Abnormal Steroidogenesis and Related Disorders of Ovulation

1
Morphology in Polycystic Ovaries
Tube
Central Stroma
Capsule
Follicle Cysts
Uterus
Cut Section
Gross Appearance
2
Ultrasound of the Polycystic Ovary
3
Ovarian Histology in Polycystic Ovary Syndrome
Capsule
Central Stroma
Follicle Cysts
Granulosa cell
Theca cell
4
Features of Polycystic Ovary Syndrome

• Excessive hair growth (Hirsutism)
• Irregular menstrual bleeding
• (Chronic anovulation)
• Polycystic ovaries
• Insulin resistance (Hyperinsulinemia)

5
Acanthosis Nigricans

• Velvety plaques on
• nape of neck and
• intertriginous areas
• Epidermal
• hyperkeratosis
• Associated with
• insulin resistance

6
Other Clinical Features

• Obesity
• About 50 of PCOS
• Distribution
• Onset of symptoms
• Familial occurrence

7
Serum Hormones in PCOS

• Increased androgens
• Androstenedione
• Testosterone
• Increased LH secretion
• (LH usually higher than FSH)
• Hyperinsulinemia
• Insulin resistance

8
Proposed Mechanism of PCOS
Normal
PCOS
Hypothalamus
GnRH
GnRH
Pituitary
Estrogen
Androgen
LH, FSH
E2, P
LH, FSH
Ovary
Ovulation
Anovulation
9
24 Hour LH Pulse Secretion Pattern in Normal and
PCOS Adult Women
Normal
pulses 9


LH mIU/ml







Normal pulses/22h 9 Orderly
secretion PCOS pulses/22h 15
Increased levels Chaotic pattern
0 6 12 18
24
PCOS















LH mIU/ml
pulses 15
0 6 12 18
24
Patel K et al, Clin Endocrinol, 2004
10
Excess Androgen Production in PCOS
FSH
LH
Granulosa
LH
FSH
Theca
Granulosa
Androgen
Normal
Estrogen
Theca
PCOS