Polycystic ovarian syndorme, PCOS (mechanism of disease)

This is a mechanism of disease flowchart for polycystic ovarian syndrome, covering the etiology, pathophysiology, and manifestations of PCOS. ADDITIONAL TAGS: Pharmacology / toxicity Infectious / microbial Biochem / molecular bio Mutation Signs / symptoms Labs / tests / imaging results Polycystic ovarian syndrome Core concepts Social determinants of health / risk factors Hormone changes Genetics / hereditary Mass effect Pathophysiology Etiology Manifestations ↑ luteinizing hormone (LH) produced by pituitary Hyperinsulinemia, peripheral insulin resistance Hirsutism: hair on chin, upper lip, chest, abdomen, back, butt Functional ovarian hyperandrogenism Metabolic syndrome (obesity, DM2) Prematurely luteinize granulosa cells Fat accumulation Stimulate theca cells ↑ estrogens Infertility Unknown intrinsic ovarian defects Stimulated keratinocyte and dermal fibroblast proliferation → epidermal hyperplasia and hyperpigmentation Acanthosis nigricans Disrupted LH / FSH balance ↓ FSH Impaired follicle maturation with cyst formation due to lack of follicle rupture anovulation / oligoovulation ↑ insulin-like growth factor 1 Endometrial hyperplasia ↑ risk of endometrial carcinoma ↓ SHBG Sleep apnea NAFLD Androgenetic alopecia Acne vulgaris Oily skin Menstrual irregularities (primary or secondary amenorrhea; oligomenorrhea; menorrhagia) Depression Anxiety disorders Gross: brown, small, uniform cysts in circle in subcapsular region of the ovary Histo: ovarian hypertrophy, thick capsule; enlarged cystic follicles; stromal hyperplasia and fibrosis; hyperluteinized theca cells, smaller granulosa cell layer Genetic predisposition? AMH, AMHR, GNAS1, DENND1A Lifestyle?