Muscle Weakness

PCOS is a common disorder with systemic metabolic manifestations. Its etiology is complex, heterogeneous, and poorly understood. There are three definitions for PCOS currently in use that variably rely on androgen excess, chronic anovulation, and PCO to make the diagnosis (Table 1). However, all criteria are consistent in that PCOS is considered a diagnosis of exclusion. All three sets of diagnostic criteria include hyperandrogenism, either clinical or biochemical, and anovulation (6 – (link)9 (link)). The Rotterdam criteria were the first to incorporate ovarian morphology on ultrasound as part of the diagnostic criteria (8 (link), 9 (link)).
The panel from a recent National Institutes of Health (NIH)-sponsored Evidence-Based Methodology workshop on PCOS endorsed the Rotterdam criteria, although they identified the strengths and weaknesses of each of the three cardinal features (Table 2). These criteria allow the diagnosis to be made clinically (based upon a history of hyperandrogenic chronic anovulation) as well as biochemically with androgen assays or with ultrasound examination of the ovaries. We do not endorse the need for universal screening with androgen assays or ultrasound if patients already meet two of the three criteria clinically. It is recommended that the features leading to the diagnosis are documented. We recommend using the current definition of the Rotterdam criteria to document PCO morphology (at least one ovary with 12 follicles of 2–9 mm or a volume >10 mL in the absence of a dominant follicle >10 mm), in the absence of age-based criteria.
Disorders that mimic PCOS are comparatively easy to exclude; therefore, all women should be screened with a TSH, prolactin, and 17-OHP level (Table 3) (10 (link)– (link)12 (link)). Hyperprolactinemia can present with amenorrhea or hirsutism (13 (link), 14 (link)). Thyroid disease may present with irregular menstrual cycles. In women with hyperandrogenism, nonclassic congenital adrenal hyperplasia should be excluded because it can be found in 1.5–6.8% of patients presenting with androgen excess (15 (link), 16 ). In select women who present with amenorrhea, virilization, or physical findings not associated with PCOS, such as proximal muscle weakness (Cushing's syndrome) or frontal bossing (acromegaly), other diagnoses should be considered and excluded (Table 4).

A total of 15 patients (11 male; mean (SD) age 51.13 (11.87) years) in the chronic phase after stroke (≥ 6 months after onset), with varying degrees of muscle weakness and spasticity as assessed clinically, were examined using the NeuroFlexor foot module. Exclusion criteria comprised severe contractures, which prevented the passive range of movement required for NeuroFlexor assessment (i.e. at least 30°); any other neurological or rheumatological disorder; recent fractures of the lower limb; presence of a pacemaker or other stimulators; pregnancy; inability to communicate; or to understand information about the study. Patients who received intramuscular injections as treatment for spasticity could participate only if the time since their last treatment was at least 3 months. The control group comprised 73 healthy adult individuals (26 male; 40.96 mean (SD) age (12.60) years) and with no history of neurological disease, constituted the control group.
Written informed consent was obtained from all participants. The study was approved by the Regional Ethics Review Board in Stockholm (DNR: 2016/2213-31/2). All procedures complied with the Declaration of Helsinki.