Relevance of polycystic ovarian morphology in the clinical evaluation of PCOS

项目摘要。多囊卵巢综合征（PCOS）是一种复杂的内分泌疾病， 和合并症对妇女一生的健康和福祉具有深远的影响。 虽然这种疾病的名称意味着一个特定的卵巢形态异常， 围绕多囊卵巢（PCO）的诊断和PCOS的临床谱的相关性。证据 在健康女性中，PCO的发生率使人们对PCO对PCOS的特异性及其存在产生了怀疑。 在高雄激素（PCOS）和正常雄激素无排卵（NA-Anov）的妇女中， 告知疾病进展和/或对治疗的反应的效用。根据这些发现，我们最近 提出新的阈值，以重新定义PCO。这些新的标准代表了在定义上的重大变化， PCO是由于新技术的分辨率提高。虽然这些标准预计将减少 在健康女性中的假阳性诊断，他们仍然是有限的。他们没有考虑已知的因素， 怀疑影响卵巢形态-也没有提供任何深入了解的病因或程度， PCOS中卵泡发生紊乱。本项目旨在通过使用状态- 最先进的超声成像技术和标准化的方法来对比卵巢形态， 多囊卵巢综合征和NA-Anov综合征的女性我们认为，界定肺尘埃沉病的基础是 超声应该反映在这些条件下窦卵泡发育的理解。中央 提出的假设是超声检查卵巢形态学捕获了窦卵泡的独特破坏 这一发现可以为无排卵障碍女性的临床和功能结局提供信息。的 该项目的目标是开发PCO的标准，其：1）与NA-Anov相比保持对PCOS的特异性， 2)说明肥胖对卵巢形态的任何混杂影响，3）告知受损的程度， 卵泡发生和4）可靠地预测排卵反应体重减轻。任何替代标记的效用 将确定PCO（即抗苗勒管激素）是否匹配或超过超声性能。通过 为PCO提供反映功能结局的定义，本研究将扩大 超声检查在多囊卵巢综合征的临床评价，并迎来了新的方法为定制的干预措施， 解释了无排卵条件下卵泡发生紊乱的范围。这些努力旨在澄清 PCO形态学的相关性与最近NIH确定的优先研究领域一致 PCOS循证方法研讨会。

PROJECT SUMMARY. Polycystic ovary syndrome (PCOS) is a complex endocrine disorder whose symptoms and co-morbidities have far-reaching implications for the health and well-being of women across the lifespan. While the name of this condition implies a specific abnormality in ovarian morphology, substantial controversy surrounds the relevance of polycystic ovaries (PCO) to the diagnosis and clinical spectrum of PCOS. Evidence of PCO in healthy women has cast doubt upon the specificity of PCO to the condition of PCOS, and its presence in both women with hyperandrogenic (PCOS) and normoandrogenic anovulation (NA-Anov) has challenged its utility to inform progression of the disease and/or response to treatment. In line with these findings, we recently proposed new thresholds to redefine PCO. These new criteria represented a major change in the definition of PCO owing to the improved resolution of new technology. While these criteria are expected to reduce the number of false positive diagnoses in healthy women, they are still limited. They do not account for factors known or suspected to influence ovarian morphology – nor do they provide any insight into the etiology or degree of disordered folliculogenesis in PCOS. This project aims to refine the sonographic definition of PCO by using state- of-the-art ultrasound imaging technology and standardized approaches to contrast ovarian morphology across a broad spectrum of women with PCOS and NA-Anov. We believe that the basis for defining PCO on ultrasonography should reflect an understanding of antral follicle development in these conditions. The central hypothesis proposed is that ovarian morphology on ultrasonography captures unique disruptions in antral follicle development that can inform both clinical and functional outcomes in women with anovulatory disorders. The goals of this project are to develop criteria for PCO that: 1) maintain specificity for PCOS compared to NA-Anov, 2) account for any confounding effect of adiposity on ovarian morphology, 3) inform on the degree of impaired folliculogenesis and 4) reliably predict the ovulatory response to weight loss. Any utility of surrogate markers of PCO (i.e. anti-Müllerian hormone) to match or exceed the performance of ultrasound will be determined. By providing definitions for PCO that reflect functional outcomes, this research will expand the role of ultrasonography in the clinical evaluation of PCOS and usher new approaches for tailored interventions that account for the spectrum of disordered folliculogenesis across anovulatory conditions. These efforts to clarify the relevance of PCO morphology are consistent with prioritized areas of research identified by the recent NIH Evidence-Based Methodology Workshop on PCOS.