Clinical meaning
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder driven by hypothalamic-pituitary dysfunction resulting in elevated GnRH pulsatility, increased LH-to-FSH ratio, and thecal cell hyperandrogenism. Insulin resistance, present in 50-70% of affected women regardless of BMI, amplifies ovarian androgen production by stimulating thecal cells and suppressing hepatic sex hormone-binding globulin (SHBG) synthesis. The resulting hyperandrogenism disrupts follicular maturation, causing anovulation and the characteristic polycystic ovarian morphology with multiple small antral follicles arrested at 2-9 mm.
Diagnosis & workup
Diagnostics & workup: - Total and free testosterone levels (elevated in hyperandrogenism) - DHEA-S level (to rule out adrenal source) - LH:FSH ratio (often > 2:1) - Fasting glucose, insulin, and HbA1c - Lipid panel (dyslipidemia screening) - 17-hydroxyprogesterone (rule out congenital adrenal hyperplasia) - TSH and prolactin (exclude thyroid disease and prolactinoma) - Pelvic ultrasound (≥ 12 follicles per ovary or ovarian volume > 10 mL)