Endocrine Abstracts

Polycystic ovarian syndrome (PCOS) is common in young women and is the cause of anovulatory infertility in 70% of cases. We report the analysis of 26 patients with polycystic ovarian syndrome (PCOS) on presentation to the Endocrine clinic, mean age 36 (range 21–53), using both electronic database and hospital notes. Fifty percent of patients (n=13) were obese, mean BMI 30 (range 19–40). Sixty five percent (n=14) never conceived, although 15% (n=4) were planning pregnancy, 8% (n=4) had previous miscarriages. Three percent (n=1) had fertility treatment in the past. Of 19% (n=5) had hyperprolactinaemia, mean 664 (77–8440), mean LH 11 (1.3–57.3), mean FSH 5.8 (1.9–9.4), mean oestradiol 281 (102–682), mean cortisol 308 (126–700), mean DHEA 3.3 (3.1–3.6), mean androstenedione 13.6 (12.2–15.1), mean testosterone 1.78 (0.8–3.1), mean SHBG 47 (2.1–230), free androgen index 6.2 (0.6–18.7) with normal thyroid function in all patients (recorded in 84%). Ovarian ultrasound was normal in 57% (n=15), however, it showed multiple follicles in 15% (n=4), tiny follicles 3% (n=1), peripheral cysts atypical for PCOS 3% (n=1), while there was no record of ovarian ultrasound in 11% (n=3) and it was not performed in 7% (n=2). CT abdomen and pelvis was performed in 8 patients and was reported as normal. Initial treatment included advice regarding weight loss, Metformin 50% (n=13), Dianette 7% (n=2), Cabergoline 3% (n=1), Cyproterone acetate 3% (n=1), Orlistat 3% (n=1), statin 15% (n=4) and none of the patients were commenced on Thiazolidinediones. Fifty three percent (n=14) had treatment for cosmetic effects including Vaniqa 46% (n=12), shaving 7% (n=2), electrolysis 19% (n=5), plucking 7% (n=2), waxing 15% (n=4), laser 11% (n=3), this data recorded only in 61% of patients (n=16).

The heterogeneity of PCOS makes not only the diagnosis but also the choice of an adequate treatment difficult. Weight loss has been consistently successful in reducing insulin resistance and restoring ovulation and fertility. More patients should be commenced on Metformin as it may help in reduction of biochemical hyperandrogenism as well as restoring ovulation in this group.