â– LECTURE OVERVIEW: Polycystic Ovary Syndrome (PCOS, Stein-Leventhal syndrome) is a metabolic-endocrine disorder and a leading cause of female infertility.
â– ENDOCRINE PATHWAY DETAIL:
1. Hyperinsulinemia: The primary driver is marked insulin resistance. Hyperinsulinemia suppresses hepatic synthesis of Sex Hormone-Binding Globulin (SHBG).
2. Free Testosterone Surge: Lower SHBG increases circulating free testosterone, driving clinical hyperandrogenism.
3. LH Excess: Pulsatile GnRH release favors the synthesis of Luteinizing Hormone (LH) over Follicle-Stimulating Hormone (FSH), elevating the LH:FSH ratio above 2.
4. Androgen Production: Excess LH stimulates ovarian Theca cells to produce androstenedione. Decreased relative FSH impairs granulosa cell aromatase activity, preventing conversion to estrogens.
5. Anovulation: Follicle maturation halts midway, presenting on ultrasound as multiple subcortical cysts (the 'string of pearls' appearance).
â– PROGNOSTIC CRITERIA & TIMELINE:
Patient outcome scales correlate heavily with diagnostic staging at presentation, age, pre-existing comorbidities, and biological markers of cellular dividing rates.
â– COMPENSATORY HORMONAL & VASCULAR FEEDBACK:
Acute systemic shifts trigger immediate neural and hormonal reflexes to preserve blood flow to vital organs like the brain and kidneys.
[HY-BOARD-1389]
🌟 Dynamic Clinical Key:
PCOS is diagnosed using the Rotterdam criteria, requiring 2 of 3 features: clinical/biochemical hyperandrogenism (hirsutism, acne), ovulatory dysfunction (oligomenorrhea), or polycystic ovaries on ultrasound. It is associated with a high risk of endometrial hyperplasia and cancer due to unopposed estrogen. Regularly reassess clinical parameters to adjust long-term therapy. Carefully evaluate the underlying cause of high blood pressure before aggressively suppressing compensatory vasoconstriction.