Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects millions of women worldwide. 

Approximately 50 to 60% of individuals with polycystic ovary syndrome (PCOS) are classified as having androgen excess of adrenal origin.

While it is commonly associated with reproductive issues and hormonal imbalances originating from the ovaries, there is a lesser-known variant of PCOS known as adrenal PCOS.

Adrenal PCOS is a case where hormonal disturbances arise from the Adrenal glands. 

This condition poses unique challenges in diagnosis and treatment, requiring a deeper understanding of the interplay between adrenal hormones and PCOS symptoms.

Understanding Adrenal PCOS

Adrenal PCOS, or non-classical or late-onset PCOS, is a subtype of Polycystic Ovary Syndrome (PCOS).

Unlike classical PCOS, primarily associated with ovarian dysfunction, Adrenal PCOS involves abnormalities in the Adrenal glands’ hormone production.

In this condition, the Adrenal glands produce excessive amounts of Androgens, such as Testosterone and DHEA-S (Dehydroepiandrosterone sulfate).

This excessive production of Androgens leads to the characteristic symptoms of PCOS.

The ovaries are not the main source of excess Androgen (male hormones), but the Adrenal glands become the primary source of Androgen production in Adrenal PCOS.

How Adrenal causes PCOS

Here’s how the Adrenal glands can cause or contribute to PCOS:

Androgen overproduction

Adrenal PCOS is characterized by the excessive production of Androgens by the Adrenal glands. 

Androgens are typically produced in small amounts in women, but in PCOS, the Adrenal glands may produce excessive Androgens, leading to hormonal imbalances.

Dysregulation of the HPA axis

The Hypothalamus-Pituitary-Adrenal (HPA) axis regulates the production of Cortisol and Androgens in the Adrenal glands. 

Disruptions or dysregulation of the HPA axis can result in increased production of Androgens, contributing to PCOS symptoms.

Insulin resistance

While insulin resistance is often associated with PCOS, it is primarily linked to ovarian Androgen production in classical PCOS.

However, in some cases of Adrenal PCOS, insulin resistance may also play a role in stimulating the Adrenal glands to produce excessive Androgens. 

Insulin resistance can disrupt hormonal balance and contribute to developing PCOS symptoms.

Inflammation

Chronic inflammation can affect Adrenal function and contribute to the overproduction of Androgens. 

Inflammatory processes in the body can disrupt the normal regulation of hormones, including those produced by the Adrenal glands.

Symptoms of Adrenal PCOS

The symptoms of Adrenal PCOS are similar to those of classical PCOS, but there are some distinctions. 

Women with Adrenal PCOS may experience irregular or absent periods, acne, Hirsutism (excessive hair growth), male-pattern baldness, and infertility. 

However, they may have less pronounced ovarian cysts or show normal or near-normal levels of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) on blood tests, differentiating it from classical PCOS.

Fact:
The production of luteinizing hormone (LH) occurs within the pituitary gland. It regulates the menstrual cycle in females and testosterone production in males.

Diagnosis of Adrenal PCOS

The diagnosis of Adrenal PCOS is typically made through clinical evaluation, hormonal testing, imaging studies, and the exclusion of other conditions. 

Here is a general overview of how Adrenal PCOS may be diagnosed:

Medical history and physical examination

The healthcare provider will review the patient’s medical history.

They will review the symptoms related to PCOS, such as irregular menstruation, signs of hyperandrogenism (excessive male hormone levels), and any previous diagnoses or treatments. 

A physical examination may be conducted to assess for signs of PCOS, such as hirsutism (excessive hair growth), acne, and abdominal or pelvic abnormalities.

Warning:
Pelvic abnormalities such as the formation of uterine fibroids and noncancerous growths in the uterus can cause symptoms like heavy or painful periods, pelvic pain, and reproductive issues. Hence, you must contact a healthcare provider if you experience pelvic pain. 

Hormonal testing

Blood tests will be performed to measure hormone levels, including those related to adrenal function and PCOS. 

These may include:

  • Androgens: Testosterone, DHEA (Dehydroepiandrosterone), DHEAS (Dehydroepiandrosterone sulfate), Androstenedione
  • Gonadotropins: Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
  • Insulin and glucose: To assess for insulin resistance and diabetes risk
  • Other hormones: Thyroid-stimulating hormone (TSH), prolactin, and others to rule out other hormonal disorders

Imaging studies

Computed tomography
Computed tomography (MRI)

In some cases, imaging studies may be conducted to evaluate the Adrenal glands and ovaries. 

This may include pelvic ultrasound to assess ovarian morphology and rule out other conditions.

Adrenal imaging (such as computed tomography or magnetic resonance imaging) is done to assess the size and structure of the Adrenal glands.

Treatment of Adrenal PCOS

Treating Adrenal PCOS involves a comprehensive approach. 

It focuses on balancing Cortisol levels, reducing DHEA-S levels, and promoting healthy hormone levels and regular menstrual cycles. 

Here are some interventions that may be recommended for the treatment of adrenal PCOS:

Prioritize sleep quantity and quality

Drinking coffee
Avoid coffee

Adequate sleep is crucial for adrenal PCOS management. 

  • Sleep for seven to eight hours each night
  • Establish a regular bedtime routine
  • Avoid sleep disruptors like alcohol and caffeine close to bedtime
  • Consider using magnesium glycinate supplements to support restful sleep

Stress management

Chronic stress can negatively impact Adrenal PCOS by increasing Cortisol and DHEA-S (Dehydroepiandrosterone sulfate) levels. 

Engage in stress-reducing activities like yoga, meditation, spending time in nature, therapy, journaling, and other relaxation techniques. 

Incorporate at least one stress-reducing activity into your daily routine.

Resveratrol

Resveratrol, found in foods like red wine, grapes, berries, and certain nuts, has shown potential in reducing DHEA-S levels in women with PCOS. 

Consider taking Resveratrol supplements as part of your treatment plan, as it may help lower DHEA-S, total Testosterone, and fasting insulin levels and reduce inflammation.

Anti-inflammatory diet

Follow an anti-inflammatory diet that includes a variety of colorful fruits, vegetables, nuts, seeds, lean proteins, and whole grains. 

Focus on balancing blood sugar levels by incorporating protein, healthy fats, and complex carbohydrates into each meal and snack. 

Increasing fiber intake can also help prevent dramatic blood sugar fluctuations.

Recommended Article:
To know more about the treatment methods of PCOS in general, read Empowering Women with Comprehensive PCOS Treatment Strategies.

Conclusion

In conclusion, Adrenal PCOS represents a distinct subset of Polycystic Ovary Syndrome, where Androgen excess originates primarily from the Adrenal glands.

While it shares many symptoms with classical PCOS, adrenal PCOS requires a tailored diagnostic approach to accurately identify the underlying hormonal imbalances. 

Addressing the root causes and managing symptoms through medications and stress reduction techniques is important. 

Women with Adrenal PCOS can improve their overall well-being and regain hormonal balance.

If you suspect you have Adrenal PCOS, contact a healthcare professional for a comprehensive evaluation and appropriate treatment guidance.

Frequently Asked Questions

Can Adrenal PCOS affect fertility?

Yes, adrenal PCOS can affect fertility, as hormonal imbalances can interfere with regular ovulation and menstrual cycles. However, with appropriate management and treatment, many individuals with Adrenal PCOS can still conceive and have successful pregnancies.

Are there any specific dietary recommendations for adrenal PCOS?

While no specific dietary guidelines are exclusively for adrenal PCOS, adopting a balanced and nutritious diet can be beneficial. A diet of whole foods, fruits, vegetables, lean proteins, and whole grains can regulate hormones and overall health. 

Can Adrenal PCOS increase the risk of other health conditions?

Adrenal PCOS, like other subtypes of PCOS, is linked with certain health conditions. These include insulin resistance, type 2 diabetes, high blood pressure, and cardiovascular disease. 

Does stress cause adrenal PCOS?

No, adrenal PCOS is not directly caused by stress. While stress can exacerbate symptoms and impact hormonal balance, it is not considered the underlying cause of adrenal PCOS. 

Citations:
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