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At a glance

Characterized by amenorrhea, infertility, hirsutism, and enlarged polycystic ovaries.

Synonyms

Polycystic Ovary Syndrome (PCOS); Sclerocystic Disease of the Ovaries.

History

American gynecologists Stein and Leventhal first described this entity in 1935.

Incidence

Common, depending on the choice of diagnostic criteria up to 3.4% of all women affected worldwide.

Genetic inheritance

Unknown.

Pathophysiology

In Stein-Leventhal Syndrome patients, the preovulatory follicle in the ovary does not develop. As a result, multiple subcapsular follicles develop. This creates an androgenic ovary, which is usually anovulatory. Insulin resistance.

Diagnosis

The National Institutes of Health has defined PCOS as a state of hyperandrogenism and chronic anovulation in the absence of other causes, for example, congenital adrenal hyperplasia, hyperprolactinemia, and Cushing Syndrome. The diagnosis is made on clinical grounds, in addition to the presence of bilateral polycystic ovaries in 90% of patients. Increased plasma levels of luteinizing hormone but normal or reduced levels of follicle-stimulating hormone. Other biochemical tests are done to exclude other causes.

Clinical aspects

Stein-Leventhal Syndrome is a condition that is usually diagnosed after the expected onset of menstruation. Symptoms can include amenorrhea or menstrual irregularity, hirsutism in androgen-dependent regions (face, chest, lower abdomen), upper body obesity (in 50% of patients), and infertility in patients of childbearing age. Associated with the obesity, patients frequently have insulin resistance resulting in adult-onset diabetes. Treatment may include progestins, oral contraceptives, antiandrogens (including spironolactone), weight reduction, ovulation-inducing medication, and surgery (laparoscopic ovarian cautery or laser vaporization).

Precautions before anesthesia

Fasting blood sugar in older patients (particularly obese patients). Ensure other conditions have been excluded, for example, Cushing Syndrome.

Anesthetic considerations

Consider implications of obesity and glucose intolerance, if present.

Pharmacological implication

There are no known implications with this condition.

References

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Bhattacharya  S, Johnson  N, Tijani  HA,  et al: Female infertility. BMJ Clin Evid pii:0819, 2010.
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Goudas  V, Dumesic  D: Polycystic ovary syndrome. Endocrinol Metab Clin North Am 4:893–911, 1997.
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Legro  R: The genetics of polycystic ovary syndrome. Am J Med 98(suppl 1A):9S, 1995.  [PubMed: 7825646]
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McCartney  CR, Marshall  JC. CLINICAL PRACTICE. Polycystic Ovary Syndrome. N Engl J Med 375:54, 2016.  [PubMed: 27406348]

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