1. Diagnosis
1.1. History and Physical Examination
1.2. Testing for hyperandrogenemia
1.3. Screening tests to detect common causes of abnormal menses
1.4. Screening tests to exclude common non-PCOS causes of hyperandrogenemia
1.5. DIAGNOSTIC CRITERIA
1.5.1. NIH/NICHD
1.5.2. ESHRE/ASRM (Rotterdam Criteria)
1.5.3. Androgen Excess Society
2. Pathophysiology
2.1. Functional ovarian hyperandrogegism (FOH)
2.1.1. 1. Impaired down regulation thecae androgen
2.1.2. 2. Excess inovularian androgen causes granular dysfunction
2.2. Hyperinsulinism and Obesity
2.3. LH excess
3. Causes
3.1. Two-hit phenomenon
3.1.1. 1. Genetics
3.1.1.1. Greater concordance for monozygotic twins than dizygotic twins
3.1.2. 2. Environmental
4. Differentials
4.1. Physiologic adolescent anovulation
4.2. Virilizing Congenital Adrenal Hyperplasia
4.3. Related congenital disorders of adrenal steroid metabolism or action
4.4. Cushing Syndrome
4.5. Virilising Tumors
4.6. Ovarian Steroidogenic blocks
4.7. Thyroid dysfunction
4.8. Acromegaly
4.9. Drugs
5. Epidemiology
5.1. - NIH/NICHD: 4-8% of women of reproductive age - Rotterdam Criteria: 32%
6. Signs and Symptoms
6.1. Cutaneous Features
6.1.1. Hirsutism (abnormal sexual hair in male pattern)
6.1.2. Acne
6.1.3. Other (balding)
6.2. Ovarian Findings
6.2.1. Polycystic Ovary Morphology (PCOM)
6.2.2. Anovulation
6.2.3. Infertility
6.3. Associated Metabolic features
6.3.1. Obesity
6.3.2. Manifestations of Insulin Resistance
6.3.2.1. Aconthosis Nigricans
6.3.2.2. Metabolic Syndrome
6.3.2.3. Sleep-Disordered Breathing
6.3.2.4. Nonalcoholic Fatty Liver Disease (NAFLD)
6.3.2.5. Pseudo Cusinghs Syndrome/Acromegaly
6.4. Other
6.4.1. Oligomenorrhea/ amenorrhea
7. Treatment
7.1. Combination oral contraceptives
7.2. Progestin
7.3. Other androgen-reducing therapies
7.4. Additional measures for specific symptoms
7.4.1. Hiritism: Cosmetic and direct hair removal/ medical/ combination oral contraceptives. anti androgens
7.4.2. Obesity and Insulin Resistance