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Encyclopedia > Polycystic ovary syndrome
Polycystic ovary syndrome
Classification and external resources
Polycystic ovary shown on ultrasound image
ICD-10 E28.2
ICD-9 256.4
OMIM 184700
DiseasesDB 10285
eMedicine med/2173  ped/2155 radio/565
MeSH D011085

Polycystic Ovary Syndrome (abbreviated PCOS or POS), also known clinically as Stein-Leventhal syndrome, is an endocrine disorder that affects approximately 10% of all women .[1] It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility.[2][3] The principal features are weight problems, lack of regular ovulation and/or menstruation, and excessive amounts or effects of androgenic (masculinizing) hormones. The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance, diabetes and obesity are all strongly correlated with PCOS. Polycystic Ovary by Sonography File links The following pages link to this file: Polycystic ovary syndrome User:Ekem/images Categories: User-created public domain images ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Endocrinology is a branch of medicine dealing with disorders of the endocrine system and its specific secretions called hormones. ... Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. ... Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... This article is about the disease that features high blood sugar. ...

Contents

Nomenclature

Other names for this syndrome include

  • Polycystic Ovarian Syndrome
  • Polycystic Ovary Disease (PCOD)
  • Syndrome O
  • Functional Ovarian Hyperandrogenism
  • Hyperandrogenic Chronic Anovulation
  • Ovarian Dysmetabolic Syndrome
  • Stein-Leventhal Syndrome

Definition

Two definitions are commonly used:

  1. In 1990 a consensus workshop sponsored by the NIH/NICHD suggested that a patient has PCOS if she has (1) signs of androgen excess (clinical or biochemical), (2) oligoovulation, and (3) other entities are excluded that would cause polycystic ovaries.
  2. In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if 2 out of 3 criteria are met: (1) oligoovulation and/or anovulation, (2) excess androgen activity, (3) polycystic ovaries (by gynecologic ultrasound), and other causes of PCOS are excluded.

The Rotterdam definition is wider, including many more patients, notably patients without androgen excess, whereas in the NIH/NICHD definition androgen excess is a prerequisite. Critics maintain that findings obtained from the study of patients with androgen excess cannot necessarily be extrapolated to patients without androgen excess. NIH can refer to: National Institutes of Health Norwegian School of Sports Sciences: (Norges idrettshøgskole - NIH) Not Invented Here This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... NICHD Logo NIH Logo The National Institute of Child Health and Human Development (NICHD) is one of the National Institutes of Health and part of the United States Department of Health and Human Services. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Oligoovulation (Oligo-ovulation) refers to infrequent or irregular ovulation. ... The European Society of Human Reproduction and Embryology (ESHRE) was created in 1985 by both Professor R.G. Edwards from Cambridge, and Dr. J. Cohen from Paris, who felt that the study and research in the field of reproduction needed to be encouraged and recognized. ... The American Society of Reproductive Medicine (ASRM) is an organization that wants to advance the art, science, and practice of reproductive medicine . It provides a forum for lay public, researchers, physicians and affiliated health workers through education, publications, and meetings. ... Nickname: Motto: Sterker door strijd (Stronger through Struggle) Location of Rotterdam Coordinates: , Country Province Government  - Mayor Ivo Opstelten  - Aldermen Jeannette Baljeu Hamit Karakus Orhan Kaya Lucas Bolsius Jantine Kriens Dominic Schrijer Roelf de Boer Leonard Geluk Area [1]  - Total 319 km² (123. ... Oligoovulation (Oligo-ovulation) refers to infrequent or irregular ovulation. ... In medicine, anovulation is absence of ovulation when it would be normally expected (in a post-menarchal, premenopausal woman). ...


Symptoms

Common symptoms of PCOS include

Mild symptoms of hyperandrogenism, such as acne or hyperseborrhea, are frequent in adolescent girls and are often associated with irregular menstrual cycles. In most instances, these symptoms are transient and only reflect the immaturity of the hypothalamic-pituitary-ovarian axis during the first years following menarche.[4] Oligomenorrhea is the medical term for infrequent or light menstrual periods in women of child-bearing age. ... Amenorrhoea (BE) or amenorrhea (AmE) is the absence of a menstrual period in a woman of reproductive age. ... The menstrual cycle is the periodic change in a womans body that occurs every month between puberty and menopause and that relates to reproduction. ... Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. ... In medicine, anovulation is absence of ovulation when it would be normally expected (in a post-menarchal, premenopausal woman). ... Hirsutism (from Latin hirsutus = shaggy, hairy) is defined as excessive and increased hair growth in women in locations where the occurrence of terminal hair normally is minimal or absent. ... Dyspareunia is painful sexual intercourse, due to medical or psychological causes. ... Alopecia is a set of disorders ranging from male and female pattern alopecia (alopecia androgenetica), to alopecia areata, which involves the loss of some of the hair from the head, alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the... Seborrhoeic dermatitis is a skin disorder affecting the scalp, face and trunk causing scaly, flaky, itchy, red skin. ... Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin, usually present in the posterior and lateral folds of the neck, the axilla, groin, umbilicus, and other areas. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... PMS redirects here. ... Bloating is any abnormal general swelling, or increase in diameter of the abdominal area. ... A mood swing is an extreme or rapid change in mood. ... Women and Pelvic pain Most women (and some men), sometime in their lives experience pelvic pain (when at least 3 mths, called chronic pelvic pain (CPP)). This is a poorly understood condition that likely represents abnormal neurological function, either in the peripheral nervous system or central nervous system. ... Back pain (also known as dorsopathies) is pain felt in the back that may come from the spine, muscles, nerves, or other structures in the back. ... Menarche (IPA: ) is the first menstrual period, or first menstrual bleeding in the females of human beings. ...


It is important to know that PCOS can present in any age. Many can be diagnosed as young children, some might not present until after menopause. It is vital to find a PCOS knowledgeable doctor to catch this disorder as many miss the diagnoses - sometimes for years.


Risks

Women with PCOS are at risk for the following:

Hyperplasia (or hypergenesis) is a general term referring to the proliferation of cells within an organ or tissue beyond that which is ordinarily seen in e. ... Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Hyperinsulinemia, present in people with Diabetes mellitus type 2 or insulin resistance where excess levels of circulating insulin in blood. ... Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Dyslipidemia is a disruption in the amount of lipids in the blood. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Miscarriage or spontaneous abortion is the natural or spontaneous end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined in humans at a gestation of prior to 20 weeks. ...

Diagnosis

Not all women with PCOS have polycystic ovaries (PCO), nor do all women with ovarian cysts have PCOS; although a pelvic ultrasound is a major diagnostic tool, it is not the only one. Diagnosis can be difficult, particularly because of the wide range of symptoms and the variability in presentation (which is why this disorder is characterized as a syndrome rather than a disease). A Pelvic ultrasound is one of the major diagnostic tools used to detect Polycystic Ovarian Syndrome and to image the uterus and ovaries or urinary bladder. ... In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... This article is about the medical term. ...

  • Standard diagnostic assessments:
    • History-taking, specifically for menstrual pattern, obesity, hirsutism, and the absence of breast discharge. A clinical prediction rule found that these four questions can diagnose PCOS with a sensitivity of 77.1% (95% CI 62.7%–88.0%) and a specificity of 93.8% (95% CI 82.8%–98.7%).[6]
    • Gynecologic ultrasonography, specifically looking for ovarian cysts. These are believed to be the result of failed ovulation, reflecting the infrequent or absent menstruation that is typical of the condition. In normal menstruation, eggs are released from follicles - essentially cysts that burst to release the egg. One dominant follicle emerges with each menstrual cycle, and after ovulation the follicle remnant shrinks and disappears. In PCOS, failure of ovulation means that the follicles remain in the ovaries for many months. There may be 10 or more in each ovary, and on ultrasound examination they may give the appearance of a 'string of pearls'. The numerous follicles mean that the ovaries are generally 1.5 to 3 times larger than normal.
    • Laparoscopic examination may reveal a thickened, smooth, pearl-white outer surface of the ovary. (This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the ovaries in this way to confirm a diagnosis of PCOS).
    • Elevated serum (blood) levels of androgens (male hormones), including dehydroepiandrosterone sulfate (DHEAS) and testosterone: free testosterone is more sensitive than total; free androgen index is often used as a substitute.
    • Some other blood tests are suggestive but not diagnostic. The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone) is greater than 1:1, as tested on Day 3 of the menstrual cycle. The pattern is not very specific and was present in less than 50% in one study.[7] There are often low levels of sex hormone binding globulin.
  • Common assessments for associated conditions or risks
    • Fasting biochemical screen and lipid profile
    • 2-hour oral glucose tolerance test (GTT) in patients with risk factors (obesity, family history, history of gestational diabetes) and may indicate impaired glucose tolerance (insulin resistance) in 15-30% of women with PCOS. Frank diabetes can be seen in 65–68% of women with this condition. Insulin resistance can be observed in both normal weight and overweight patients.
  • For exclusion of other disorders that may cause similar symptoms:
    • Prolactin to rule out hyperprolactinemia
    • TSH to rule out hypothyroidism
    • 17-hydroxyprogesterone to rule out 21-hydroxylase deficiency (CAH). Many such women may appear similar to PCOS and be made worse by insulin resistance or obesity, but they can be greatly helped by adrenal suppression with low-dose glucocorticoid therapy.

The role of other tests is more controversial, including: A clinical prediction rule is type of medical research study in which researchers try to identify the best combination of medical sign, symptoms, and other findings in predicting the probability of a specific disease or outcome. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... Gynecologic ultrasonography or Gyn sonography refers to the application of medical ultrasonography to the female pelvic organs, specifically the uterus, the ovaries, the Fallopian tubes, as well as the bladder, the Pouch of Douglas, and any findings in the pelvis of relevance outsite of pregnancy. ... Not to be confused with Mensuration. ... Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Dehydroepiandrosterone (DHEA) is a natural steroid hormone produced from cholesterol by the adrenal glands found atop of the kidneys in the human body. ... Testosterone is a steroid hormone from the androgen group. ... Free Androgen Index or FAI is a ratio used to determine abnormal androgen status in humans. ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ... Follicle stimulating hormone (FSH) is a hormone produced by gonadotropes in the anterior pituitary gland. ... Sex hormone-binding globulin (SHBG) is a glycoprotein that binds to sex hormones, specifically testosterone and estradiol. ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Prolactin (PRL) is a peptide hormone primarily associated with lactation. ... Prolactin is a hormone secreted by lactotropes in the adenohypophysis (anterior pituitary gland) which is made up of 199 amino acids with a molecular weight of about 23,000 daltons. ... Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland which regulates the endocrine function of the thyroid gland. ... This article or section does not cite its references or sources. ... 17-hydroxyprogesterone ( also 17-OH progesterone, or 17OHP))is a C-21 steroid that is derived from progesterone by 17-hydroxylase, a P450c17 enzyme, and is a prohormone for both glucocorticoids and androstenedione, a precursor for sex steroids. ... Congenital adrenal hyperplasia (CAH) refers to any of several autosomal recessive diseases resulting from defects in steps of the synthesis of cortisol from cholesterol by the adrenal glands. ...

  • Fasting insulin level or GTT with insulin levels (also called IGTT). Elevated insulin levels have been helpful to predict response to medication and may indicate women who will need higher dosages of Metformin or the use of a second medication to significantly lower insulin levels. Elevated blood sugar and insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise. Many women with normal levels may benefit from combination therapy. A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. A mathematical derivation known as the HOMAI, calculated from the fasting values in glucose and insulin concentrations, allows a direct and moderately accurate measure of insulin sensitivity.
  • Glucose tolerance testing instead of fasting glucose can increase diagnosis of increased glucose tolerance and frank diabetes among patients with PCOS according to a prospective controlled trial. [8]. While fasting glucose levels may remain within normal limits, oral glucose tests revealed that up to 38% of asymptomatic women with PCOS (versus 8.5% in the general population) actually had increased glucose tolerance, 7.5% of those with frank diabetes according to ADA guidelines. [8]

In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ...

Differential diagnosis

Other causes of irregular or absent menstruation and hirsutism, such as congenital adrenal hyperplasia, Cushing's syndrome, hyperprolactinemia, androgen secreting neoplasms, and other pituitary or adrenal disorders, should be investigated. PCOS has been reported in other insulin resistant situations such as acromegaly. Congenital adrenal hyperplasia (CAH) refers to any of several autosomal recessive diseases resulting from defects in steps of the synthesis of cortisol from cholesterol by the adrenal glands. ... Prolactin is a hormone secreted by lactotropes in the adenohypophysis (anterior pituitary gland) which is made up of 199 amino acids with a molecular weight of about 23,000 daltons. ... Acromegaly (from Greek akros high and megas large - extremities enlargement) is a hormonal disorder that results when the pituitary gland produces excess growth hormone (hGH). ...


Pathogenesis

Polycystic Ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinizing hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus. Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ...


This syndrome acquired its most widely used name because a common sign is multiple (poly) ovarian cysts. These form where egg follicles matured but were never released from the ovary because of abnormal hormone levels. These generally take on a 'string of pearls' appearance. The condition was first described in 1935 by Dr. Stein and Dr. Leventhal, hence its original name of Stein-Leventhal syndrome. A cyst (soft c, rhymes with list) is a cloed sac having a distinct membrane and division on the nearby tissue. ... // For ovary as part of plants see ovary (plants) An ovary is an egg-producing reproductive organ found in female organisms. ... 1935 (MCMXXXV) was a common year starting on Tuesday (link will display full calendar). ...


PCOS is characterized by a complex set of symptoms, and the cause cannot be determined for all patients. However, research to date suggests that insulin resistance could be a leading cause. PCOS may also have a genetic predisposition, and further research into this possibility is taking place. No specific gene has been identified, and it is thought that many genes could contribute to the development of PCOS.


A majority of patients with PCOS have insulin resistance. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that lead to PCOS.


Specifically, hyperinsulinemia increases GnRH pulse frequency, LH over FSH dominance, increased ovarian androgen production, decreased follicular maturation, and decreased SHBG binding; all these steps lead to the development of PCOS. Insulin resistance is a common finding among patients of normal weight as well as those overweight patients. Gonadotropin Releasing Hormone (GnRH) is a peptide hormone responsible for the release of FSH and LH from the anterior pituitary. ... Sex hormone binding globulin (SHBG) is a glycoprotein that binds to sex hormones, specifically testosterone and estradiol. ...


PCOS may be associated with chronic inflammation, with several investigators correlating inflammatory mediators with anovulation and other PCOS symptoms.[9][10]


Treatment

Medical treatment of PCOS is tailored to the patient's goals. Broadly, these may be considered under four categories:

  • Lowering of insulin levels
  • Restoration of fertility
  • Treatment of hirsutism or acne
  • Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer

In each of these areas, there is considerable debate as to the optimal treatment. One of the major reasons for this is the lack of large scale clinical trials comparing different treatments. Smaller trials tend to be less reliable, and hence may produce conflicting results.


General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims, because they address what is believed to be the underlying cause of the syndrome.


Insulin lowering

Dietary therapy

Where PCOS is associated with overweight or obesity, successful weight loss is probably the most effective method of restoring normal ovulation/menstruation, but many women find it very difficult to achieve and sustain significant weight loss. Low-carbohydrate diets and sustained regular exercise may help, and some experts recommend a low Glycemic index diet in which a significant part of the total carbohydrates are obtained from fruit, vegetables and whole grain sources[citation needed]. Low-carbohydrate diets or low-carb diets are nutritional programs that advocate restricted carbohydrate consumption, based on research that ties consumption of certain carbohydrates with increased blood insulin levels, and overexposure to insulin with metabolic syndrome (the most recognized symptom of which is obesity). ... Glycemic index (also glycaemic index, GI) is a ranking system for carbohydrates based on their effect on blood glucose levels. ...


Medications

Many women find insulin-lowering medications such as metformin hydrochloride (Glucophage), pioglitazone hydrochloride (Actos), and rosiglitazone maleate (Avandia) helpful, and ovulation may resume when they use these agents. Many women report that metformin use is associated with upset stomach, diarrhea, and weight-loss. Such side effects usually resolve within 2–3 weeks. Starting with a lower dosage and gradually increasing the dosage over 2–3 weeks and taking the medication toward the end of a meal may reduce side effects. It may take up to six months to see results, but when combined with exercise and a low glycemic index diet up to 85% will improve menstrual cycle regularity and ovulation. Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ... Pioglitazone is a prescription drug of the class thiazolidinedione with hypoglycemic (antihyperglycemic, antidiabetic) action. ... Rosiglitazone is an anti-diabetic drug from the thiazolidinedione class. ... Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ... Glycemic index (also glycaemic index, GI) is a ranking system for carbohydrates based on their effect on blood glucose levels. ...


While insulin sensitizing agents are often used for overweight patients, a cohort study has shown that metformin can also improve insulin resistance in thin PCOS patients without clinically apparent insulin resistance as measured by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). [11]. Treatment of thin PCOS patients with 1500mg Metformin twice daily was shown to reduce HOMA-IR to 1.1 versus 1.7 in control groups. Besides positive effects on insulin resistance, metformin treatment was also shown to improve hirsuitism, acne, and menstrual irregularities in thin PCOS patients. [11]


Treatment of infertility

Not all women with PCOS have difficulty becoming pregnant. For those who do, clomiphene citrate and metformin are the principal treatments used to help infertility. Both have been shown to be effective, but in the largest trial to date clomiphene appeared to be most effective.[12] In this trial, 626 women were randomized to three groups: metformin alone, clomiphene alone, or both. The live birth rates following 6 months of treatment were 7.2% (metformin), 22.5% (clomiphene), and 26.8% (both). The major complication of clomiphene was multiple pregnancy, affecting 0%, 6% and 3.1% of women respectively. The overall success rates for live birth remained disappointing, even in women receiving combined therapy, but it is important to consider that the women in this trial had already been attempting to conceive for an average of 3.5 years, and over half had received previous treatment for infertility. Thus, these were women with significant fertility problems, and the live birth rates are probably not representative of the typical PCOS woman. Categories: Stub | Selective estrogen receptor modulators ... Metformin (INN; trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class of oral hypoglycemic agents. ...


However, many specialists continue to recommend metformin which has, separately, been shown to increase ovulation rates[13] and reduce miscarriage rates.[14]. Metformin may be a rational choice in women in whom significant insulin resistance is diagnosed or suspected, as clomiphene works through a different mechanism and does not affect insulin resistance.


Diet adjustments and weight loss also increase rates of pregnancy. The most drastic increase in ovulation rate occurs with a combination of diet modification, weight loss, and treatment with metformin and clomiphene citrate[15]. It is currently unknown if diet change and weight loss alone have an effect on live birth rates comparable to those reported with clomiphene and metformin.


Though the use of basal body temperature or BBT charts is sometimes advised to predict ovulation, clinical trials have not supported a useful role. This is because it is difficult to predict ovulation from a temperature curve alone, though a chart that tracks other signs, such as cervical position and mucus, is better at ovulation prediction. Further, fertility charts containing basal body temperature and cervical mucus information can be useful in diagnosing anovulation. They can also be used to evaluate the effectiveness of treatments to stimulate ovulation and to time intercourse or insemination appropriately. Basal body temperature is the body temperature measured immediately after awakening and before any physical activity has been undertaken. ...


For patients who do not respond to clomiphene, metformin, other insulin-sensitizing agents, diet and lifestyle modification, there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation and in vitro fertilisation. Ovarian stimulation has an associated risk of ovarian hyperstimulation in women with PCOS — a dangerous condition with morbidity and rare mortality. Thus recent developments have allowed the oocytes present in the multiple follicles to be extracted in natural, unstimulated cycles and then matured in vitro, prior to IVF. This technique is known as IVM (in-vitro-maturation) Assisted reproductive technology (ART) is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. ... For the Inter-Varsity Fellowship, see Universities and Colleges Christian Fellowship. ...


Though surgery is usually the treatment option of last resort, the polycystic ovaries can be treated with surgical procedures such as

  • laparoscopy electrocauterization or laser cauterization
  • ovarian wedge resection (rarely done now because it is more invasive and has a 30% risk of adhesions, sometimes very severe, which can impair fertility) was an older therapy
  • ovarian drilling

Treatment of hirsutism and acne

When appropriate (e.g. in women of child-bearing age who require contraception), a standard contraceptive pill may be effective in reducing hirsutism. The most common choice of contraceptive pill is one that contains cyproterone acetate; in the UK/US the available brand is Dianette®/Diane®. Cyproterone acetate is a progestogen with anti-androgen effects that blocks the action of male hormones that are believed to contribute to acne and the growth of unwanted facial and body hair. Cyproterone acetate (Androcur®, Cyprostat®) is an antiandrogen, i. ... Oral contraceptives come in a variety of formulations. ... Progestagens (also spelled progestogens or gestagens) are hormones similar in effect to progesterone, the only natural progestagen. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ...


Other drugs with anti-androgen effects include flutamide and spironolactone, both of which can give some improvement in hirsutism. Spironolactone is probably the most-commonly used drug in the US. Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes or obesity that should also benefit from metformin. Eflornithine is a drug which is applied to the skin in cream form (Vaniqa), and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face. Flutamide is an oral antiandrogen drug primarily used to treat prostate cancer. ... Spironolactone (marketed under the trade names Aldactone, Novo-Spiroton, Spiractin, Spirotone, or Berlactone) is a diuretic and is used as an antiandrogen. ... Eflornithine (α-difluoromethylornithine or DFMO) is a drug manufactured by Aventis which has various uses. ...


Although all of these agents have shown some efficacy in clinical trials, the average reduction in hair growth is generally in the region of 25%, which may not be enough to eliminate the social embarrassment of hirsutism, or the inconvenience of plucking/shaving. Individuals may vary in their response to different therapies, and it is usually worth trying other drug treatments if one does not work, but drug treatments do not work well for all individuals. Alternatives include electrolysis and various forms of laser therapy.


Treatment of menstrual irregularity, prevention of endometrial hyperplasia

If fertility is not the primary aim, then menstruation can usually be regularised with a contraceptive pill. The purpose of regularising menstruation is essentially for the woman's convenience, and perhaps her sense of wellbeing; there is no medical requirement for regular periods, so long as they occur sufficiently often (see below). Most brands of contraceptive pill result in a withdrawal bleed every 28 days. Dianette (a contraceptive pill containing cyproterone acetate) is also beneficial for hirsutism, and is therefore often prescribed in PCOS. Cyproterone acetate (Androcur®, Cyprostat®) is an antiandrogen, i. ...


If a regular menstrual cycle is not desired, then therapy for an irregular cycle is not necessarily required - most experts consider that if a menstrual bleed occurs at least every three months, then the endometrium (womb lining) is being shed sufficiently often to prevent an increased risk of endometrial abnormalities or cancer. If menstruation occurs less often or not at all, some form of progestogen replacement is recommended. Some women prefer a uterine progestogen implant such as the Mirena® coil, which provides simultaneous contraception and endometrial protection for years, though often with unpredictable minor bleeding. An alternative is oral progestogen taken at intervals (e.g. every three months) to induce a predictable menstrual bleed. The IntraUterine System or IUS is an IntraUterine Device (IUD or coil) that has a coating of levonorgestrel (a progesterone) on its shaft, rather than the traditional copper wire. ...


Alternative approaches

D-chiro-inositol (DCI) offers a well-tolerated and effective alternative treatment for PCOS. It has been evaluated in two peer-reviewed, double-blind studies and found to help both lean and obese women with PCOS; diminishing many of the primary clinical presentations of PCOS.[16] [17] It has no documented side-effects and is a naturally occurring human metabolite known to be involved in insulin metabolism.[18] Contrary to common — but false — claims, DCI is not a drug but rather a nutrient (as defined by the DSHEA) and is commercially available as a nutritional supplement in the USA. D-chiro-inositol (commonly abbreviated DCI) is a member of a family of related substances often referred to collectively as inositol, although that term encompasses several isomers of questionable biological relevance. ... In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994 as a product taken by the mouth that contains a dietary ingredient that is intended as a supplement to the diet. ...


Ian Stoakes, a UK-based scientist has recently claimed some success in treating PCOS through tailored diets, believing that there is a strong link between PCOS, diabetes (and associated diseases) and inflammation caused by the failure of the blood to absorb specific foods.[citation needed] Blood samples are tested to see how they react to different food types to provide the patient with a list of foods she can eat and foods to avoid. Weight loss, alleviation of symptoms and successful pregnancies are claimed for this approach.[citation needed] It remains a totally unproven approach with no research papers listed in PubMed by Stoakes concerning PCOS. Medline is a comprehensive literature database of life sciences and biomedical information. ...


References

  1. ^ [|Gallagher, Kathe] (January 16), Polycystic Ovary Syndrome (PCOS), <http://www.revolutionhealth.com/conditions/reproductive-health/infertility/female-causes/pcos>. Retrieved on 11 July 2007 
  2. ^ a b Goldenberg N, Glueck C (2008). "Medical therapy in women with polycystic ovarian syndrome before and during pregnancy and lactation". Minerva Ginecol 60 (1): 63-75. PMID 18277353. 
  3. ^ a b Boomsma CM, Fauser BC, Macklon NS (2008). "Pregnancy complications in women with polycystic ovary syndrome". Semin. Reprod. Med. 26 (1): 72-84. doi:10.1055/s-2007-992927. PMID 18181085. 
  4. ^ Christine Cortet-Rudelli, Didier Dewailly (Sep 21 2006). Diagnosis of Hyperandrogenism in Female Adolescents. Hyperandrogenism in Adolescent Girls. Armenian Health Network, Health.am. Retrieved on 2006-11-21.
  5. ^ Navaratnarajah R, Pillay OC, Hardiman P (2008). "Polycystic ovary syndrome and endometrial cancer". Semin. Reprod. Med. 26 (1): 62–71. doi:10.1055/s-2007-992926. PMID 18181084. 
  6. ^ Pedersen SD, Brar S, Faris P, Corenblum B (2007). "Polycystic ovary syndrome: validated questionnaire for use in diagnosis". Canadian family physician Médecin de famille canadien 53 (6): 1042–7, 1041. PMID 17872783.  - see Table 5 Clinical tool for diagnosis of polycystic ovary syndrome
  7. ^ Banaszewska B, Spaczyński RZ, Pelesz M, Pawelczyk L (2003). "Incidence of elevated LH/FSH ratio in polycystic ovary syndrome women with normo- and hyperinsulinemia". Rocz. Akad. Med. Bialymst. 48: 131-4. PMID 14737959. 
  8. ^ a b Legro RS, Kunselman AR, Dodson WC, Dunaif A (1999). "Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women". J. Clin. Endocrinol. Metab. 84 (1): 165-9. doi:10.1210/jc.84.1.165. PMID 9920077. 
  9. ^ Fukuoka M, Yasuda K, Fujiwara H, Kanzaki H, Mori T (1992). "Interactions between interferon gamma, tumour necrosis factor alpha, and interleukin-1 in modulating progesterone and oestradiol production by human luteinized granulosa cells in culture.". Hum Reprod 7 (10): 1361-4. PMID 1291559. 
  10. ^ González F, Rote N, Minium J, Kirwan J (2006). "Reactive oxygen species-induced oxidative stress in the development of insulin resistance and hyperandrogenism in polycystic ovary syndrome.". J Clin Endocrinol Metab 91 (1): 336-40. doi:10.1210/jc.2005-1696. PMID 16249279. 
  11. ^ a b Tan S, Hahn S, Benson S, et al (2007). "Metformin improves polycystic ovary syndrome symptoms irrespective of pre-treatment insulin resistance". Eur. J. Endocrinol. 157 (5): 669-76. doi:10.1530/EJE-07-0294. PMID 17984248. 
  12. ^ Legro RS, Barnhart HX, Schlaff WD (2007). "Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome". N Engl J Med 356 (6): 551-566. doi:10.1056/NEJMoa063971. PMID 17287476. 
  13. ^ Efficacy of metformin for ovulation induction in polycystic ovary syndrome. Endocrine Abstracts. Retrieved on 2007-07-17.
  14. ^ Diabetes Drug Helps Prevent Miscarriage. WebMD. Retrieved on 2007-07-17.
  15. ^ Do insulin-sensitizing drugs increase ovulation rates for women with PCOS?. Find Articles. Retrieved on 2007-07-17.
  16. ^ Nestler J E, Jakubowicz D J, Reamer P, Gunn R D, Allan G (1999). "Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome". N Engl J Med 340 (17): 1314–1320. doi:10.1056/NEJM199904293401703. PMID 10219066. 
  17. ^ Iuorno M J, Jakubowicz D J, Baillargeon J P, Dillon P, Gunn R D, Allan G, Nestler J E (2002). "Effects of d-chiro-inositol in lean women with the polycystic ovary syndrome". Endocr Pract 8 (6): 417–423. PMID 15251831. 
  18. ^ Larner J (2002). "D-chiro-inositol--its functional role in insulin action and its deficit in insulin resistance". Int J Exp Diabetes Res 3 (1): 47–60. doi:10.1080/15604280212528. PMID 11900279. 

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Endocrinology is a branch of medicine dealing with disorders of the endocrine system and its specific secretions called hormones. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... Among the hundreds of endocrine diseases (or endocrinological diseases) are: Adrenal disorders: Adrenal insufficiency Addisons disease Congenital adrenal hyperplasia (adrenogenital syndrome) Mineralocorticoid deficiency Conns syndrome Cushings syndrome Pheochromocytoma Adrenocortical carcinoma Glucose homeostasis disorders: Diabetes mellitus Hypoglycemia Idiopathic hypoglycemia Insulinoma Metabolic bone disease: Osteoporosis Osteitis deformans (Pagets... This article or section does not cite its references or sources. ... This article does not cite any references or sources. ... This article is about the medical term. ... Congenital hypothyroidism (CHT) is a condition of thyroid hormone deficiency present at birth. ... A goitre (BrE), or goiter (AmE) (Latin struma), also called a bronchocele, is a swelling in the neck (just below Adams apple or larynx) due to an enlarged thyroid gland. ... Myxedema (English: myxoedema) is a skin and tissue disorder usually due to severe prolonged hypothyroidism. ... Hyperthyroidism (or overactive thyroid gland) is the clinical syndrome caused by an excess of circulating free thyroxine (T4) or free triiodothyronine (T3), or both. ... Graves disease is a thyroid disorder characterized by goiter, exophthalmos, orange-peel skin, and hyperthyroidism. ... Toxic multinodular goitre (also known as toxic nodular goitre, toxic nodular struma) is a form of hyperthyroidism - where there is excess production of thyroid hormones. ... Look up teratoma in Wiktionary, the free dictionary. ... A teratoma is a type of tumor that derives from pluripotent germ cells. ... de Quervains thyroiditis, is also known as subacute granulomatous thyroiditis or subacute thyroiditis; usually occurs in women between 30 and 50 years of age. ... Hashimotos thyroiditis or chronic lymphocytic thyroiditis is an autoimmune disease where the bodys own antibodies attack the cells of the thyroid. ... Riedels thyroiditis, also called Riedels struma is a chronic form of thyroiditis. ... Euthyroid sick syndrome is a thyroid hormone disorder where the levels of T3 and/or T4 are at unusual levels, but the thyroid gland does not appear to be dysfunctional. ... The pancreas is a gland organ in the digestive and endocrine systems of vertebrates. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, T1DM, IDDM, juvenile diabetes) is a form of diabetes mellitus. ... Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ... Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of three acute complications of diabetes: Severe diabetic hypoglycemia Advanced diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic... Angiopathy is a disease of the blood vessels (arteries, veins, and capillaries) that occurs when someone has diabetes for a long time. ... Diabetic ketoacidosis(DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... Hyperinsulism or hyperinsulinemia is a condition in which the bodys cells do not respond properly to insulin, the hormone that functions to control blood sugar levels. ... Zollinger-Ellison syndrome is a disorder where increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid. ... The four human parathyroid glands are adjacent to the thyroid. ... In medicine (endocrinology), hypoparathyroidism is decreased function of the parathyroid glands, leading to decreased levels of parathyroid hormone (PTH). ... Pseudohypoparathyroidism is a condition that mimics hypoparathyroidism, but is due to a resistance to parathyroid hormone, rather than a lack of the hormone (akin to the distinction between Type 1 diabetes and Type 2 diabetes. ... Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH). ... Primary hyperparathyroidism causes hypercalcemia (elevated blood calcium levels) through the excessive secretion of parathyroid hormone (PTH), usually by an adenoma (benign tumors) of the parathyroid glands. ... Secondary hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels) and associated hypertrophy of the glands. ... Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone (PTH) after a long period of secondary hyperparathyroidism and resulting in hypercalcemia. ... | Latin = hypophysis, glandula pituitaria | GraySubject = 275 | GrayPage = 1275 | Image = Gray1180. ... Hyperpituitarism is the result of an overactive pituitary gland producing too much of the bodies natural growth hormones. ... Acromegaly (from Greek akros high and megas large - extremities enlargement) is a hormonal disorder that results when the pituitary gland produces excess growth hormone (hGH). ... Prolactin is a hormone secreted by lactotropes in the adenohypophysis (anterior pituitary gland) which is made up of 199 amino acids with a molecular weight of about 23,000 daltons. ... The syndrome of inappropriate antidiuretic hormone (SIADH) is a condition commonly found in the hospital population, especially in patients being hospitalized for central nervous system (CNS) injury. ... Hypopituitarism is a medical term describing deficiency (hypo) of one or more hormones of the pituitary gland. ... Simmonds disease (also Simmonds syndrome) refers to panhypopituitarism caused by the destruction of the pituitary gland due to infiltrative processes (e. ... Sheehan syndrome, also known as postpartum hypopituitarism or postpartum pituitary necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by necrosis due to blood loss and hypovolemic shock during and after childbirth. ... Kallmann syndrome is an example of hypogonadism (decreased functioning of the sex hormone-producing glands) caused by a deficiency of gonadotropin-releasing hormone (GnRH), which is created by the hypothalamus. ... Growth Hormone Deficiency is the medical condition of inadequate production of growth hormone (GH) and its effects on children and adults. ... Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced. ... Adiposogenital dystrophy is a medical condition. ... Empty sella syndrome (abbreviated ESS) is a disorder that involves the sella turcica, a bony structure at the base of the brain that surrounds and protects the pituitary gland. ... In mammals, the adrenal glands (also known as suprarenal glands) are the triangle-shaped endocrine glands that sit on top of the kidneys; their name indicates that position (ad-, near or at + -renes, kidneys). They are chiefly responsible for regulating the stress response through the synthesis of corticosteroids and catecholamines... Wikipedia does not have an article with this exact name. ... Pseudo-Cushings syndrome is a medical condition in which patients display the signs, symptoms, and abnormal hormone levels seen in Cushings syndrome. ... Congenital adrenal hyperplasia (CAH) refers to any of several autosomal recessive diseases resulting from defects in steps of the synthesis of cortisol from cholesterol by the adrenal glands. ... Lipoid congenital adrenal hyperplasia refers to an uncommon form of CAH resulting from defects in the earliest stages of adrenal cortisol synthesis: the transport of cholesterol into the mitochondria of the cells of the adrenal cortex and the conversion to pregnenolone. ... 3β-Hydroxysteroid dehydrogenase II deficient congenital adrenal hyperplasia (3βHSD CAH) is an uncommon form of CAH resulting from a defective gene for one of the key enzymes in cortisol synthesis by the adrenal glands. ... 11β-Hydroxylase deficient congenital adrenal hyperplasia (11β-OH CAH) is an uncommon form of congenital adrenal hyperplasia resulting from a defect in the gene for the enzyme which mediates the final step of cortisol synthesis in the adrenal. ... Congenital adrenal hyperplasia due to 17α-hydroxylase deficiency is an uncommon form of congenital adrenal hyperplasia resulting from a defect in the gene for the enzyme CYP17A1, which mediates several key transformations in the synthesis of both cortisol and sex steroids. ... Congenital adrenal hyperplasia due to 21-hydroxylase deficiency, in all its forms, accounts for about 95% of diagnosed cases of congenital adrenal hyperplasia, and CAH in most contexts refers to 21-hydroxylase deficiency. ... Conns syndrome is overproduction of the mineralocorticoid hormone aldosterone by the adrenal glands. ... Bartter syndrome is a rare genetic disease characterized by low potassium levels (hypokalemia), decreased acidity of blood (alkalosis), and normal to low blood pressure. ... In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ... Addisons disease(also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces insufficient amounts of steroid hormones (glucocorticoids and often mineralocorticoids). ... In medicine (endocrinology), hypoaldosteronism refers to decreased levels of the hormone aldosterone. ... The gonad is the organ that makes gametes. ... Premature Ovarian Failure (POF) is the cessation of menstrual periods and ovulation in women under the age of 40. ... It has been suggested that this article or section be merged with Guevedoche. ... 17-beta-hydroxysteroid dehydrogenase deficiency is a rare disorder of sexual development which can produce impaired virilization (traditionally termed male pseudohermaphroditism) of genetically male infants and children and excessive virilization of female adults. ... Hypogonadism is a medical term for a defect of the reproductive system which results in lack of function of the gonads (ovaries or testes). ... Puberty is described as delayed when a boy or girl has passed the usual age of onset of puberty with no physical or hormonal signs that it is beginning. ... Precocious puberty means early puberty. ... Androgen insensitivity syndrome (AIS, or Androgen resistance syndrome) is a set of disorders of sexual differentiation that results from mutations of the gene encoding the androgen receptor. ... In medicine, autoimmune polyendocrine syndromes are a heterogenous group of rare diseases characterised by autoimmune activity against more than one endocrine organs, although non-endocrine organs can be affected. ... Carcinoid syndrome refers to the array of symptoms that occur secondary to carcinoid tumors. ... Anna Haining Bates with her parents Greek gigas, gigantus (giant) is a condition characterized by excessive height growth and bigness. ... People who are shorter have short stature. ... Laron syndrome is a disorder characterized by an insensitivity to growth hormone, caused by a variant of the growth hormone receptor. ... Psychogenic dwarfism, Psychosocial dwarfism or Stress dwarfism is a growth disorder that is observed between the ages of 2 and 15, caused by extreme emotional deprivation or stress. ... Multiple endocrine neoplasia (MEN) (or multiple endocrine adenomas, or multiple endocrine adenomatosis -- MEA) consists of three syndromes featuring tumors of endocrine glands, each with its own characteristic pattern. ... Multiple endocrine neoplasia type 1 is part of a group of disorders that affect the endocrine system. ... Multiple endocrine neoplasia type 2 is part of a group of disorders that affect the endocrine system. ... Progeria (Greek, old age) refers specifically to Hutchinson-Gilford Progeria syndrome. ...

  Results from FactBites:
 
Polycystic ovary syndrome (PCOS) (2893 words)
Polycystic (literally, many cysts) ovary syndrome (PCOS or PCO) is a complex condition that affects the ovaries (the organs in a woman's body that produce eggs).
In PCOS, the ovaries are bigger than average, and the outer surface of the ovary has an abnormally large number of small follicles (the sac of fluid that grows around the egg under the influence of stimulating hormones from the brain).
The ovaries are polycystic, with many small follicles scattered under the surface of the ovary (usually more than 10 or 15 in each ovary) and almost none in the middle of the ovary.
  More results at FactBites »

 
 

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