0:00
My name is Dr. Thom Barber.
I'm an Associate Professor
and Honorary Consultant
Endocrinologist
based at the University
of Warwick in UK
and UHCW NHS Trust.
So in the second part
of this talk,
I'm going to
specifically talk about
Polycystic Ovary Syndrome,
which is a very common condition
affecting pre-menopausal women
and a condition which is very
closely associated with obesity.
0:24
In this part of the talk,
I will firstly consider
what is PCOS.
I'll talk about
its pathogenesis,
genetic corroboration
with obesity,
links with obstructive
sleep apnea
and then consider specifically
whether having PCOS may
make it harder to lose weight
and also use of
metformin therapy
in women with PCOS.
0:44
So what is
Polycystic Ovary Syndrome?
0:48
Some historical aspects.
In 1921, Archard and Thiers
first made a link between
hirsutism and metabolic
derangements
in their description
of a bearded lady with diabetes.
But it wasn't until 1935
when Stein and Leventhal
first described
the syndrome of PCOS.
But it really wasn't until much
more recently in 1980
when we realized
that Polycystic Ovary Syndrome
is actually
an insulin resistant condition
and a condition
which is associated
with multiple
dysmetabolic features.
And since then, of course,
there has been much research
into the cardiometabolic
associations of PCOS.
1:26
What is
Polycystic Ovary Syndrome?
A couple of diagnostic criteria
which I used,
and on the right is shown
the NIH criteria from 1990.
And the NIH criteria
defined PCOS
as presence of both
hyperandrogenic features
in addition
to chronic anovulation.
Hyperandrogenic features are
defined by either chemically,
mainly through increased levels
of testosterone
or free androgen index,
for example.
Clinically, and the main
clinical manifestations include,
for example, hirsutism,
androgenetic alopecia and acne.
In 2003, the NIH criteria was
superseded by Rotterdam criteria
which used two of three ruled
and the three criteria
are defined as, number one,
Polycystic ovarian morphology,
which is defined
presence of at least 12 follicles
of between 2 and 9 millimeters
in diameter
in either ovary
or an ovarian volume
of at least 10 milliliters
in either ovary.
Oligo-amenorrhoea
is the second criteria
and this is
an inter-menstrual interval
of at least 42 days.
And finally,
as with the NIH criteria,
hyperandrogenism, which again
defined either biochemically,
and, or clinically
in terms of hirsutism definition
and this is defined
as the Ferriman-Gallwey score
of at least eight or the need
for at least weekly
cosmetic treatments
of hirsutism.
Now importantly,
Polycystic Ovary Syndrome
is a diagnosis of exclusion.
There are many conditions
which can masquerade as PCOS
and many conditions
are associated with hirsutism,
for example, under
oligo-amenorrhoea in women.
And some of these are
shown here, for example,
Cushing's syndrome, acromegaly,
congenital adrenal hyperplasia,
hyperprolactinemia,
adrenal and ovarian tumors
which cause hyperandrogenaemia.
And of course, it's important
to exclude
these other conditions
before we diagnose
a woman with PCOS.
In terms of Cushing's
and acromegaly,
we only tend to screen
for these biochemically
if there clinical features
of these syndromes, but looking
for a 17-hydroxyprogesterone
can be quite useful
to exclude CAH, for example.
And prolactin level should be
a part of the biochemical workup
as well.
As a general rule of thumb,
if testosterone levels are above
5 nanomoles per liter,
then we would then need to look
for an adrenal and ovarian origin
with scanning
to exclude any tumor of
the adrenal gland or ovaries.
