Polycystic ovarian disease not related to

(A) (Hypertension) (459,469, Dutta Gynae 6th)POLYCYSTIC OVARIAN SYNDROME (PCOS)Multifactorial and polygenic conditionsMost obese woman with oligomenorrhea have the polycystic ovarian syndrome (PCOS), with its associated anovulation and ovarian hypcrandrogenism 40% of women with PCOS are absess (Not always). Most non obese with PCOS are also insulin resistance, hyperinsulinemia or the combination of the two are causative or contribute to the ovarian pathophysiology in PCOS in both obese and lean individuals (476-H17th)PCOS (Novak's Gynaecology)Clinical characteristicDiagnostic Criteria* Hirsutism* Obesity* Oligomenorrhea or AmenorrheaMajor criteria Minor criteria* Chronic anovulation* Pre menarchial onset of* Infertility* Hyper androgcncmia (in absence of any notable cause)- Hirsutism- Obesity* Insulin resistance (Abnormal glucose tolerance)* Elevated LH (LH/FSH ratio>2)* Intermittent anovulation associated with hyperandrogenemia (| ed free estosterone, |ed DHEAS)* Multiple cysts are located peripherally along the surface of the ovary giving a ''Necklace" appearance in UCG is diagnostic* The increased conversion of androstenedione to estrogen which occurs to a greater degree in women with lower body obesity may contribute to the increased incidence of uterine cancer in post menopausal women with obesity (467-HI 7th)* PCOS is most strongly associated with a risk of endometrial carcinoma and may also be associateed with an increased risk of ovarian and breast cancer**** Long term sequelae of PCOS- Diabetes mellitus- CVS disorders- MI- Lipidaemia- Hypertension- Endometrial cancer- Breast cancer- Premature ovarian failure following surgery* Autosomal dominant inherited factor** were added as aetiological factor in the development of PCOS CYP21 gene mutation has been discovered in this connectionSerum level in PCOSAndrogens (|)Estrogens (|)LH/FSHInsulinAndroeen excessEstroeen excessLH levels are |edInsulin |ed* Excess production of androgens is seen from both the ovaries and adrenals, (postulated to be due to abnormal regulation of androgen forming enzyme)* Estrogen levels are increased due to peripheral aromatization of androgens* EstrogenQ levels are raised(Estrone>Estradiol)* Enhanced estrogen levels exert a- Positive feedback on LH levels (|ed)- Negative feedback on FSH levels (|ed)* | ed insulin resistance LH/FSH Ratio is characteristically >2