The Classification of Polycystic Ovarian Syndrome (PCOS)
The classification basis:
1. Steroid Hormone;
2. Insulin and Blood glucose;
3. Body shape;
5. Unilateral and bilateral;
6. The time of polycystic ovarian syndrome (PCOS) occurs.
1. The hyperandrogenism type, under basic conditions, including testosterone, DHT, androstenedione and elevation of ketosteroid 17. Decreased SHBG cause free androgen increases.
2. The hyperandrogenism type, under basic conditions, the total estrogen can be reached 140pg/ml, androstenediol is equivalent to the early follicular level of about 60pg/ml, the production of extragonadal estrone increased to E1/E2≥1.
3. High DHEA Type, under basic conditions, adrenal gland of dehydroepiandrosterone (DHEAS) production increased and plasma concentration ≥3.3μg/ml.
4. High 17 hydroxyprogesterone type, under basic conditions, 17 hydroxyprogesterone (normally <200ng/dl), however, ≥800ng/dl should be considered as delayed congenital adrenal hyperplasia, 21 hydroxylase or 11β hydroxylase deficiency. If it is between 200 and 800ng/dl, ACTH test should be performed (Cotrosyn0.25mg iv) the congenital adrenal hyperplasia should be observed in patients with 17 hydroxyprogesterone elevates 60 mins after injection.
5. Hyperprolactin Type, under basic conditions, prolactin (PRL) ≥25ng/ml.
6. Hyperinsulinism type, insulin rises on an empty stomach ≥14mu/l, IGF-I elevates (normal value is120mmol/l), plasma binding protein decreased (normally <300ng/ml).
Diagnosis of insulin resistance in polycystic ovary: the sum of 3 hours OGGTT is exceed 280uiu.
Diagnostic criteria for polycystic ovary hyperinsulinemia: emptiness insulin <3; if only endocrine disorders and ovulatory disorders can not explain the PCOS, it’s time to look at glycolipid metabolism, just like screening for gestational diabetes mellitus.
7. Proopiomelancortin (POMC) and its derivatives: β-lipotropin, β-endorphin and β-MSH increases. TSH and GH are normal.
8. Obesity type, centripetal obesity, excess body mass index.
9. Ectomorphy type, along with dark skin and light weight.
10. Unilateral, alternating menstrual cycle length, vaginal B ultrasound found polycystic changes on one side of the ovary and normal changes on the other.
11. Mediastinal type, vaginal 4D ultrasound or imaging findings of uterine mediastinum, it accounts more than 50%.
12. Acne type, repeated acne and pus on the back and face.
13. Primary type, adolescent menstruation begins namely oligomenorrhea, arrive amenorrhea gradually.
14. Secondary, menstruation begins regular, some kind of inducement appears oligomenorrhea and come on gradually.