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Stein and Leventhal: first report of seven amenorrheic women with smooth, enlarged ovaries, who ovulated following wedge polycystic ovary syndrome, hirsutism, PCO resection, polycistic
The advent of radioimmunoassay
Obesity: seen in at least 50% of women with polycystic ovary syndrome (PCO).
Upper body obesity is frequently characteristic
Oligomenorrhea or amenorrhea
Hirsutism 1. Not always present 2. Hirsutism is a function of both target tissue response and hyperandrogenism
Premenarchal onset of symptoms
Infertility
Acne
Biochemical Features
Increased free testosterone: if not present, the diagnosis is suspect; the most reliable biochemical indicator of the disorder
Decreased sex hormone-binding globulin polycystic ovary syndrome, hirsutism (SHBG): a consequence of both elevated androgen secretion and obesity
Increased luteinizing hormone (LH): not always present, and may vary from time to time polycystic ovary syndrome, PCO, hirsutism, polycistic, polysistic
Normal follicle-stimulating hormone (FSH)
Prolactin occasionally elevated
Dehydroepiandrosterone sulfate often elevated: no longer viewed as evidence of intrinsic adrenal dysfunction
Insulin resistance
Subsequent risk for type II diabetes mellitus may be increased
A. Simple obesity
B. Congenital adrenal hyperplasia
C. Hyperprolactinemia
D. Hypothyroidism
E. Severe insulin resistance syndromes
A. The "vicious cycle" theory
1. Originally proposed by Yen
2. No longer considered viable in toto in light of clinical experience with
gonadotropin-releasing hormone (GnRH) analogs
B. The role of hyperinsulinism: data indicating ability of insulin to stimulate ovarian androgen production is very suggestive
Treatment