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Table of Contents
EDITORIAL
Year : 2013  |  Volume : 17  |  Issue : 4  |  Page : 545-547

Trends in endocrine onomastics: The case of polycystic ovarian syndrome


1 Department of Endocrinology, BRIDE, Karnal, Haryana, India
2 Department of Endocrinology, Excel Care Hospitals, Guwahati, Assam, India
3 Department of Endocrinology, Gauhati Medical College, Guwahati, Assam, India

Date of Web Publication20-Jun-2013

Correspondence Address:
Manash P Baruah
Excel Center (A Unit of Excel Care Hospitals Pvt Ltd) Ulubari, Guwahati, Assam - 781 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.113719

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How to cite this article:
Kalra S, Baruah MP, Saikia M. Trends in endocrine onomastics: The case of polycystic ovarian syndrome. Indian J Endocr Metab 2013;17:545-7

How to cite this URL:
Kalra S, Baruah MP, Saikia M. Trends in endocrine onomastics: The case of polycystic ovarian syndrome. Indian J Endocr Metab [serial online] 2013 [cited 2019 Nov 19];17:545-7. Available from: http://www.ijem.in/text.asp?2013/17/4/545/113719

In the good old days, endocrine diseases were simply named after the people who discovered them. Sheehan's syndrome, Hashimoto's thyroiditis, and Addison's disease are examples of such monikers. Such was the craze of naming diseases, symptoms and signs after men of eminence that Graves' disease could not be diagnosed without memorizing scores of eponymously named signs.

A sudden spurt in the discovery of hormones, and in parallel, an increase in the number of endocrinopathies, led to an even simpler solution. Endocrine dysfunction began to be termed as hypo-or hyper-functioning of a particular gland, taking advantage of these dependable Latin prefixes. Yet other diseases were named after their diagnostic features. Diabetes mellitus and diabetes insipidus could be contrasted and compared with the help of their Latin-derived names, which meant exactly what the diseases meant. Continuing advances in the field of endocrinology, and lack of Latin scholars in this field, perhaps, encouraged authors to think of English names. Solitary thyroid nodule or metabolic syndrome, for example, are unpretentious names that explain exactly what they are, without the student of endocrinology having to reach for a voluminous classic language dictionary.

But good things do not last forever. Researchers soon began to classify and sub-classify hormonal diseases. Diabetes was split into juvenile and adult diabetes, then rechristened as insulin-dependent diabetes mellitus (IDDM) and noninsulin dependent diabetes mellitus (NIDDM), and renamed yet again as Type I and Type II diabetes, not content with this.

A numberphile movement ensured that the disease was later known as type 1 and type 2 diabetes. [1] Other figure-loving endocrinologists have added type 1.5 and type 3 diabetes to the list of number-based names, much to the consternation of endocrine students. Not to be left behind, literary buffs have continued the process of noun-piling, adding more and more eponyms to the onomastidon, or dictionary of proper nouns, of endocrinopathy. The metabolic syndrome, for example, offers a full course menu of epithets to chose from: Diabesity, syndrome X, and many more. [2]


   Onomastics and Reproductive Endocrinology Top


The Oxford English dictionary defines 'onomastics', a noun, as the study of the history and origin of proper names, especially personal names. Mostly expressed singularly, onomastics plays an important role in shaping perception of health and disease. This is especially true in the field of gonadal endocrinology or reproductive endocrinology. The choice of the two systems in the preceding sentence is itself subject to debate. The word 'gonadal' conveys a gonadocentric, hormone-oriented meaning, which can be used from infancy till old age. The term 'reproductive' encompasses the multiple nonhormonal aspects of reproductive, but captures only the child-bearing age group, leaving out pediatric and geriatric segments. The definition of 'geriatric' is not uniform across countries, and newer phrases such as 'the elderly' and 'the elder elderly' are now making their way into our lexicon. Within this supposedly calm, homogenous cohort, there rages a hot endocrine-linguistic argument as to which term to use: Andropause, androgen deficiency in the aging male (ADAM), androgen deficiency, hypogonadism, or simple aging. Each option has its pros and cons, but the healthy discussion that surrounds this issue ensures that gonadal endocrinology retains its vitality, while geriatric endocrinology maintains a healthy cognitive function.


   Polycystic Ovarian Syndrome Top


Every change comes with a certain amount of discomfort and debate, and this is what has greeted the United States National Institutes of Health (NIH) suggestion to rename polycystic ovarian syndrome (PCOS). PCOS is perhaps the most common endocrinopathy in women, with albeit uncertain etiology. Its clinical manifestations are protean, and its impact lasts much beyond the cessation of ovarian function, that is, menopause. Living its first life as the epoch making 'Stein Leventhal Syndrome', its subsequent incarnation as polycystic ovarian disease (PCOD) was rather dull and straightforward. Authorities including the NIH, have shown respect to the complex etiopathogenesis by settling, perhaps for the time being, with the name PCOS. People working on the metabolic syndrome want to move a step further by rechristening it as Syndrome O, or even Syndrome Z. [3],[4] Spelling deep trouble in women of reproductive age, PCOS is in real need of an identity, a nom de guerre.

Though an overweight, hirsute phenotype is associated with PCOS, it is by no means an absolute necessity for diagnosis. Neither is any single symptom diagnostic of PCOS. The symptomatology ranges from cutaneous to obstetric and gynecological, or from cardiovascular to psychological. Even more diverse is the patient perception of symptomatologyoara of PCOS, with the chief complaints ranging from acne to amenorrhea, or from seborrhea to subfertility. A wide range of endocrine and metabolic comorbid conditions often make their presence felt with PCOS. Hypothyroidism, diabetes mellitus, dyslipidemia, and obesity are but an incomplete list.

The sign upon which the nomenclature of PCOS is based, the polycystic ovary, a radiological finding which is highly operator-dependent, is not found in all cases of PCOS, and is often encountered in healthy women. Another finding that binds all PCOS women together, the clinical or biochemical evidence of hyperandrogenism is not as black and white a statement as some would like it to be. Clinical hyperandrogenism is a culture-specific and ethnicity-specific diagnosis, driven by patient perceptions rather than biochemical accuracy. The amount of hirsutism acceptable in one ethnic group may be considered unhealthy in another. While some cultures welcome prolonged menstrual bleeding, perhaps because of taboos, which ensure a break from household work during this period, others welcome scanty menses as a means of maintaining freedom of activity. The biochemical diagnosis of PCOS is fraught with even greater difficulties. Currently available testosterone assays are more appropriate for the higher, masculine range of hormone concentration. They also do not detect nontestosteronic androgenic compounds that may be present.


   An Onomastic Challenge Top


With the endocrine arena being no stranger to onomastic duels, it is surprising that it took so long to propose renaming of PCOS. A name that is neither short nor catchy, and does not capture the etiology, pathogenesis, clinical features, or pathogenic laboratory findings of the condition should not have survived so long. While it may have been appropriate when it was coined, it does not reflect the significant advances that have taken place since then in our understanding of the condition. The persistence of the PCOS nomenclature may be due to a linguistic inertia, similar to the clinical inertia that we often experience in diabetology and thyroidology. The tendency to stick to the familiar may be strengthened by the There is no alternative (TINA) hypothesis, with no simple, yet self-explanatory, description of PCOS available. Yet another reason may lie in the 'tangibility' of polycystic ovaries, which are relatively easier to identify (with), than hyperandrogenism.


   Of Eponyms and Acronyms Top


What maiden name should be given to PCOS, the grand old dame of endocrinology, whose study includes virtually every field of medicine? The new name should be easy to pronounce, easy to write, preferably with an acronym that makes sense. More importantly, it should reflect the basic characteristics of the syndrome. The name should carry a fresh feeling, of simplicity, of endocrine understanding, of manageability. On second thoughts, perhaps, we can persist with PCOS: The diagnosis and management of the syndrome will not change with the name.

If we do agree to search for a new name, one should find it EASY (Excess Androgen Secretion of the ovarY) and feel HAPPY (Hyper Androgenic Production - Primarily off the ovarY) to write. It would do no harm if it reminds us of flowers like DAISY (Disorder of excess Androgen- Inappropriately Secreted from ovarY) or, the Roman Goddess of love, beauty, sex and fertility known as VENUS (oVarian ENdogenous Uncontrolled Secretion of androgen), or even a lesser known deity of love, charm and passion in the Greek mythology known as LYNX (Lesions of ovarY with aNdrogen eXcess). LYNX seems to be a suitable choice from another angle as it is considered an elusive and mysterious creature, known in some American Indian traditions as a 'keeper of secrets'.

The new name should not be a mere SHADOW (Syndrome of Hyper Androgenic Disorder of Ovaries of Women) of the proud PCOS. Neither should it sound ugly or corpulent such as HyFATSO (Hyper Functional Androgen/Testosterone Syndrome of Ovaries) and it certainly should not carry socio-politically incorrect connotations of gender bias such as SEX-T (Syndrome of Excess Testosterone) or failure such as FLOP ASS (FunctionaL Ovarian Preferential Androgen Synthesis Syndrome).


   Endocrine Opinion Top


From an endocrine point of view, the name of any endocrinopathy should be based around the hormone in question. From hypopituitarism to hyperparathyroidism, from hyperthyroidism to hypogonadism names of diseases convey a crisp and clear idea of the major hormonal abnormality involved. Etiologies and other characteristics are added as adjectives, as in acquired hypopituitarism, secondary hyperparathyroidism or late onset congenital adrenal hyperplasia. Yet other names are based on pathological abnormalities, such as osteoporosis and osteomalacia. With this in mind, a new name for PCOS should revolve around hyperandrogenemia, or androgen excess. Should it be limited to one gender alone, that is, women, or should a fresh christening include, within its purview, the emerging concept of male PCOS? How will the diagnostic criteria for the 'new' entity differ from those of metabolic syndrome, or should PCOS be included as a diagnostic criterion of metabolic syndrome, dethroning it from its status as an independent syndrome?


   Your Opinion Top


These are questions that have no simple answers. We invite our readers to contribute, through letters and brief communications, to this debate. What name should we give to PCOS and why? Do our readers believe that IJEM looks forward to igniting the innovative minds of our readers to find a name for PCOS? And should you win a special editor's prize for this campaign, your success might shine like a mythical HALO around condition(s) sharing a common attribute, i.e. Hyper Androgenism Linked to Ovaries !

 
   References Top

1.Alberti K, Zimmet P. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Provisional report of a WHO expert consultation. Diabet Med 1998;15:539-53.  Back to cited text no. 1
    
2.Metabolic syndrome- Wikipedia, the free encyclopedia. Available from: http://en.wikipedia.org/wiki/Metabolic_syndrome. [Accessed in 2012].  Back to cited text no. 2
    
3.Hart R, Hickey M, Franks S. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004;18:671-83.  Back to cited text no. 3
    
4.Hacihanefioglu B. Polycystic ovary syndrome nomenclature: Chaos? Fertil Steril 2000;73:1261-2.  Back to cited text no. 4
    




 

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    An Onomastic Cha...
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