Metabolic Syndrome amongst Polycystic Ovarian Disease

INTRODUCTION: The most common form of anovulatory infertility is polycystic ovary syndrome1. The most typical form, the association of hyperandrogenism and chronic anovulation without specific underlying diseases of the adrenal or pituitary glands. The principle underlying disorder is insulin resistance resulting in hyper insulinemia and hyperandrogenism2,3 in later on life results in metabolic Syndrome which predisposes to cardiovascular disease and NIDDM in later life4. Metabolic syndrome is a combination of several factors which may share a common etiology and each of which is a risk factors for cardiovascular disease. The clustering of Insulin resistance, dysglycemia, dyslipidemia and hypertension was originally defined as syndrome X in 19885 Metabolic syndrome includes general obesity (as reflected by BMI defined as wt in kg/ht in m2 central obesity as reflected by waist circumference or waist hip ratio) dyslipidemia (as reflected by Low HDL and High TGL levels) hyperglycemia, high blood pressure and resistance to action of insulin. The risk of diabetes and cardiovascular disease with polycystic ovarian syndrome necessitates the awareness to detect it at an earlier stage. The identification of these insults in the preclinical state will lead on to delay in clinical manifestation and the postponement of metabolic morbidity. The current study focuses this problem to identify early markers and to set guidelines for defining the metabolic syndrome among PCOS patients. AIM OF THE STUDY: To study the significance of: 1. Anthropometric Measurements, 2. Insulin Resistance (Fasting Glucose), 3. Lipid Profile (TGL/HDL Ratio), 4. Hypertension (Blood Pressure) in Polycystic ovarian disease. MATERIALS AND METHODS: Patients who attended the Endocrinology OPD, Institute of Obstetric and Gynecology with history and clinical examination suggestive of polycystic ovaries were analyzed and those who fit in inclusion criteria were taken for study numbering one hundred and nine. A control group consisting of hundred women were also studied. The group had spontaneous, regular cylical menstrual flow and with out hyperandrogenic features. All were euthyroid and euprolactinemic. Study and Control group were in the age group 16-35. Period of study was between Oct 2005 to Sep 2006. Inclusion Criteria: 1. Less than 40 years 2. USG findings of Polycystic ovaries 3. Hyperandrogenic features\ud 4. Menstrual disorders. Exclusion Criteria: 1. Prior known endocrine or medial disorder 2. Patients with chronic infection 3. Patients on hormone therapy. CONCLUSION: PCOS, a clinical entity is a complex association of metabolic disturbances expressing in different ways both clinically and chemically. The focus of our study is to unreveil its association. Compared to the western literature, PCOS, has profoundly present in our Asian population. Body weight has direct correlation with the presence of PCOS as weight, BMI, waist hip ratio increasing which tells us the importance of documenting anthropometic measurements. Clinical scenerio inclusive of Hypertention, fasting lipid abnormality goes hand in hand amongst PCOS Patients. The Significane of elevated fasting glycemic status was not appreciably present which precludes the importance of documenting post glucose challenge which will unmask the impairment of glucose tolerance. The role of treating physician is expanded in cases of polycystic orarian syndrome after realising its close association whith chemical abberations resulting in the Misery of Systemic abnormalities. Till we understand the real etiological factor which result in PCOS, the responsibility to detect and treat the tentacles of morbid associations as highlighted in our study