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Polycystic Ovarian Syndrome

  • Alpana Shukla
  • Lindsay Mandel
Chapter

Abstract

A 28-year-old female presents to her primary care doctor for concern of increased weight gain and amenorrhea. She has had irregular menses since menarche at 11 years of age. She has been intermittently on oral contraceptive pills (OCPs) in the past which regularized her menses, but she hasn’t taken an OCP in the past 2 years. She was overweight as a teenager but has had a recent abrupt weight gain of 30 lbs in the past year. She has tried to lose weight with a low-fat diet and exercise in the past and lost 10 lbs 2 years ago, which she subsequently regained. Although her menses were irregular in the past, she would have 3–4 cycles/year, but now her last menstrual period was 6 months ago. Home pregnancy test is negative. She has always had facial hair which she has managed cosmetically by waxing, but she feels this has now become excessive and darker over the past year. She has a family history of type 2 diabetes in her mother. She is not trying to conceive but she is anxious about her fertility in the future. Her physical examination is significant for a body mass index (BMI) of 32 kg/m2, waist circumference 95 cm, BP 130/80, moderate hirsutism and acne, and acanthosis nigricans around the neck. She has no clinical stigmata suggestive of Cushing’s syndrome. Laboratory tests reveal a total testosterone level of 60 ng/dl (reference range, 14–53 ng/dl), calculated free testosterone level of 15.3 pg/ml per milliliter (reference range, 0.6–6.8 pg per milliliter), TSH 3.5 μIU/ml, FBG 102 mg/dl, and HbA1c 5.7%.

Keywords

Polycystic ovary syndrome Amenorrhea Weight gain Oligomenorrhea Hyperandrogenism 

References

  1. 1.
    The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.CrossRefGoogle Scholar
  2. 2.
    Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H. Position statement: utility, limitations, and pitfalls in measuring testosterone: an endocrine society position statement. J Clin Endocrinol Metab. 2007;92:405–13.CrossRefGoogle Scholar
  3. 3.
    Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF. The androgen excess and PCOS society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91(2):456–88.CrossRefGoogle Scholar
  4. 3.
    Kristensen S, Ramlau-Hansen CH, Ernst E, et al. A very large proportion of young Danish women have polycystic ovaries: is a revision of the Rotterdam criteria needed? Hum Reprod. 2010;25:3117–22.CrossRefGoogle Scholar
  5. 4.
    ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin no. 108: polycystic ovary syndrome. Obstet Gynecol. 2009;114(4):936–49.CrossRefGoogle Scholar
  6. 5.
    Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89:2745–9.CrossRefGoogle Scholar
  7. 6.
    Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352:1223–36.CrossRefGoogle Scholar
  8. 7.
    Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98:4565–92.CrossRefGoogle Scholar
  9. 8.
    Vgontzas AN, Legro RS, Bixler EO, Grayev A, Kales A, Chrousos GP. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab. 2001;86(2):517–20.PubMedGoogle Scholar
  10. 9.
    Hossain N, Stepanova M, Afendy A, Nader F, Younossi Y, Rafiq N, Goodman Z, Younossi ZM. Non-alcoholic steatohepatitis (NASH) in patients with polycystic ovarian syndrome (PCOS). Scand J Gastroenterol. 2011;46(4):479–84.CrossRefGoogle Scholar
  11. 10.
    Dumesic DA, Lobo RA. Cancer risk and PCOS. Steroids. 2013;78:782–5.CrossRefGoogle Scholar
  12. 11.
    Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the androgen excess and polycystic ovary syndrome society. Fertil Steril. 2009;92:1966–82.CrossRefGoogle Scholar
  13. 12.
    Padwal R, Li SK, Lau DC. Long-term pharmacotherapy for over-weight and obesity: a systematic review and meta-analysis of randomized controlled trials. Int J Obes Relat Metab Disord. 2003;27:1437–46.CrossRefGoogle Scholar
  14. 13.
    Mandel, L, Shukla A, Litman E, and Aronne L. The utility of metformin as antiobesity pharmacotherapy. Poster presented at: Obesity Week 2017; 2017 Oct 29–Nov 2; Washington DC.Google Scholar
  15. 14.
    Lamos EM, Malek R, Davis SN. GLP-1 receptor agonists in the treatment of polycystic ovary syndrome. Expert Rev Clin Pharmacol. 2017;10(4):401–8.CrossRefGoogle Scholar
  16. 15.
    Butterworth J, Deguara J, Borg CM. Bariatric surgery, polycystic ovary syndrome, and infertility. J Obes. 2016;2016:1871594.CrossRefGoogle Scholar
  17. 16.
    Skubleny D, Switzer NJ, Gill RS, Dykstra M, Shi X, Sagle MA, de Gara C, Birch DW, Karmali S. The impact of bariatric surgery on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Surg. 2016;26(1):169–76.CrossRefGoogle Scholar
  18. 17.
    McCartney CR, Marshall JC. Polycystic ovary syndrome. N Engl J Med. 2016;375(1):54–64.CrossRefGoogle Scholar
  19. 18.
    Kamalanathan S, Sahoo JP, Sathyapalan T. Pregnancy in polycystic ovary syndrome. Indian J Endocrinol Metab. 2013;17(1):37–43.CrossRefGoogle Scholar
  20. 19.
    American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013;121:210–2.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and MetabolismWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Weill Cornell Medical CollegeNew YorkUSA

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