Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) was first described in 1935 by Stein and Leventhal [1]. They described several women with amenorrhea, hirsutism, obesity, and polycystic ovaries. Today, PCOS is one of the most common endocrine diseases in women. It is als
- PDF / 129,833 Bytes
- 6 Pages / 439.37 x 666.14 pts Page_size
- 111 Downloads / 241 Views
Polycystic Ovary Syndrome Joslyn Kirby
21.1
Introduction
Polycystic ovary syndrome (PCOS) was first described in 1935 by Stein and Leventhal [1]. They described several women with amenorrhea, hirsutism, obesity, and polycystic ovaries. Today, PCOS is one of the most common endocrine diseases in women. It is also one of the most common causes of infertility and menstrual irregularity. Acne is common in women with PCOS and may be the initial reason women with occult PCOS seek medical attention. Inquiring about menstrual irregularity and/or hirsutism in women with acne may facilitate referral to a gynecologist or endocrinologist for early intervention on fertility issues and medical comorbidities.
21.2
Background
PCOS is one of the most common endocrine disorders in women. In a study of unselected black and white women, the prevalence was 6–12 % [2]. The prevalence is higher in women with obesity, diabetes mellitus (type 1, type 2, or gestational), and those with first-degree family members with PCOS [3]. The variability in the reported prevalence is in part due to the inherent variability among patient populations (black, Caucasian, Latina, etc.) and the method of diagnosis (which diagnostic criteria are used) [4].
J. Kirby, M.D. (*) Department of Dermatology, Penn State Hershey, 500 University Drive, Hershey, PA 17033, USA e-mail: [email protected]
J.A. Zeichner (ed.), Acneiform Eruptions in Dermatology: A Differential Diagnosis, DOI 10.1007/978-1-4614-8344-1_21, © Springer Science+Business Media New York 2014
149
150
J. Kirby
The principle characteristics of PCOS are anovulation, polycystic ovaries, and hyperandrogenism. PCOS is likely a multifactorial condition with genetic as well as environmental contributions. Studies have shown women with PCOS have abnormal function of the hypothalamic–pituitary–ovary endocrine axis as well as other tissues and organs. The hypothalamus in women with PCOS secretes gonadotropinsecreting hormone (GnRH) at an elevated frequency. It is not known what factor(s) incites the abnormal pulse frequency, be it an intrinsic abnormality in the hypothalamus or faulty feedback mechanisms at the ovary [5]. This increased frequency favors the production of lutenizing hormone (LH) over follicle-stimulating hormone (FSH). This results in an elevated LH to FSH ratio and excess LH results in the overproduction of androgens by the ovarian theca cells. Acne has been shown to be more common in women with high levels of androgens. Androgen overproduction in PCOS likely contributes to acne by triggering excessive sebum production. Conversely, acne is less common in women with elevated levels of sex-hormone binding globulin (SHBG) [6]. This protein binds the hormones and reduces the amount of free androgens available in the serum. Oral contraceptive pills have been shown to increase levels of SHBG, partially explaining their efficacy in treating acne [7]. In addition to overproduction of androgens, acne may be more common in these patients due to the influence of 5-α-reductase. This enzyme
Data Loading...
