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
Although pathogenesis is unclear , chronic hyperandrogenaemia either due to
-Erratic high LH levels
– 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.
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.
These are definitely hyperandrogenic and relatively obese.
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.
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 .
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.