Name
POLYCYSTIC OVARIAN SYNDROME
DESCRIPTION
DETAIL
The diagnosis of PCOS requires the exclusion of all disorders that can result in menstrual irregularity and hyperandrogenism. Polycystic ovaries are defined as 12 or more follicles in at least 1 ovary measuring 2-9 mm in diameter or a total ovarian volume of >10 cm3. * PCOS is a diagnosis of exclusion * SERUM FREE TESTOSTERONE LEVELS - ELEVATED * SEXHORMONE BINDING GLOBULIN LEVELS - GENERALLY LOW * DEHYDROEPIANDROSTERONE-SULPHATE (DHEA-S) - NORMAL OR SLIGHTLY ABONE NORMAL * A serum hCG level should be checked to rule out pregnancy in women with oligomenorrhea or amenorrhea. * Patients with androgen-secreting ovarian or adrenal tumors can present with hirsutism, amenorrhea, and signs of virilization. However, these tumors are rapidly progressive, and patients have high androgen levels. Their testosterone level may be higher than 150 ng/dL, and their DHEA-S level may be greater than 800 mcg/dL. * Late-onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency can be ruled out by measuring serum 17-hydroxyprogesterone levels after a cosyntropin stimulation test. A 17-hydroxyprogesterone level of less than 1000 ng/dL, as measured 60 minutes after cosyntropin stimulation, rules out late-onset congenital adrenal hyperplasia. * Cushing syndrome can be ruled out by checking a 24-hour urine sample for free cortisol and creatinine. Levels of urinary free cortisol that are 4-fold the upper limit of normal are diagnostic for Cushing syndrome. * Hyperprolactinemia can be excluded by checking a fasting serum prolactin concentration. * Because the prevalence of impaired glucose tolerance and type 2 diabetes mellitus is high in women with PCOS, a 75-g oral glucose-tolerance test (OGTT) can be performed. * A serum IGF-1 level should be checked to rule out acromegaly. Serum IGF-1 is a sensitive and specific marker of GH excess. Normal levels rule out GH excess.
TYPENOTES
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
SERUM PROLACTIN ( NONPREGNANT FEMALE ), GLUCOSE TOLERANCE TEST ( I - FASTING ), COMPLETE BLOOD COUNT