorno), poliquistosis ovárica, síndrome de Stein - Leventhal, Ovarios poliquísticos, Sindrome de Stein-Leventhal, Síndrome del Ovario Poliquístico, Síndrome de Stein-Leventhal, Sindrome del Ovario Poliquistico
Japanese スタイン・レーヴェンタール症候群, 多嚢胞性卵巣, ﾀﾉｳﾎｳｾｲﾗﾝｿｳｼｮｳｺｳｸﾞﾝ, ﾀﾉｳﾎｳｾｲﾗﾝｿｳ, ｽﾀｲﾝﾚｰｳﾞｪﾝﾀｰﾙｼｮｳｺｳｸﾞﾝ, シュタイン･レバンタール症候群, スタイン･レベンタール症候群, 多嚢胞性卵巣症候群, Stein-Leventhal症候群, シュタイン-レバンタール症候群, 多のう胞性卵巣症候群, 多嚢胞卵巣症候群
Swedish Polycystiskt ovariesyndrom
Czech syndrom polycystických ovarií, Stein-Leventhalův syndrom, Syndrom polycystických ovárií, Polycystický vaječník, Polycystická ovaria
Finnish Munasarjojen monirakkulatauti
Russian POLIKISTOZNOGO IAICHNIKA SINDROM, SHTEINA-LEVENTALIA SINDROM, ПОЛИКИСТОЗНОГО ЯИЧНИКА СИНДРОМ, ШТЕЙНА-ЛЕВЕНТАЛЯ СИНДРОМ
Korean 다낭성 난소 증후군
Croatian POLICISTIČNI OVARIJ, SINDROM
Polish Zespół androgennych jajników, Zespół jajników wielotorbielowatych, Zespół policystycznych jajników, Zespół Steina-Leventhala
Hungarian Polycystás petefészkek, Polycystás ovarium, Stein-Leventhal syndroma, Polycystás ovarium syndroma
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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