This is a mechanism of disease flowchart for polycystic ovarian syndrome, covering the etiology, pathophysiology, and manifestations of PCOS.

ADDITIONAL TAGS:
Pharmacology / toxicity
Infectious / microbial
Biochem / molecular bio
Mutation
Signs / symptoms
Labs / tests / imaging results
Polycystic ovarian syndrome
Core concepts
Social determinants of
health / risk factors
Hormone changes
Genetics / hereditary
Mass effect
Pathophysiology
Etiology
Manifestations
↑ luteinizing hormone (LH) produced by pituitary
Hyperinsulinemia, peripheral insulin resistance
Hirsutism: hair on chin, upper lip, chest, abdomen, back, butt
Functional ovarian hyperandrogenism
Metabolic syndrome (obesity, DM2)
Prematurely luteinize granulosa cells
Fat accumulation
Stimulate theca cells
↑ estrogens
Infertility
Unknown intrinsic ovarian defects
Stimulated keratinocyte and dermal fibroblast proliferation → epidermal hyperplasia and hyperpigmentation
Acanthosis nigricans
Disrupted LH / FSH balance
↓ FSH
Impaired follicle maturation with cyst formation due to lack of follicle rupture
anovulation / oligoovulation
↑ insulin-like growth factor 1
Endometrial hyperplasia
↑ risk of endometrial carcinoma
↓ SHBG
Sleep apnea
NAFLD
Androgenetic alopecia
Acne vulgaris
Oily skin
Menstrual irregularities (primary or secondary amenorrhea; oligomenorrhea; menorrhagia)
Depression
Anxiety disorders
Gross: brown, small, uniform cysts in circle in subcapsular region of the ovary
Histo: ovarian hypertrophy, thick capsule; enlarged cystic follicles; stromal hyperplasia and fibrosis; hyperluteinized theca cells, smaller granulosa cell layer
Genetic predisposition?
AMH, AMHR, GNAS1, DENND1A
Lifestyle?