General and cosmetic features

· Young woman

· Central obesity

· BMI > 30 kg

· Central obesity/cm²

· Waistline > 88 cm

· Acanthosis nigra due to insulin resistance (Thick pigmented skin over the nape of the neck, inner thigh, and axilla)

Reproductive features

· Ovulatory and menstrual dysfunction (Oligomenorrhoea, amenorrhoea)

· Infertility (20%)

· Signs of hyperandrogenism, Hirsutism, acne

· Complications in pregnancy (Miscarriage, gestational diabetes, pregnancy-induced hypertensive disorders) and neonatal complications and increased endometrial hyperplasia.

Hormonal picture(5)

· Increased E2 level

· Decreased FSH increased LH > 10 IU/mL

· Decreased FSH/LH ratio

· Increased Androgens (Most androgens from the ovary)

· Testosterone, epiandro-stenedione, dehydroepiandrosterone increased

· 17-a-hydroxyprogesterone > 300 ng/dL

· Testosterone > 2 ng/mL

· Prolactin increased

· Sex hormone binding globulin (SHBG) decreased

· Decreased E2/oestrone (E1) ratio (or increased E1/E2 ratio)

· F. glucose/insulin ratio < 4.5

· Increased fasting insulin > 10 mIU/L