Metabolic changes in polycystic ovarian syndrome

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is a heterogeneous multifactorial disease characterized by menstrual disorders, chronic anovulation, hyperandrogenism, cystic changes in the ovaries and infertility. The syndrome is a condition with prepubertal onset, affecting especially women of childbearing age. Objectives o f the study were to elucidate the main etiopathogenic mechanisms, the criteria for diagnosis of metabolic changes and the most common complications in PCOS. Materials and Methods: Relevant scientific articles regarding PCOS from medical databases were analyzed. Results: The frequency of PCOS is estimated at 0.6-11% among gynecological diseases. PCOS is found in 1.5-20% women of childbearing age, 50-75% - with anovulatory infertility and 30-40% - with amenorrhea. Etiopathogenesis of PCOS remains unknown despite multiple studies. Decreased peripheral insulin sensitivity and consequently hyperinsulinemia are considered primary factors in the pathogenesis of PCOS. Insulin resistance and hyperinsulinemia are largely found laboratory symptoms of PCOS, insulin resistance being indentified in 25% of middle-aged pacients. Thyroid disorders also are frecuently accompaning PCOS, highlightening the link between PCOS and autoimmune thyroiditis, rising concern that female hormones may play a role in triggering these diseases. Of all cases of thyroid pathology there were an increased frequency of cases of goiter (49.2%) and autoimmune thyroiditis (41.3%). Metabolic manifestations of hyperandrogenism were identified in PCOS: 42.8% of the patients had increased levels of plasma testosterone with normal urine excretion of 17-CS, 28.6% - the increase in both plasma testosterone as well as 17-CS excretion. In 14.3% of patients ovarian hyperandrogenia genesis was demonstrated only by applying the test with dexamethasone and chorionic gonadotropin, while in 9.5% of patients hyperandrogenia could not be demonstrated by hormone investigations. In 30% of cases PCOS was accompaned by secondary hyperprolactinemia. Conclusion: Based on available literature data polycystic ovarian syndrome may be defined by the presence of hyperandrogenic (clinical and/or biochemical) and ovarian (oligo-, anovulation and/or polycystic ovaries) disorders. The main metabolic symptoms of PCOS are hyperandrogenism, hyperinsulinemia with insulin resistance, hypo- and hyperthyroidism and secondary hyperprolactinemia. Most common complications are impaired glucose tolerance and type II diabetes, cardiovascular disorders (dyslipidemia, hypertension, coronary heart disease) and risk of abortion or premature birth.