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Paper III
Published in Justin C Konje, Complete Revision Guide for MRCOG Part 3, 2020
Information gatheringDetailed history of the hirsutismAssociated symptoms – acne, weight gain, acanthosis nigricans and irregular periodsFamily historyExclusive factors – drugs or other medical problemsInvestigations – biochemistry (follicular phase) and ultrasound scan of the ovaries and adrenalsExplains need for examination, including quantification of hirsutism – Ferriman–Gallwey score
Polycystic Ovary Syndrome
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
Rita M. Sneeringer, Kristen Page Wright
Hyperandrogenism is the other major component of PCOS. Hirsutism (excessive hair growth) is dependent [12,13]. The Ferriman–Gallwey score has been the gold standard in assessing the degree of hirsutism. A modified Ferriman–Gallwey scoring system has been recently proposed (Figure 14.2). This scale assesses the density and distribution of hair growth on multiple areas of the body. Generally, a summation score of greater than 3 is consistent with hirsutism. Acne, oily skin, and male-pattern alopecia are less specific features and should not be considered clinical evidence of hyperandrogenemia [14]. Biochemical markers of hyperandrogenism include elevated testosterone or DHEA-S levels.
Development and validation of nomograms for predicting adverse neonatal outcomes in women with polycystic ovary syndrome: a retrospective study
Published in Journal of Obstetrics and Gynaecology, 2022
Shanshan Li, Jinlan Li, Qingxiu Ai, Huichun Liu
Blood androgen levels were able to predict adverse perinatal outcomes in multivariable analyses. Previous studies (de Wilde et al. 2017) have observed that women with hyperandrogenic PCOS experienced a significant increase in the rate of pregnancy complications, such as SGA. This suggests that hyperandrogenism itself maybe play an essential role in the aetiology of pregnancy-related diseases. Other findings (Koster et al. 2015) suggest that placenta morphology is frequently abnormal in patients with hyperandrogenism PCOS. Moreover, excess androgens may impair decidual trophoblast infiltration and lead to both macroscopic and microscopic placental alterations, cervical remodelling and changes in myometrial function (Palomba et al. 2012; Sun et al. 2012; Palomba et al. 2013; Palomba et al. 2014). Hyperandrogenemia is linked to severe metabolic dysfunction (such as obesity and insulin resistance) in patients with PCOS and may also partly contribute to the risk of neonatal disease. Thus, our findings indicate that androgen independently influences disease risk. Additionally, hyperandrogenemia likely increases the chance of perinatal disease in women with PCOS before pregnancy. Excess body hair is a signal of hyperandrogenemia. The modified Ferriman-Gallwey Score system is also suitable to evaluate hirsutism in Asian women, which is also a reliable predictor of perinatal disease.
Circulating level of serum secreted frizzled-related protein 5 decreases in polycystic ovary syndrome
Published in Biomarkers, 2022
Fatma Nurgul Tasgoz, Nergis Kender Erturk, Muzaffer Temur
After obtaining the local ethics committee approval, in accordance with the principles of the Declaration of Helsinki, this study was performed in a tertiary research hospital. The study complied with the principles of the Declaration of Helsinki. Patients in reproductive period that applied to the gynecology clinic between October 2019 and April 2020 were enrolled into the study. Women who agreed to participate in the study were included with their informed consent. Those with any systemic diseases such as diabetes mellitus, thyroid diseases, other hormonal diseases, any drugs and cigarette users were excluded from the study. Patient group consisted of women diagnosed as PCOS according to Rotterdam 2003 Criteria (Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004). Those with two of the following criteria were considered PCOS: ovulation dysfunction (OD), clinical and/or biochemical hyperandrogenism (HA), polycystic ovarian morphology (PCOM) in ultrasonography. OD was defined as menstrual cycles longer than 45 days. Clinical HA was defined as hirsutism (Ferriman-Gallwey score> 8) or the presence of moderate to severe acne (Ferriman and Gallwey 1961). The Ferriman–Gallwey score was evaluated by the same physician in each patient. Biochemical HA was defined as total testosterone> 55 ng/ml. For ultrasonographic PCOM diagnosis having 12 or more follicles of 2–9 mm and/or ovarian volume greater than 10 cm3 were used. The control group consisted of healthy women with regular menses (25–32 days), who applied for routine gynaecological control, as well as they had neither hirsutism nor HA.
Correlation between anti-Mullerian hormone levels and antral follicle counts in polycystic ovary and metabolic syndromes
Published in Systems Biology in Reproductive Medicine, 2021
Huo Fu, Youshi Lin, Xueqing Deng, Lin Wu
This study confirmed that HOMA/IR is significantly higher in the PCOS group (6.1 ± 2.49) compared to that in the control group (2.4 ± 0.5). There was a significant positive correlation between HOMA/IR and cholesterol level. This result was consistent with other studies that had previously shown a significant correlation between HOMA-IR and variables such as TG, LDL cholesterol, and HDL (Jung et al. 2017). In this study, the HOMA/IR cutoff value was ≥3.22 with 87.3% sensitivity and 87.3% specificity, which turned out to be consistent with the recent research (Jung et al. 2017). The Ferriman–Gallwey score was significantly higher in the PCOS group (26.49 ± 3.6 vs 7.73 ± 1.66), with a cutoff value of ≥15.7 at 100% sensitivity and 100% specificity. Some authors (Nieschlag and Vorona 2015; Jung et al. 2017) conducted an extensive review of publications in which they reported a cutoff point for mFG of ≥11 for indigenous women in China (Jung et al. 2017). Androgenic disorders may be present with normal body hair; therefore, the absence of hirsutism does not exclude consideration of PCOS with other symptoms of androgen excess such as the presence of acne, alopecia, infertility, or menstrual dysfunction (Jung et al. 2017).