Can You Name This Can You Name This Group?Group?

• Insert photo of Spice Girls hereInsert photo of Spice Girls here

http://www.spicegirls.co.uk/gallery.ahttp://www.spicegirls.co.uk/gallery.aspsp

• Which Spice Girl Which Spice Girl is this?is this?

• Posh Spice- Posh Spice- Victoria Beckham Victoria Beckham

• Insert Posh Spice Insert Posh Spice photo here.photo here.

http://www.spicegirlhttp://www.spicegirls.co.uk/gallery.asps.co.uk/gallery.asp

• Why am I showing you slides of Why am I showing you slides of Victoria Beckham?Victoria Beckham?

• Believe it or not, she has Believe it or not, she has Polycystic Ovary SyndromePolycystic Ovary Syndrome

Polycystic Ovary Polycystic Ovary SyndromeSyndrome

Peter Valenzuela, MD, MBAPeter Valenzuela, MD, MBAAssistant Dean for Clinical Affairs/Assistant ProfessorAssistant Dean for Clinical Affairs/Assistant Professor

Texas Tech University Health Sciences Center at the Permian Texas Tech University Health Sciences Center at the Permian BasinBasin

OverviewOverview

• Prevalence and PathogenesisPrevalence and Pathogenesis• Signs and SymptomsSigns and Symptoms• DiagnosisDiagnosis• TreatmentTreatment

BackgroundBackground

• Stein & Leventhal 1935Stein & Leventhal 1935• AmenorrheaAmenorrhea• InfertilityInfertility• HirsutismHirsutism• Enlarged polycystic ovariesEnlarged polycystic ovaries

PrevalencePrevalence

• Most common hormonal and Most common hormonal and reproductive problem affecting reproductive problem affecting women of child-bearing agewomen of child-bearing age• Present in 5-10% of women Present in 5-10% of women

• Commonly under-diagnosed due to Commonly under-diagnosed due to use of birth control pillsuse of birth control pills

PathogenesisPathogenesis

• UNKNOWNUNKNOWN• High insulin levels High insulin levels • High androgen High androgen

levelslevels• High LHHigh LH• Low estro/prog Low estro/prog

• Insert pathway Insert pathway diagram here.diagram here.

• http://www.mja.cohttp://www.mja.com.au/public/issuem.au/public/issues/180_03_020204/s/180_03_020204/nor10314_fm-2.gifnor10314_fm-2.gif

PathogenesisPathogenesis

• GeneticsGenetics• Insulin-receptor substrate (IRS-1,IRS-Insulin-receptor substrate (IRS-1,IRS-

2)2)• Calpain-5Calpain-5• Calpain-10Calpain-10

Signs and SymptomsSigns and Symptoms

• Pre-pubertyPre-puberty• Increased levels of adrenal androgen Increased levels of adrenal androgen • Increased insulin levelsIncreased insulin levels• Ovarian HyperandrogenismOvarian Hyperandrogenism

• Leads to precocious pubertyLeads to precocious puberty

Signs and SymptomsSigns and Symptoms

• Adolescence and AdulthoodAdolescence and Adulthood• AnovulationAnovulation• HyperandrogenismHyperandrogenism• Polycystic ovariesPolycystic ovaries• Obesity-50% of womenObesity-50% of women

• Leads to reproductive Leads to reproductive disordersdisorders

Signs and SymptomsSigns and Symptoms

• Late AdulthoodLate Adulthood• DiabetesDiabetes• HypertensionHypertension• DyslipidemiaDyslipidemia• Cardiovascular diseaseCardiovascular disease

• Leads to metabolic effectsLeads to metabolic effects

Clinical FeaturesClinical Features

• AcneAcne

• HirsutismHirsutism

• Insert Acne imageInsert Acne image

http://http://www.skintactix.com/www.skintactix.com/art/Adult-Acne-art/Adult-Acne-2BB.JPG2BB.JPG

• Insert hirsutism imageInsert hirsutism image

http://www.endotext.org/http://www.endotext.org/female/female4/female/female4/figures/figure4.jpgfigures/figure4.jpg

Clinical FeaturesClinical Features

• Acanthosis Acanthosis nigricansnigricans

• Skin tagsSkin tags

• Insert acanthosis Insert acanthosis nigricans imagenigricans image

http://www.mja.com.au/http://www.mja.com.au/public/issues/public/issues/182_03_070205/182_03_070205/bat10421_fm-2.jpgbat10421_fm-2.jpg

Insert skin tags imageInsert skin tags image

http://www.emedicine.com/http://www.emedicine.com/derm/images/derm/images/11acanthosis_nigricans_0111acanthosis_nigricans_012405.jpg2405.jpg

Clinical FeaturesClinical Features

• Male-pattern Male-pattern alopeciaalopecia

• Central obesityCentral obesity

• Insert alopecia image Insert alopecia image herehere

http://http://www.stophairlossnow.www.stophairlossnow.co.uk/images/Hair1.gifco.uk/images/Hair1.gif

• Insert obesity image Insert obesity image here.here.

http://http://www.npheadstart.org/www.npheadstart.org/images/P5170219-images/P5170219-small.jpgsmall.jpg

DiagnosisDiagnosis

• Previous CriteriaPrevious Criteria• Clinical featuresClinical features• Laboratory testsLaboratory tests• Ultrasound findingsUltrasound findings• Exclusion of other causesExclusion of other causes

DiagnosisDiagnosis

• Updated CriteriaUpdated Criteria• Presence of at least two of the Presence of at least two of the

following:following:• Olig/anovulationOlig/anovulation• HyperandrogenismHyperandrogenism• Polycystic ovaries on ultrasoundPolycystic ovaries on ultrasound

• And the absence of secondary And the absence of secondary causescauses

Treatment Treatment

• Decrease hyperinsulinismDecrease hyperinsulinism• Decrease hyperandrogenismDecrease hyperandrogenism• Induce ovulationInduce ovulation• Prevent endometrial hyperplasiaPrevent endometrial hyperplasia• Weight lossWeight loss

Complications Complications

• Endometrial CancerEndometrial Cancer• Breast CancerBreast Cancer

Patient Support Patient Support

• www.soulcysterswww.soulcysters. com. com

• www.pcos.meetup.www.pcos.meetup.comcom

SummarySummary

• Prevalence and PathogenesisPrevalence and Pathogenesis• Signs and SymptomsSigns and Symptoms• DiagnosisDiagnosis• TreatmentTreatment

Questions?Questions?

ReferencesReferences

• American Journal of Gynecology. 1998. American Journal of Gynecology. 1998. Dec:179 (6 Pt 2): S101Dec:179 (6 Pt 2): S101

• Hunter MH. Sterrit JJ. Am Fam Phys 2000, vol. Hunter MH. Sterrit JJ. Am Fam Phys 2000, vol. 62, no. 562, no. 5

• Norman RJ. Wu R. Stankiewicz MT. Polycystic Norman RJ. Wu R. Stankiewicz MT. Polycystic Ovary Syndrome. MJA 2004; 180 (3): 132-137.Ovary Syndrome. MJA 2004; 180 (3): 132-137.

• Marrinan G. Stein M. Polycystic Ovarian Marrinan G. Stein M. Polycystic Ovarian Disease (Stein-Leventhal Syndrome. E-Disease (Stein-Leventhal Syndrome. E-Medicine, May 24, 2005.Medicine, May 24, 2005.

ReferencesReferences

• Hall S. Not Such a Posh Disorder. The Hall S. Not Such a Posh Disorder. The Guardian. February 28, 2002Guardian. February 28, 2002

• Trust for America’s Health. Facts on Fat: How Trust for America’s Health. Facts on Fat: How Obesity Policies are Failing America, 2006.Obesity Policies are Failing America, 2006.

• Knochenhauer ES, Key TJ, Kahsar-Miller M, et Knochenhauer ES, Key TJ, Kahsar-Miller M, et al. Prevalence of the Polycystic Ovary al. Prevalence of the Polycystic Ovary Syndrome in Unselected Black and White Syndrome in Unselected Black and White Women of the Southeastern United States: A Women of the Southeastern United States: A Prospective Study. J Clin Endocrinol Metab Prospective Study. J Clin Endocrinol Metab 1998; 83: 3078-3082.1998; 83: 3078-3082.

ReferencesReferences• Dunaif A. Hyperandrogenic Anovulation. Dunaif A. Hyperandrogenic Anovulation.

American Journal of Medicine. 1995; 98:33S-9SAmerican Journal of Medicine. 1995; 98:33S-9S• PCOD. Journal of Family Practice. 2006. April; PCOD. Journal of Family Practice. 2006. April;

55 (4):35155 (4):351• Wild RA. Hyperandrogenism: Implications for Wild RA. Hyperandrogenism: Implications for

Cardiovascular Endometrial and Breast Cardiovascular Endometrial and Breast Disease. Disease.

• Adashi EY, Rock JA, Rosenwaks Z, eds. Adashi EY, Rock JA, Rosenwaks Z, eds. Reproductive endocrinology, surgery, and Reproductive endocrinology, surgery, and technology. Philadelphia: Lippincott-Raven, technology. Philadelphia: Lippincott-Raven, 1996:1617.)1996:1617.)

ReferencesReferences

• Vollmert C. et al. American Journal of Vollmert C. et al. American Journal of Physiology-Endocrinology and Physiology-Endocrinology and Metabolism December 11, 2006.Metabolism December 11, 2006.

• Gonzalez A. Human Reproduction. Gonzalez A. Human Reproduction. January 5, 2006January 5, 2006

• (Fertil Steril 2002 Dec;78(6):1240 in J (Fertil Steril 2002 Dec;78(6):1240 in J Watch Online 2003 Jan 14)Watch Online 2003 Jan 14)

• Fertil Steril 2004 Jan;81(1):19 in J Fam Fertil Steril 2004 Jan;81(1):19 in J Fam Pract 2006 Apr;55(4):351Pract 2006 Apr;55(4):351

• Dynamed websiteDynamed website