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  #1  
Old 08-26-2012
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Question excess adrenal androgen

excess adrenal androgen resulting in extraglandular estrone production is likely mechanism for PCOs
C/F: amenorhea,or oligomenorhea,obesity and hirsutism
lab: elevated LH
Please explain it i cant undrstand
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Old 08-26-2012
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i think PCOS is due to excess production of LH(theca interna hypertrophy)....which lead to increase androgen synthesis( causes hirsutism)
excess androgen converts to estrogen by aromatization(in adipose tissue)...
now estrogen cause negative feedback on FSH...causing follicle suppression and enlargement with cystic fluid(so, amenorrhea)..
so ,LH increases, FSH decreases, estrogen and androgen increases

some studies say there is defect in signalling pathways of FSH,IGF-1 leading to cystic ovaries and insulin resistance
when i searched the topic i got this...
http://www.elsevierimages.com/image/28448.htm
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Old 08-26-2012
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Quote:
Originally Posted by riya_rai84 View Post
excess adrenal androgen resulting in extraglandular estrone production is likely mechanism for PCOs
C/F: amenorhea,or oligomenorhea,obesity and hirsutism
lab: elevated LH
Please explain it i cant undrstand
polycystic ovarian syndrome (PCOS), a condition characterized by the combination of obesity, hirsutism and oligomenorrhea PCOS occurs due to an abnormality of the hypothalamic-pituitary-ovarian system.[B] Androgen [/B (testosterone and androstenedione) and LH levels are elevated, whereas FSH levels are normal. An increased LH/FSH ratio (>3) is characteristic. There is a tendency toward insulin resistance and lipid profile abnormalities as well.
Polycystic ovarian syndrome is associated with the following signs and symptoms
1. Menstrual irregularity (most often oligomenorrhea) and infertility, due to anovulation.
2. Hormonal dysregulation (progesterone deficiency, acyclic estrogen production, and elevated LH
level). The effects of abnormally high levels of unopposed estrogen on the endometrium increase the
long-term risk of endometrial hyperplasia and endometrial adenocarcinoma.
3. Increased insulin resistance leads to obesity. Patients with PCOS have a higher risk of developing
type 2 diabetes mellitus.
4. Hirsutism and acne occur due to increased androgen levels
5. Changes of lipid metabolism put patients at increased risk for atherosclerosis and coronary artery
disease.
8 . Abdominal ultrasonography in patients with PCOS reveals bilateral ovarian enlargement. Histologic
examination reveals multiple enlarged, sclerotic, cystic follicles


For unknown reasons, affected patients have persistently elevated estrogen, androgen, and luteinizing hormone (LH) levels, resulting in hyperandrogenism, chronic anovulation, oligomenorrhea, and multiple ovarian cysts. Anovulation is the cause of infertility in these patients which is a common presenting complaint Theca cell hyperplasia can result in excess androgen production and symptoms of hyperandrogenism such as acne, hirsutism, male pattern balding, and other forms of virilization. Obesity, insulin resistance, and dyslipidemia are also common features of PCOS, which result in an increased risk of diabetes and cardiovascular disease.



(I don't know what exactly was confusing you... so here is all what i have on PCOS in my notes)
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Old 08-27-2012
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Quote:
Originally Posted by Step-step View Post
polycystic ovarian syndrome (PCOS), a condition characterized by the combination of obesity, hirsutism and oligomenorrhea PCOS occurs due to an abnormality of the hypothalamic-pituitary-ovarian system.[B] Androgen [/B (testosterone and androstenedione) and LH levels are elevated, whereas FSH levels are normal. An increased LH/FSH ratio (>3) is characteristic. There is a tendency toward insulin resistance and lipid profile abnormalities as well.
Polycystic ovarian syndrome is associated with the following signs and symptoms
1. Menstrual irregularity (most often oligomenorrhea) and infertility, due to anovulation.
2. Hormonal dysregulation (progesterone deficiency, acyclic estrogen production, and elevated LH
level). The effects of abnormally high levels of unopposed estrogen on the endometrium increase the
long-term risk of endometrial hyperplasia and endometrial adenocarcinoma.
3. Increased insulin resistance leads to obesity. Patients with PCOS have a higher risk of developing
type 2 diabetes mellitus.
4. Hirsutism and acne occur due to increased androgen levels
5. Changes of lipid metabolism put patients at increased risk for atherosclerosis and coronary artery
disease.
8 . Abdominal ultrasonography in patients with PCOS reveals bilateral ovarian enlargement. Histologic
examination reveals multiple enlarged, sclerotic, cystic follicles


For unknown reasons, affected patients have persistently elevated estrogen, androgen, and luteinizing hormone (LH) levels, resulting in hyperandrogenism, chronic anovulation, oligomenorrhea, and multiple ovarian cysts. Anovulation is the cause of infertility in these patients which is a common presenting complaint Theca cell hyperplasia can result in excess androgen production and symptoms of hyperandrogenism such as acne, hirsutism, male pattern balding, and other forms of virilization. Obesity, insulin resistance, and dyslipidemia are also common features of PCOS, which result in an increased risk of diabetes and cardiovascular disease.



(I don't know what exactly was confusing you... so here is all what i have on PCOS in my notes)
then what is causing multiple ovarian cysts (patho physiology)according to you...?
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Old 08-27-2012
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sorry venky about the last post.... read your post wrong. my bad. TOOOOO LATE. i need to sleep.
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Old 08-27-2012
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Quote:
Originally Posted by Step-step View Post


Not according to me. wth... I don't have a phd. where did I claim that this is according to me?
If you try to read the very last line it specifically says... according to the notes I have taken.
ok ..i'm not judging you but what i learnt from my notes is that FSH decreases due to negative feedback from estrogen..which leads to follicular degeneration with FSH decrease and cystic fluid is scereted into follicles leading to multiple cysts..it is the decrease of FSH may lead to endometrial hyperplasia too...
correct me if i'm wrong....btw i'm not a PhD master too...
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Originally Posted by venky2600 View Post
then what is causing multiple ovarian cysts (patho physiology)according to you...?
I have absolutely no clue. I haven't come across an explanation of the cause... and I've never come across a question in Kaplan nor Usmle world regarding the "cause" of POCS... Only the manifestations of it... and how to treat the infertility caused due to it... thats about it.
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Quote:
Originally Posted by venky2600 View Post
ok ..i'm not judging you but what i learnt from my notes is that FSH decreases due to negative feedback from estrogen..which leads to follicular degeneration with FSH decrease and cystic fluid is scereted into follicles leading to multiple cysts..it is the decrease of FSH may lead to endometrial hyperplasia too...
correct me if i'm wrong....btw i'm not a PhD master too...
Yes, i agree with you... that LH is increased... but why? why is LH increased. No one knows. I could be wrong... but I haven't come across any source explaining why LH is increased. They all say due to unknown reasons or for reasons not completely understood... etc etc
Increased LH is not the cause of the disease... Its just a part of the disease.
But if you come across a source saying increased LH is the cause of PCOS... please feel free to share it with me.
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Quote:
Originally Posted by Step-step View Post
Yes, i agree with you... that LH is increased... but why? why is LH increased. No one knows. I could be wrong... but I haven't come across any source explaining why LH is increased. They all say due to unknown reasons or for reasons not completely understood... etc etc
Increased LH is not the cause of the disease... Its just a part of the disease.
But if you come across a source saying increased LH is the cause of PCOS... please feel free to share it with me.

from one source i came to know that

there is defect in signalling pathways in FSH and IGF1-----so, follicle degeneration and cyst formation takes place(amenorrhea)....cysts are with thickened superficial cortex and hyperplasia of theca interna---which increases LH-->increase androgens
(hirsutism)--> increase peripheral aromatization and estrone increase---> risk of endometrial hyperplasia
IGF1 signalling defect leading to insulin resistance(obesity)----hyperinsulinemia lead to increased GnRH-----> leading to LH increase( due to hyperplasia)....FSH decreases( due to signalling defect)

it understands everything to me.....i may be wrong, guide me if i'm wrong...
the following diagram also try to explain it but, in a complex way
http://www.elsevierimages.com/image/28448.htm
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Old 08-27-2012
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Lol, I still fail to see where it specifically explains that "LH" is the cause of the syndrome. It's clear that the symptoms of the syndrome are due to increased LH... But increased LH is not the cause of the syndrome it self. This is the best I can do to explain. Don't mean to undermine you or any such thing. I wonder what thoughts others have on this. either way... Good night for now
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Old 08-27-2012
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Stop confusing yourselves with all these unncesary explanations for things that even the scientists who discovered them cannot explain how... Yea it can b fascinating but i think you should just take what kaplan FA etc gives you and Go with it!! because you'll only get more confused. and Question in USMLE Don't test them.

Gudluck!!
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  #12  
Old 08-29-2012
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Default PCOS

pcos pathophysio is confusing though i hope the link below will help you claer your doubts http://www.fastbleep.com/medical-not...aeds/17/38/259
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Default PCOS

pcos pathophysio is confusing i hope this will clear your doubts


LH and FSH are released from the anterior pituitary in response to GnRH. In PCOS LH stimulates the theca interna cells of the ovaries to release androgens. FSH on the other hand normally promotes the conversion of androgens to oestrogen via aromatase activity. However due to the lower levels of FSH in PCOS, this process is not as active.

An increase in androgen production and release causes an increase in inhibin (Inhibin B) release, which leads to an increase in the production of androgens. This vicious cycle leads to inhibin suppressing the levels of circulating FSH, thereby contributing to the increased LH:FSH ratio.
nsulin resistance (possibly a cause or effect of PCOS) is thought to be exacerbated by the increase in androgens. Insulin resistance then causes compensatory hyperinsulinemia, which acts to increase levels of androgens, by two methods. Firstly, by lowering the circulating levels of sex hormone binding globulin (SHBG). Secondly, by acting on both insulin and IGF-1 (Insulin-like growth factor-1) receptors on the ovaries. It is also known to increase the pulse frequency of GnRH, resulting in to the contribution of the increase in LH:FSH ratio.
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Old 08-29-2012
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Increase in pituitary synthesis of LH and decreased synthesis of FSH (Don't know the reason but if you learn this as fact will answer all your questions)
1. hirsutism: Due to increased LH cause increase in androgen synthesis
2. Amenorrhea: Increased androgens.
3. Endometrial cancer: androgen are aromatized to estrogen in adipose tissues (Obese patients)
4. Increased estrogen gives +ve feedback to LH and -ve feedback to FSH (this can explain above mentioned fact- but not sure)
5. Suppression of FSH causes follicle degeneration.
5. Cyst: fluid accumulation produces subcortical cyst that enlarge ovaries.

In short: PCOs: LH increase, FSH decrese and LH/FSH.2
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