19.8: Case Study Conclusion - Hormonal Havoc

Case Study Conclusion: Hormonal Havoc

Gabrielle, whom you read about at the beginning of this chapter, has polycystic ovary syndrome (PCOS). PCOS is named for the multiple fluid-filled sacs, or cysts, that are present in the ovaries of women with this syndrome. You can see these cysts in the illustration above, which compares a normal ovary with a polycystic ovary. The cysts result from follicles in the ovary that did not properly produce and release an egg. Mature eggs are normally released from follicles monthly during the process of ovulation, but in PCOS, this often does not occur. Ovarian cysts can be common and do not necessarily mean that a woman has PCOS, but the presence of multiple ovarian cysts plus other telltale signs and symptoms may cause her physician to suspect PCOS.

Figure \(\PageIndex{1}\): Polycystic Ovary.  Polycystic Ovary, HHS CC0

Gabrielle’s symptoms of PCOS included irregular menstrual periods, weight gain, acne, and excess facial hair. There are many other symptoms of PCOS that women can experience, such as male-pattern baldness, pelvic pain, and depression, among others. As you may recall, Gabrielle also had abnormal blood test results, including elevated androgen levels and elevated blood glucose. These can also be indications of PCOS.

As you have learned, androgens are a term for male sex hormones, but females also normally produce androgens, albeit to a lesser extent than males. In women with PCOS, the level of androgens is abnormally high. These androgens include testosterone, produced by the ovaries, and DHEA, produced by the adrenal glands. This increase in androgens can have a “masculinizing” effect on women, including an increase in facial and body hair, male-pattern baldness, and interference with the menstrual cycle by preventing ovulation. Androgens can also cause weight gain and acne, two of the other common symptoms of PCOS.

In addition to hypersecretion of androgens, PCOS often causes high blood glucose as a result of insulin resistance. As you have learned, insulin is a hormone secreted by the pancreas that works in conjunction with other pancreatic hormones (such as glucagon) to regulate the level of blood glucose. What is another disease involving insulin resistance? If you answered type 2 diabetes, you are correct! In fact, women with PCOS are at a high risk of developing type 2 diabetes because of their resistance to insulin. More than 50 percent of women with PCOS will develop diabetes or pre-diabetes before they are 40 years old.

Besides diabetes, women with PCOS have a higher chance of developing fertility problems, heart disease, sleep apnea (briefly stopping breathing during sleep), and uterine cancer, among other diseases and disorders. There is hope, however. Lifestyle modifications and medicines not only can help women cope with the symptoms of PCOS, but may also reduce the risk of some of the possible long-term consequences by lowering blood sugar and androgen levels.

For instance, eating a healthy diet and exercising regularly can help women with PCOS lose weight. This can help lower blood glucose levels, improve insulin functioning, and even make the menstrual cycle more regular. Medications such as birth control pills and anti-androgens can help restore a more regular menstrual cycle and reduce facial and body hair and acne. The diabetes medication metformin can be used to treat several of the symptoms of PCOS, and may even prevent type 2 diabetes by improving insulin functioning and lowering testosterone. Finally, women with PCOS who are trying to conceive may be helped with fertility medications that stimulate ovulation.

The underlying cause of PCOS is not definitively known, although it is thought that both genetic and environmental factors play a role. PCOS tends to run in families, and women with a sister with PCOS are twice as likely to also have it. Researchers think that insulin resistance in PCOS may lead to increased androgen levels, illustrating how hormonal systems can influence one another.

As you have seen throughout this chapter, endocrine hormones can have a wide variety of effects on the body, including regulating metabolism, reproductive functions, and the homeostasis of ions and molecules, and mediating responses to stressful situations. Different hormones have different effects, but even a single hormone can have multiple effects. Hormones travel through the bloodstream and affect cells that have the appropriate receptors, known as target cells.

Many hormones target cells in multiple organs and tissues, or regulate molecules, such as blood glucose, that affect many organ systems. These are some of the reasons why changes in the normal level of an endocrine hormone — either hypersecretion or hyposecretion — can result in a wide range of symptoms, including those seen in Cushing’s syndrome, diabetes, and PCOS. By understanding what goes wrong in these disorders, you can better appreciate how important the endocrine system is for regulating the many diverse functions of the human body.