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शुक्रवार, 10 जून 2016

PCOS (Classification)

Dr Rupali Mahadik.
MD ( Streerog )
Amrutwel Women's Clinic Kharaghar.
Ex Prof and HOD streerog Dept.
D.Y.Patil Ayu College Nerul

PCOS (Classification )

Polycystic Ovary Syndrome (PCOS)  is an incompletely understood enigmatic disease.

It is usually, but not necessarily ; characterized by
- Oligomenorrhea
- obesity
- hyperandrogenaemia
- infertility

Although pathogenesis is unclear , chronic hyperandrogenaemia either due to

-Erratic high LH levels
  or
- insulin resistance with compensatory hyperinsulinaemia,
Is a predominant feature of this syndrome.

Both LH and Insulin act at the Thecal compartment of Ovary to stimulate hyperandrogenaemia.

Moreover the small and intermediate follicles predominate the PCOS scenaria and they gradually proceed to atresia rather than follicular dominance.

* Classification of PCOS -
Based on Endocrine and Sonographic  landmarks following classes of PCOS subjects are arbitrarily identified with gradation of hyperandrogenism , individual approach of treatment is needed.

1- PCO

Normoandrogenic, normoestrogenic and non obese subjects.

Do not exhibit usual manifestation of hyperandrogenaemia,
menstrual delay/ Oligomenorrhea ,

But anovulation is present.

These subjects have bilateral active ovaries with no evidence of follicular dominance or ovulation .

No significant alteration is expected in the hormonal profile.
Constitutes 80% of PCOS subjects and form the link between normal and significantly androgenised PCOS subjects.

2- PCOD

These are definitely hyperandrogenic and relatively obese.
Oligomenorrhea
anovulation are almost certain.
Evidence of high LH to FSH ratio
Higher testosterone levels
Ovaries large  with evidence of homogeneous polyfollicular enlargement with significant Thecal hyperplasia .
Necklace pattern in USG

20% of PCOS Pt gave the typical features of PCOD.

3. - Hyperinsulinaemia

Picture same like PCOD with Endocrine difference of hyperinsulinaemia instead of high LH levels.

4- Hyperthecosis

These subjects with Ovarian Hyperthecosis are much more androgenised, with testosterone levels bordering that of tumor range( > 1 ng/ml).

Sonographically they present with sparse Ovarian follicles and predominant thecal excess.

These patients could manifest insulin resistance and acanthosis Nigerians.
Hence condition is known as Hairan syndrome.

Less then 5 % among PCOS population .

5- Hyperprolactinaemia

Borderline Hyperprolactinaemia and hypodopaminergic state could co exist in nearly 5% PCOS subjects.

They may or may not be galactorrhoeic and may not evidence significantly high prolactin levels.
Represents like type 1 PCO case but with borderline/ Hyperprolactinaemia.

6 - High DHEAS

Few pts may present with Congenital adrenal hyperplasia, a genetic defect in 21- hydroxylase enzyme in adrenal cortex.
Only 3% have this defect and they present with high DHEAS levels ( between 250 and 800 ng/ml), .
They are usually thin , hirsute with ovulatory dysfunction, and an alternate presentation is that a thin adolescent subject with symptomatology of hirsutism.

7 - Tumour

Occasionally a Virilizing ovarian or adrenal tumours present with features of virilism , and  these subjects have serum testosterone (1.5 ng/ml or more) or DHEAS ( 9000 ng/ml or more) respectively.
Easily spotted at routine sonographic study of ovaries and adrenal in all PCOS subjects.

According to this the treatment protocol differs.

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