الفهرس 
Overview Of PolycysticOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary syndrome is the most common endocrinal disorder; it was first brought to the attention of the medical profession in 1935 by Stein and Leventhal with prevalence rates of 5-10%. Part of the difficulty in understanding PCOS is that there is no universally accepted clinical definition. PCOS remains an enigmatic disorder with variable clinical presentations and uncertain etiology. There is no single diagnostic criterion that can be recommended for diagnosis of PCO. Its main clinical criteria include: ovulatory dysfunction and evidence of hypergonadism in the presence of polycystic ovaries.
PCOS was found to be not only a hormonal disturbance, but also a metabolically detrimental condition exhibiting such features as insulin resistance that plays an important role in the pathogenesis of the reproductive disturbances of the disorder.
As regards the diagnosis of PCOS, the clinical pictures include : menstrual irregularity, hyperandrogenic characteristic features, obesity and infertility. The radiological investigations include: the ultrasound image which is the gold standard choice showing multiple peripheral small cysts and MRI only as second-line technique. As regards the laboratory diagnosis, various biochemical abnormalities have been described in PCOS such as: inappropriate gonadotropin secretion which is one of the characteristic signs of PCOS represented as elevated GnRH, and elevated LH values with increased LH: FSH ratio to more than 2.5. Furthermore, there is an abnormally high circulating androgen concentration, together with a chronic hyperestrogenic state, while SHBG is in low concentrations.
The complex picture of PCOS makes the treatment difficult. The warranted therapy is multidirectional. Oral contraceptives, clomiphene citrate, gonadotropins, anti-androgens, metformin and cortisol are drugs used in PCOS treatment that must be personalized according to each case. Also surgical treatment increases the percentage of ovulatory cycles either with electrocoagulation or laser.
As regards the metabolic markers of PCOS, PCOS patients show significantly lower adiponectin and ghrelin levels, both correlating negatively with obesity. Also, ghrelin levels were strongly related to insulin resistance. On the other hand, serum leptin concentrations do not correlate with PCOS but rather correlate positively with adiposity.
Polycystic ovary syndrome has been associated with elevated plasma Hcy that shows different correlation with insulin resistance among the literature. Serum resistin levels are also high in PCOS as a consequence of obesity, while total renin serum levels are elevated in PCOS women independently of obesity and serum insulin.
Furthermore, the elevated PAI-1 levels lead to marked elevation in cardiovascular risk in PCOS.
Circulating concentrations of MMPs, especially levels of MMP-9 and MMP-2 and serum PSA levels, were found to be significantly higher in PCOS than healthy controls.
Finally, the raised concentration of inhibin in PCOS reflects the increased number of small antral follicles characteristically present in this disease.