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polycystic ovary syndrome spotlights

Pathogenesis (etiology?). Hypersecretion of adrenal androgens?Hypersecretion of ovarian androgens?A genetic disorder with an autosomal dominant mode of inheritance?A multifactorial genetic disorder?. Prevalence . PCO on ultrasound 20%Oligomenorrhea 4

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polycystic ovary syndrome spotlights

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    1. POLYCYSTIC OVARY SYNDROMESPOTLIGHTS Dr. Mohammed AbdallaEgypt, Domiat general Hospital

    2. Pathogenesis (etiology?) Hypersecretion of adrenal androgens? Hypersecretion of ovarian androgens? A genetic disorder with an autosomal dominant mode of inheritance? A multifactorial genetic disorder?

    3. Prevalence PCO on ultrasound 20% Oligomenorrhea 4 – 21 %

    4. Ultrasound in vs. Megalocystic ovaries PCO Polycystic ovaries Bilateral Multiple cysts Cyst diam <4-6 mm Stroma increased

    5. Long term risks in PCOS Definite risk Type 2 diabetes Dyslipidemia (Hypercholesterolemia with diminished HDL2 and increased LDL) Endometrial cancer (OR 3.1 95% CI 1.1 -7.3)

    6. Possible risk Hypertension Cardiovascular disease Gestational diabetes mellitus Pregnancy-induced hypertension Ovarian cancer Unlikely Breast cancer Long term risks in PCOS

    9. Obesity and insulin resistance

    12. PCOS - Pathogenesis Excessive ovarian stimulation caused by the progressively rising insulin and insulin like growth factor - I (IGF-I) levels during puberty induces a PCOS in predisposed girls Nobels and Devailly FertilSteril 1992 5-alfa reductase activity is stimulated by iGF-I. This intensifies the hirsute response in hyperandrogenic patients Speroff 1993

    13. “Insulin resistance” is characterized by decreased sensitivity to insulin in peripheral tissues (muscle and adipose tissue), but not in hepatic tissue Franks 1995

    17. Gonadotropin Secretion in PCOS Increased LH secretion: •Ratio of LH/FSH: 2-3/1 •Prevalence: 30 to 90% !

    18. Treatments for PCOS Weight loss Oral Contraceptives. Clomiphene. Ovarian diathermy/laser tx. ART. Cyproterone acetate+ EE, Spironolactone. Insulin sensitizing agents. Biguanides (metformin) Thiazolidinediones (troglitazone).

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