PCO-Different criterion of PCO

Remind you fellow  members that PCOS without excess androgen comprises one of the least severe phenotypes .

Who is more responsible for prime disorder of PCO? Is it primary androgen excess  or  Hyperinsulinaemia ??   

Quick recapitulation of criteria of defining PCO:: The Androgen Excess and PCOS (AE-PCOS) Society concluded that PCOS should be first considered as a disorder of androgen excess or hyperandrogenism. The key message of AE-PCOS Society task force, therefore boils down to the fact that  PCOS should be defined by the presence of hyperandrogenism (clinical and/or biochemical .

However looking back:- The recommended NIH-NICHD diagnostic criteria were 1) clinical or biochemical evidence of hyperandrogenism and 2) chronic anovulation. Most gynacologists thereafter considered and still feel that  sonographic evidence of PCOM should be an element in PCOS diagnosis.

As we know , that in 2003, new guidelines for diagnosing PCOS were suggested at a joint meeting of the European Society for Human Reproduction and the American Society of Reproductive Medicine. Redefining PCOS to incorporate an appropriate definition of a polycystic ovary was then strongly felt.

A diagnosis of PCOS can now be reached when at least two findings among 1) HA(hyperandrogenism)  2) Oligo-An, (oligo-anovulation ) and 3) PCOM are present and after the exclusion of causes of  any androgen excess disorders .

The Rotterdam 2003 criteria have expanded rather than replaced the 1990 NIH criteria, having added the following two PCOM phenotypes: PCOM with HA(hyperandrogenism)  but  without Oligo-An(oligo-amenorrhoea) , and PCOM with Oligo-An and without HA Few women with a) PCOS had PCOS without HA, and nearly  equal number exhibit  PCOS without Oligo-An (oligo-amenorrhoea) .However, the patient populations with the newly extended phenotypes had less severe ovulatory dysfunction and less androgen excess than patients diagnosed using the 1990 NIH criteria which were very strict and included few population only  .

 The prevalence of abnormal sonographic features (PCOM) has been suggested to be higher than 20% in both Asian and Western women.  Follow up of about 1000 cases and keeping records for such women since2009 till date my personal observation  is that  PCOM (ovarian morphology) is  the most common component

AS m=many as 85% of patients in my personal series diagnosed  with Rotterdam criteria had abnormal USG findings .Regarding clinical presentation, excess androgen has been suggested to have a principal role in diagnostic criteria. Analytical results have demonstrated that PCOS without excess androgen comprises one of the least severe phenotypes

In some far East countries , it has been observed that  PCOS without HA is a common phenotype and these are the  women who are less likely to have metabolic dysfunction, insulin resistance, or elevated blood pressure. Most previous reports support the proposal that excess androgen is the condition directly responsible for the signs and symptoms that are recognized as PCOS and not hyperinsulinaemia .More recently, clinical data have demonstrated that hyperandrogenism is the key component of PCOS, and the Androgen Excess and PCOS (AE-PCOS) Society concluded that PCOS should be first considered as a disorder of androgen excess or hyperandrogenism. The AE-PCOS Society task force recommended that PCOS should be defined by the presence of hyperandrogenism (clinical and/or biochemical), ovarian dysfunction (oligo-anovulation and/or polycystic ovaries), and the exclusion of related disorders .