Polycystic ovary syndrome (PCOS) is a common metabolic abnormality and endocrine disorder in women of reproductive age.
It often causes menstrual disorders and is the main cause of anovulatory infertility in women of childbearing age.
Hirsutism: distributed on the cheeks, upper lip, under the jaw to the neck, and pubic hair growing towards the umbilicus
Acne: mainly on the face
Acanthosis nigricans: often occurs when there is excessive insulin resistance combined with diabetes mellitus
Laboratory tests
Increased testosterone, free testosterone, testosterone index
Polycystic ovarian changes
Follicular development stops at mid-sinus follicles
2-3 times more primary follicles, secondary follicles and sinus follicles than normal
abnormal increase in the interstitium (stroma) of the ovary
insulin resistance
Obesity
Types of obesity
Male-pattern obesity (central fat distribution)
More visceral fat than peripheral fat
Evaluation index
Body mass index = weight (kg)/height (m)2.
BMI ≥ 24 for overweight and ≥ 26 for obese for women
Waist-to-hip ratio (WHR) was used
WHR > 0.8 as upper abdominal obesity or male obesity with increased T production rate and FT level.
Most obese women with PCOS are abdominally obese, and PCOS patients with abdominal obesity have more severe insulin resistance and high androgen levels compared to non-PCOS patients with abdominal obesity only
The excessive accumulation of visceral fat in PCOS patients increases the incidence of cardiovascular disease. Altered fat distribution, abnormal adipocyte function and chronic low-grade inflammation may be novel mechanisms that increase cardiovascular disease risk in PCOS patients
White adipose tissue has a powerful endocrine function and its secreted adipocytokines may affect female endocrine and metabolism through multiple pathways
Produce endoenvironmental disorders such as hyperandrogenism and hyperinsulinemia, which lead to an interaction between the hormonal endoenvironment and obesity
Inflammatory mediators and PCOS
Leukocyte counts are still in the normal range in both PCOS patients and healthy women, but leukocyte counts are significantly higher in PCOS patients than in healthy women
CRP directly accelerates the process of atherosclerosis and promotes the formation of inflammation in vascular endothelial cells, becoming a predictor of cardiovascular disease, insulin resistance and other diseases
CRP levels are higher in patients with PCOS, TNF stimulates CRP production and is associated with obesity, insulin resistance, endothelial dysfunction and cardiovascular disease
Chronic low-grade inflammation and insulin resistance in PCOS patients are both associated with abdominal obesity. TNF-α regulates chronic inflammation and various metabolic disorders and plays an important role in insulin resistance. excessive sources of TNF-α in circulating blood in PCOS patients may be associated with adipose tissue
Possible causes of high LH levels
Increased GnRH activity
Persistent estrogen secretion without reaching peak levels leading to positive feedback to the hypothalamus
High levels of androgens inhibit the negative feedback of estrogen and progesterone on LH pulse release
Possible mechanisms of altered adrenal function
Increased DHEAS and androstenedione levels in 50% of PCOS patients
Insulin and IGF-1 enhance ACTH-stimulated P450c17 expression and adrenal androgen production (DHEAS)
Insulin induces a decrease in 17/20 cleavage enzyme activity and an increase in 17 hydroxyprogesterone levels
Hyperandrogenism and insulin resistance
Mechanism of hyperandrogenemia due to hyperinsulinemia: insulin may lead to enhanced activity of cytochrome P450c17α, which directly stimulates ovarian androgen synthesis causing hyperandrogenemia
Insulin may inhibit the synthesis of hepatic SHBG, which leads to the increase of free testosterone level. The key to the treatment of obese PCOS patients is to improve insulin resistance, hyperinsulinemia and hyperandrogenemia
Diagnostic criteria.
Sporadic ovulation and/or anovulation
Clinical and/or biochemical parameters suggesting hyperandrogenemia and exclusion of other possible causative factors, such as congenital adrenal hyperplasia secreting androgenic tumors Cushing syndrome, etc.
Polycystic change of ovaries (PCO): ultrasound examination shows ≥12 follicles of 2-9 mm in diameter and/or ovarian volume increase >10 ml.