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December 25, 2001

Research: Causes and Prevention

Question from Roseville, California, USA:

I am 45 years old, and as a teenager was diagnosed with Stein-Leventhal syndrome (PCOS). I had a surgical wedge resection and peeling of my ovaries, which seemed to remedy my condition. I subsequently had two easy pregnancies and believe that the surgery "cured" me. An ovarian ultrasound two years ago showed no ovarian cysts. Am I still vulnerable to developing type 2 diabetes, or has my hormonal predisposition been alleviated by my surgery?

Answer:

A recent large, long term, Swedish follow up study of women with Polycystic Ovary Syndrome did show that after surgery they continued to be at some increased risk for the development of type 2 diabetes, especially if they were overweight.

DOB
Additional comments from Dr. Bill Jones:

The only patients I see with PCOS are already pregnant, and once they deliver I do not follow them long-term. Nevertheless, I will offer some comments. In Adolescent Medicine: State of the Art Reviews, June 1999, there is a discussion of PCOS. From the authors’ review of the literature among adolescents with PCOS there is a prevalence of insulin resistance of 11-38%. In long term follow-up, the prevalence of type 2 diabetes is seven times greater than in the control population. These numbers are high, but obviously not everyone with PCOS develops type 2 diabetes. The exact etiology of PCOS is not known. Whether it is primarily an ovarian problem or a hypothalamic problem is still subject to discussion. In terms of insulin resistance, there appears to be a defect in the insulin receptor site that once again may not be directly related to ovarian function. Another point is that wedge resection of the ovary used to be done to improve fertility. The idea being that this procedure improved follicle development and release of eggs. This procedure is rarely performed these days, unless all the medical options have failed. In other words, wedge resection is not a very effective treatment and certainly does not address the underlying hormonal disorders. From this, I would conclude that in a woman with PCOS any ovarian procedures may not necessarily cure the problem or reduce any long-term risks.

Based on the above information, the fact that this woman had two pregnancies and has had not other signs or symptoms (hirsutism, hyperglycemia, irregular menses), I offer two possible explanations. Either she does not even have PCOS or if she does, it is mild, and she is in the population that does not develop insulin resistance. If she has PCOS, I cannot say exactly what her long term risk of type 2 diabetes may be. She may develop type 2 diabetes due to some other unrelated condition.

OWJ