PCOD – Polycystic Ovarian Disease: NEET-PG Latest Concepts
PCOS/PCOD is a new epidemic especially common among Young girls and girls in the reproductive age group. It has got the potential for future Reproductive failure and should be taken with caution.
The Topic is a hot favorite for NEET PG Aspirants as well as Students preparing for USMLE Exams, NEET PG Exams, Endocrinology Examinations. Our Experts recommend Medical Students, PG Aspirants to go through the Topic in detail.
Usually, a young woman/ Female in Reproductive Age group presents with:-
- infertility and hirsutism
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Remember Hormonal changes of PCOS
Hormones Increased in PCOD are:
- Androgens (Testosterone, Androstenedione DHEAS)
- Luteinizing hormone (LH > 10 IUI ml)
- Estrogen (Estrone > Oestradiol)
- LDL/ cholesterol and triglycerides
- Insulin (> 10 ml IUI / L due to insulin resistance)
Hormones Decreased in PCOD are:
- Follicle-stimulating hormone (FSH)
- Progesterone (due to anovulation)
- Sex hormone-binding Globulin
- HDL & Apoprotein A-I
Rotterdam criteria for PCOD:
According to Rotterdam criteria – PCOD is diagnosed if 2 of the following criteria are being fulfilled
- Ovulatory dysfunction such as oligomenorrhea or hyperandrogenism
- Clinical or biochemical evidence of hyperandrogenism
- USG criteria
PCOS is seen usually in a young female. The most common age affected is 15-25 years.
- The Ovaries are enlarged (2-5 times the normal size). This can be confirmed on USG.
- The Covering (Tunical albuginea) is thickened.
- There is Theca cell hypertrophy (stromal hyperthecosis) and multiple follicular cysts are located along the surface of the ovary
Sonographic findings in a case in PCOS include:
- ≥ 12 small cysts (2 to 9 mm in diameter)
- Increased ovarian volume (>10 ml)
- The increased amount of stroma relative to the number of follicles.
Estrogen (in the body has 3 forms)
- Oestradiol (E₂) – Predominant estrogen in the reproductive age group. Most potent form E2>E1.
- Oestradiol (E₁) – Predominant estrogen following menopause. It is formed when androgen is converted to estrogen.
- Another form of estrogen is oestriol. Which is a metabolite of estrogen? It is the predominant form of pregnancy.
- “Patients with PCOS, E1, levels are increased E2 is at a follicular phase level.”
“Elevated androstenedione levels contribute to an increase in estrone levels through peripheral conversion.”
“Approximately 70-80%of women with PCOS demonstrate frank elevations in circulating androgens particularly free testosterone, and 25-30% will have elevated levels of adrenal androgen metabolite, DHEAS.”
Thus serum DHEAS concentration id moderately elevated in over half of the woman with PCOS.
Medical Treatment of Hirsutism associated with PCOS:
- Oral contraceptives
- Gonadotropin-releasing hormone analogues
- Cyproterone acetate
Drugs used In PCOS:
- The progestin component suppression LH, resulting in decreased ovarian androgen production
- The estrogen component increases hepatic production of SHBG (sex hormone-binding globulin), resulting in decreased free testosterone concentration
- Circulating androgen levels are reduced
- Estrogen decreases the conversion of testosterone to Dihydrotestosterone in some by inhibition of 5 alpha reduction
- “ It is usually recommended that OCP’s are the foremost and first line of management of oligomenorrhea caused by PCOS. Progestins decrease total androgen levels by reducing the activity of 5 alpha reduction. OCP usage results in an overall decrease in the formation of new androgen-dependent hair growth and androgen stimulated acne. All low dose OCP preparation is believed to have similar results. If therapy with OCP’s is suboptimal, the addition of an anti-androgen, such as spironolactone or finasteride, is recommended.”
Medroxy progesterone acetate Gonadotropin-releasing hormone agonists:
“GnRH agonists effectively lower Gonadotropin levels over time, and in turn subsequently lower androgen levels. Androgen receptor antagonists – like spironolactone, cyproterone acetate, and flutamide. These antiandrogens are competitive inhibitors of androgen binding to the androgen receptor.
5 ὰ reduction inhibitor :
Conversion of testosterone can be decreased by 5 ὰ reductase inhibitor, Finasteride. It is modest effective in treating hirsutism and similar to other antiandrogens the risk of male fetus teratogenicity is present.
For Excessive Hair Growth :
Eflornithine hydrochloride cream: It is an irreversible inhibitor of ornithine decarboxylase enzyme. This enzyme is necessary for hair follicle cell division and function, and its inhibitor results in slower hair growth. It is mainly applied to the face in the form of cream.
Depilation methods i.e. hair removal above the skin surface e.g.-
- Depilation creams
- Thermal destruction using electrolysis or laser
- Ethinyl estradiol + desogestrel
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