Polycystic ovarian syndrome: a new perspective.

Polycystic ovarian syndrome (PCOS) is sometimes called Stein-Leventhal Syndrome after the two doctors who first described it in 1935. 1 It is the most common ovarian disorder with typical features of obesity, anovulation, hyperandrogenism, hirsutism and infertility. The accepted nomenclature for the syndrome is PCOS, despite the fact that polycystic ovaries are non-specific findings and can occur in women with regular cycles and no hormonal derangements. 2 Other names such as hyperandrogenic chronic anovulation and functional ovarian hyperandrogenism have failed to gain wide acceptance. rrence varies from 1-8% in genera! population depending upon the diagnostic criteria, as there is no universal definition for this syndrome. 3-5 Despite extensive research, the etiology and the mechanisms underlying PCOS are largely unknown, but there is considerable evidence suggesting that insulin plays the basic pathologic role along with a genetic component to the syndrome. It is not purely an ovarian disease but an extremely heterogeneous clinical syndrome that should be recognized as a systemic endocrine and metabolic disorder. The first insight into the biochemical derangements came in the mid 1950s with the detection of elevated urinary luteinizing hormome (LH) levels; later increased androgen production was documented. Abnormalities in the hypothalamic-pituitary-ovarian axis with increased pulsatile LH release and increased pituitary gonadotroph sensitivity to gonadotropin releasing hormone were characterized in the early 1970s. In mid 1980s it was found that insulin resistance and hyperinsulinemia are also important components of PCOS that play a causal role in both hyperandrogenemia and chronic anovulation 6,7