'Acute' Residual Ovary Syndrome

Summary: This development of pathology in conserved ovaries is defined as the residual ovary syndrome (ROS). It consists of pelvic pain, pelvic mass, dyspareunia as a single or a cluster of symptoms. It is estimated that at least 5% of patients will develop ROS and require surgery for it following hysterectomy. We describe a case of ROS in a 41-year-old woman who developed an abdominopelvic mass the size of a pregnancy of 24 weeks' gestation within 11 weeks of hysterectomy and right salpingo-oophorectomy. At laparotomy, the mass was found to be a huge benign ovarian cyst measuring 11.5 ± 11.0 ± 14.1 cm. Histology showed benign thick-walled follicular cysts. ROS can occur 'acutely', our case having the shortest latent period of onset ever reported.     

The Residual Adnexa Syndrome

Summary: The clinical profile of a group of 208 women who presented with residual adnexal disease subsequent to hysterectomy was studied retrospectively; 121 patients had the uterus removed vaginally and 87 per abdomen. The majority of the patients had the hysterectomy at less than 40 years of age, with a mean and median age of 33 years, and more than 60% presented with adnexal symptoms and signs within 5 years of hysterectomy. A detailed analysis of the symptoms and signs and pathology of the removed uterus in both groups was similar although as expected there was an associated finding of prolapse in a significant number of those treated by vaginal hysterectomy. There were significant delays both in the definitive diagnosis of subsequent residual adnexal disease and definitive treatment. The pathological changes in the removed residual adnexa were varied, but with a high incidence of inflammatory changes involving both the tube and ovary. This was particularly evident in those patients in whom the uterus had been removed by the vaginal route, suggesting that this may be related to the usual fixation or approximation of the conserved tube to the vaginal vault at the time of vaginal hysterectomy.     

Ovulation and the Polycystic Ovary Syndrome

Summary: In the 1930s, Stein and Leventhal added amenorrhoea to anovulatory dysfunctional uterine bleeding among the known clinical manifestations of the polycystic ovary syndrome (PCOS). Whatever the menstrual pattern, infrequent or absent ovulation with symmetrical enlargement of the ovaries is now a familiar abnormality in women of reproductive age. Diagnosis of PCOS has developed from just the clinically obvious to an appreciation, through ultrasound imaging of the ovaries and endocrine testing, of its subtler forms. Today's clinicians will identify PCOS on the ultrasound image of many small follicles apparent in the periphery of both ovaries, on raised serum unbound testosterone assays, on exaggeration of serum LH levels with the start of pulsatile GnRH therapy, and on follicular overresponsiveness to injections of FSH. Once among the most treatable causes of infertility, ovulation-induction for PCOS remained unsophisticated while microsurgery and assisted conception dissolved frontiers for other causes of infertility. Whereas we now have the benefit of high technology embryo cryostorage to cope with embarassingly high yields of PCOS oocytes, we still need to explain why, the bigger the ovaries, the more likely (we have long known it to be) that PCOS can be cured simply by reducing ovarian mass. Some cases of PCOS are hereditary and most seem constitutionally determined. PCOS is so common that the questions must be asked, Are we appreciating an extreme of normal? Could the milder forms of PCOS have - or could PCOS have had - evolutionary usefulness?     

多囊卵巢综合征的心血管疾病风险

胰岛素抵抗、腹型肥胖、脂代谢紊乱、低度慢性炎症和高雄激素是多囊卵巢综合征（PCOS）的主要心血管危险因素,而其他因素如同型半胱氨酸、氧化应激、血栓形成等也可能增加心血管危险。而且,代谢综合征、2型糖尿病、高血压和阻塞性睡眠呼吸暂停等疾病在PCOS人群中更为常见,同样提示PCOS和心血管疾病问可能存在某种关系。然而,目前并无任何流行病学资料显示。PCOS人群比正常同龄人心血管疾病的发病率和死亡率更高。考虑到PCOS中高发的心血管危险因素,仍需对其远期风险给予重视并给予早期干预。     

多囊卵巢综合征的心血管疾病风险

胰岛素抵抗、腹型肥胖、脂代谢紊乱、低度慢性炎症和高雄激素是多囊卵巢综合征(PCOS)的主要心血管危险因素,而其他因素如同型半胱氨酸、氧化应激、血栓形成等也可能增加心血管危险.而且.代谢综合征、2型糖尿病、高血压和阻塞性睡眠呼吸暂停等疾病在PCOS人群中更为常见,同样提示PCOS和心血管疾病间可能存在某种关系.然而,目前并无任何流行病学资料显示,PCOS人群比正常同龄人心血管疾病的发病率和死亡率更高.考虑到PCOS中高发的心血管危险因素,仍需对其远期风险给予重视并给予早期干预.     

炎症因子与多囊卵巢综合征的关系

多囊卵巢综合征（PCOS）的发病机制十分复杂,包括遗传因素、环境因素、炎症因素等。近年来在PCOS中炎症因子与胰岛素抵抗（IR）、肥胖及下丘脑-垂体-性腺轴之间的相互关系是讨论的重点。炎症因子可直接或经由脂肪组织间接介导IR,脂肪组织可分泌多种细胞因子,PCOS患者细胞因子表达异常,促使炎症反应的发生,并参与IR过程。此外,炎症因子可能直接参与下丘脑-垂体-性腺轴功能紊乱,通过对性腺轴的直接作用,影响PCOS患者卵泡发育、成熟及排卵等过程。遗传因素方面,许多炎症因子基因多态性与PCOS发生、发展存在一定关联。     

Polycystic Ovary Syndrome and Incidental Diagnosis of Mosaic Turner Syndrome

BackgroundPolycystic ovary syndrome (PCOS) is a common condition in women of reproductive age. Mosaic Turner syndrome (TS) is a genetic disorder with significant phenotypic variability. The occurrence of PCOS in women with mosaic TS has been infrequently studied.CaseA 30-year-old nulligravid woman presented with oligomenorrhea, hyperandrogenism, infertility, and ultrasound polycystic ovary morphology. She was diagnosed with PCOS and conceived following ovulation induction. After 2 inconclusive non-invasive prenatal screening results, she was referred to medical genetics. A maternal karyotype resulted in a diagnosis of 45,X/46,XX mosaic TS. She delivered a healthy 46,XY infant at term.ConclusionPCOS can affect women with mosaic TS. Further studies are needed to better characterize the reproductive profile of women with mosaic TS, including the presentation of concurrent PCOS.     

多囊卵巢综合征的基因多态性研究进展

多囊卵巢综合征(PCOS)是育龄期妇女的常见疾病,具有高雄激素、高胰岛素和胰岛素抵抗等特征。PCOS是妇科内分泌疾病中最具争议的疾病之一,其家族遗传特性已被证明,但目前可能参与其发病的基因尚未完全阐明,并且没有广为接受的PCOS基础致病基因。PCOS的异质性使研究更加困难,目前研究的基因主要是影响雄激素生物合成、转运、作用和调节的基因,与胰岛素抵抗和相关异常有关的基因以及与慢性炎症相关的基因。     

多囊卵巢综合征妊娠患者的产科结局

多囊卵巢综合征（PCOS）是生育期妇女最常见的生殖内分泌疾病,病因至今未明。高雄激素、胰岛素抵抗（IR）及高胰岛素血症是PCOS的病理生理基础。由于PCOS患者特殊的病理生理特点,妊娠后可能会并发流产、妊娠期糖尿病（GDM）、妊娠高血压疾病等合并症。充分认识PCOS患者的妊娠期并发症及新生儿结局,有针对性地预防和治疗母儿并发症,对保障母婴健康有重要意义。     

多囊卵巢综合征妊娠患者的产科结局

多囊卵巢综合征（PCOS）是生育期妇女最常见的生殖内分泌疾病,病因至今未明。高雄激素、胰岛素抵抗（IR）及高胰岛素血症是PCOS的病理生理基础。由于PCOS患者特殊的病理生理特点,妊娠后可能会并发流产、妊娠期糖尿病（GDM）、妊娠高血压疾病等合并症。充分认识PCOS患者的妊娠期并发症及新生儿结局．有针对性地预防和治疗母儿并发症,对保障母婴健康有重要意义。     

CYP11A与多囊卵巢综合征

CYP11A编码胆固醇侧链裂解酶P450scc是固醇类激素合成的第一步关键限速酶,几乎存在于所有动植物中。CYP11A受激素水平和自身启动子区域某些特定结构调控,其启动子区域的基因多态性可能与转录活性和基因表达相关。多囊卵巢综合征(PCOS)是一种很常见的女性生殖内分泌疾病,高雄激素是PCOS的主要特征。CYP11A基因是PCOS的一个重要遗传易感位点,在PCOS发病机制中其多态性表现的作用仍有争论,并未完全阐明,值得进一步深入研究。     

肥胖与青少年多囊卵巢综合征

多囊卵巢综合征（PCOS）是育龄妇女常见生殖内分泌疾病。近年发现,随着儿童肥胖患病率增加,青少年PCOS发病率也逐年提高。肥胖可通过增加外周循环胰岛素水平影响PCOS发病机制,PCOS患者高雄激素血症也会增加内脏脂肪沉积。肥胖会增加与PCOS相关的代谢和心血管方面的并发症的患病风险,如胰岛素抵抗（IR）、高脂血症、高血压以及临床症状不明显的动脉粥样硬化等。早期识别青春期PCOS,有利于及时纠正、阻断其内分泌紊乱,防止近期及远期并发症发生。     

肥胖与青少年多囊卵巢综合征

多囊卵巢综合征（PCOS）是育龄妇女常见生殖内分泌疾病。近年发现,随着儿童肥胖患病率增加,青少年PCOS发病率也逐年提高。肥胖可通过增加外周循环胰岛素水平影响PCOS发病机制,PCOS患者高雄激素血症也会增加内脏脂肪沉积。肥胖会增加与PCOS相关的代谢和心血管方面的并发症的患病风险,如胰岛素抵抗（IR）、高脂血症、高血压以及临床症状不明显的动脉粥样硬化等。早期识别青春期PCOS,有利于及时纠正、阻断其内分泌紊乱,防止近期及远期并发症发生。     

多囊卵巢综合征的发育学起源

多囊卵巢综合征（PCOS）是常见的生殖内分泌及代谢紊乱性疾病。通过对实验诱导的产前雄激素化的恒河猴和绵羊的观察,以及人类相关的数据的支持,得出结论：尽管PCOS是一个复杂的异质的疾病,但是其临床和生物学特征可以用卵巢雄激素产生的发育学起源所解释。胎儿的和（或）青春期的雄激素过剩重排下丘脑-垂体单元对黄体生成激素（LH）的控制,增加内脏脂肪分布,诱发胰岛素抵抗和无排卵,引起成年雄激素过多症的临床表现。其他的遗传和环境因素（尤其是饮食）可以与这个潜在的进程相互作用,修饰最终的表型,引起PCOS异质的特征。综述PCOS的发育学起源。     

Polycystic Ovary Syndrome: Fertility Management

Polycystic ovary syndrome (PCOS) is characterized by a series of symptoms, including oligomenorrhea or amenorrhea anovulation or infertility; it is associated with insulin resistance and compensatory hyperinsulinemia. Several treatment options are available for women with anovulatory infertility related to PCOS. Clomiphene citrate (CC) is the first-choice for induction of ovulation in PCOS patients. Laparoscopic ovarian drilling (LOD) or gonadotropin ovarian stimulation can be offered after failure of CC to achieve pregnancy. Hyperinsulinemia related to PCOS can be corrected by weight loss or insulin-sensitizing agents, such as metformin, which alone or in combination with other agents are capable of restoring ovulation. Only very limited clinical data are available on the use of letrozole at present, so letrozole cannot be recommended for routine use in ovulation induction. When all treatments fail, in vitro fertilization and embryo transfer (IVF/ET) can be tried and can have excellent results. Many treatment options available today ensure that the majority of women who are subfertile due to PCOS can be treated successfully.     

Polycystic Ovary Syndrome among Obese Adolescents

Background and aims: In adolescence and obesity, the pathophysiology of polycystic ovary syndrome (PCOS) is very difficult to distinguish. We aimed to assess the diagnosis of PCOS in the population of obese adolescent.

Methods: Cross-sectional study. Setting: Pediatric Endocrinology Weight and Management Clinic from Children's Institute, São Paulo, Brazil. Participants: Forty-nine post-menarcheal obese adolescents with mean age of 14.7 years. Interventions: Anthropometric assessment and review of medical records were done. Clinical and laboratory hyperandrogenism were quantified using Ferriman–Gallwey index and androgenic dosages, respectively. Ovarian morphology was evaluated through suprapubic ultrasonography.

Results: By the 2015 Witchel et al. guideline for PCOS in adolescence, 18.4% were diagnosed as having PCOS. When assessed by Rotterdam, Androgen Excess and PCOS Society, and American National Institute of Health criteria's, 26.4%, 22.4%, and 20.4% had PCOS, respectively. Irregular menstrual cycles were found in 65.3% of patients. Clinical hyperandrogenism was observed in 16.3% of girls and 18.4% had elevated serum androgen values. Suprapubic ultrasonography revealed enlarged ovaries in 18.4% of the adolescents.

Conclusions: PCOS in all-comers obese adolescents from a Weight and Management Clinic in a quaternary hospital is more frequent when compared to adult women showed in the literature.