Polycystic ovary

Introduction Polycystic ovary syndrome is an endocrine disease in which the ovary is enlarged and contains many fluid-filled sacs with elevated androgen levels and inability to ovulate. The most striking feature is anovulation. Shorthand PCOS. The cause of PCOS is unclear. It is generally considered to be related to hypothalamic-pituitary-ovarian axis dysfunction, adrenal dysfunction, genetics, metabolism and other factors. A small number of PCOS patients have sex chromosomes or autosomal abnormalities, and some have a family history. Recently, it has been found that certain genes (such as CYP11A, VNTR of insulin gene) are involved in the occurrence of PCOS, further affirming the role of genetic factors in the pathogenesis of PCOS.

Cause

First, genetic factors

PCOS is an autosomal dominant inheritance, or X-linked (associated) inheritance, or a disease caused by a genetic mutation. Most patients have a karyotype of 46, XX, and some patients have chromosomal aberrations or chimeric types such as 46, XX/45, XO. 46, XX/46, XXq and 46, XXq.

Second, the adrenal sprouting hypothesis

Chom (1973) believes that PCOS originated from pre-puberty adrenal gland disease, that is, when stimulated by strong stress, the reticular band secretes excessive androgen, and is converted to estrone outside the gonad, which feedbackly releases the HP axis GnRH-GnH. Rhythm disorder, LH / FSH ratio increased, secondary to increased ovarian androgen production, that is, the adrenal gland and ovary jointly secrete more androgen into hyperandrogenism. Hyperandrogenism causes thickening of the envelope fibrosis in the ovary, inhibits follicular development and eggs, resulting in cystic enlargement of the ovary and chronic anovulation.

an examination

Related inspection

Luteinizing hormone laparoscope

First, hormone determination

Gonadotropin: about 75% of patients with elevated LH, LH/FSH blood LH and FSH ratio and concentration are abnormal, showing a non-periodic secretion, most patients with increased LH, and FSH is equivalent to early follicular phase, LH / FSH 2.5 to 3. Many scholars believe that the increase in the proportion of LH/FSH is a feature of PCOS.

Second, imaging examination

1. Pelvic B-ultrasound: ovarian enlargement, at least 10 or more 2 ~ 6mm diameter follicles per plane, mainly distributed in the periphery of the ovarian cortex, a few scattered in the interstitial, interstitial increased.

2. Pneumopera: The bilateral ovaries increase 2 to 3 times. If the main source of androgen is the adrenal gland, the ovary is relatively small.

3. Laparoscopy: (or during surgery) See the ovarian form is full, the surface is pale and smooth, the capsule is thick, and sometimes there is a capillary network under it. Because the appearance of the color is pearl-like, commonly known as oyster ovary, a number of vesicular follicles can be seen on the surface.

4. Transvaginal high-resolution ultrasonography of the ovaries makes a breakthrough in the diagnosis of PCOS. At present, experienced doctors have made this examination the basis of diagnostics. Polycystic ovary can be detected 100% through the vagina, and 30% of patients in the abdomen are missed. Anal ultrasound can be used to detect unmarried obese patients. In 1986, Adams first reported that the ultrasound features of the ovary of patients with PCOS were more than 8 follicles with diameter <10 mm in both ovaries, arranged along the periphery, accompanied by an increase in the central interstitial region. Polycystic ovaries are usually enlarged, but there are also normal-sized polycystic ovaries. The ultrasound phase of PCOS patients can also be normal.

5. CT, MRI can also be used for ovarian morphology examination.

Third, laparotomy

It is performed when a ovarian tumor is to be diagnosed or when an ovarian wedge is to be performed.

Fourth, other inspections

Vaginal exfoliation cell maturation index

It is an easy way to get an idea of the sex hormones in the body. A smear of excessive testosterone tends to have a three-layer cell type at the same time. When the concentration is significantly increased, the number of cells in the three layers is almost equal, but it must be distinguished from inflammation. Estrogen levels can be estimated from the percentage of superficial cells, but do not reflect the amount of hormones in the blood.

2. Determination of basal body temperature

Judging whether there is ovulation, ovulation is biphasic, and ovulation is generally single-phase.

Differential diagnosis

1. Clinical diagnosis After menarche, menstruation is still irregular, menstrual scarcity and (or) amenorrhea, accompanied by obesity and hairy, infertility after marriage, etc., should be suspected of PCOS. Typical cases have various symptoms and signs mentioned above, namely menstrual disorders, hairy, acne, obesity, infertility and the like.

Atypical cases can be expressed as:

1 simple amenorrhea without obesity, hairy and ovarian enlargement, exclude other diseases, and those with positive progesterone test should still consider PCOS.

2 ovulatory dysfunctional bleeding.

3 menstrual abnormalities combined with hairy.

4 menstrual abnormalities with masculine symptoms, no obvious obesity.

5 dysfunctional uterine bleeding with infertility.

For atypical cases, detailed information about the medical history, such as age of onset, growth and development, onset of illness, history of medication, family history, personal habits, and general systemic diseases are required. Combined with auxiliary examination, exclude other diseases, and confirm the diagnosis by B-ultrasound and other tests.

2. Diagnostic criteria Due to the heterogeneity of the disease, the diagnostic criteria have not been unified. Most scholars have combined with an androgen level according to the onset of puberty, abnormal menstruation and ovulation, hairy, blood LH and/or LH/FSH ratio. High, ultrasound examination of polycystic ovary signs, after the exclusion of other similar diseases, can determine the diagnosis of this disease.

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