#194 Polycystic Ovary Syndrome Flashcards
What is the Rotterdam criteria?
Criteria for diagnosis of PCOS. Need 2/3 hyperandrogenism, oligo or amenorrhea, polycystic ovaries by ultrasound
What is the National Institutes of Health Criteria (1990) for diagnosis of PCOS?
Requires both hyperandrogenism and olgio or amenorrhea
What is the Androgen Excess Society 2006 criteria for diagnosis of PCOS?
Requires hyperandrogenism plus one of the two oligo or amenorrhea; or polycystic ovaries by ultrasound
What suggested physical exam is recommended for patients with PCOS?
Blood pressure, BMI, waist circumference (value >35 in = abnormal), presence of stigmata of hyperandrogenism and insulin resistance (acne, hirsutism, androgenic alopecia, acanthosis nigricans)
What laboratory studies are recommended in patients with PCOS?
Documentation of biochemical hyperandrogenemia (total testosterone and sex hormone-binding globulin or bioavailable and free testosterone); exclusion of other causes of hyerandrogenism (TSH, prolactin, 17-hydroxyprogesterone [non classical CAH d/t 21 hydroxylase deficiency], consider screening for Cushing syndrome and acromegaly), evaluation for metabolic abnormalities (2h gtt), fasing lipid and lipoprotein level (HDL <50, triglycerides >150, abnormal)
What is seen on ultrasound as polycystic ovaries?
In one or both ovaries, either 12 or more follicles measuring 2-9mm in diameter, or increased ovarian volume (>10cm^3). If there is a follicle with diameter >10mm, scan should be repeated at a time of ovarian quiescence. Presence of one polycystic ovary is enough for diagnosis
What test can be performed to screen for Cushing syndrome?
24 hour urinary free-cortisol excretion test or a low-dose dexamethasone suppression test
How is metabolic syndrome diagnosed?
Adult Treatment Panel III criteria: elevated bp (=> 130/85), increased waist circumference (=>35in), elevated fasting glucose (=>100), HDL <50, triglycerides >150
What % of patients with PCOS are not obese?
20%
How do patients with PCOS typically present?
Menstrual disorders and infertility; skin disorders
What concerns are raised for women with PCOS going through fertility treatments?
Increased risk of ovarian hyperstimulation and increased risk of multifetal pregnancy
Are women with PCOS at increased risk for complications of pregnancy?
Yes, including gestational diabetes and hypertensive disorders
True of false, women with PCOS are at increased risk of nonalcoholic fatty liver disease?
True
True or false, women with PCOS are at increased risk of sleep apnea?
True
What is a concern for women with PCOS who are persistently amenorrheic?
Endometrial cancer. Women with PCOS have multiple risk factors including chronic anovulation, centripetal obesity, and diabetes
Is PCOS associated with mood disturbances?
Yes, Increased recognition of mood disturbances and depression among women with PCOS
What should be considered in the differential diagnosis of PCOS?
Androgen secreting tumor, exogenous androgens, Cushing syndrome, nonclassical congenital adrenal hyperplasia, acromegaly, genetic defects in insulin action, primary hypothalamic amenorrhea, primary ovarian failure, thyroid disease, prolactin disorders
What is acanthosis nigricans?
A dermatologic condition marked by velvety, mossy, verrucous, hyperpigmented skin. Seems to be a sign of insulin resistance or medication reaction. Found on back of neck, axillae, under breasts, vulva.
True or false, clitoromegaly is commonly associated with PCOS?
False, rarely associated with PCOS. Its presence should elicit a search for other causes
What is the incidence of Cushing syndrome?
1 in 1,000,000 individuals
Should all women with hyperandrogenic chronic anovulation be routinely screened for Cushing syndrome?
No because it is so rare. Only screen those with coexisting signs of Cushing syndrome
What are signs of Cushing syndrome?
moon facies, buffalo hump, abdominal striae, centripetal fat distribution, or hypertension. Proximal myopathies and easy bruising
Is there a specific testosterone and/or dehydroepiandrosterone sulfate (DHEAS) level that is pathognomonic for a tumor?
No. Previously 2ng/mL of testosterone and 700mcg/dL DHEAS were used, but these cutoff levels have poor sensitivity and specificity
Where do circulating female androgens originate from?
Both ovaries and adrenal glands
What androgens do the adrenal glands secrete?
Weak androgens such as dehydroepiandrosterone (DHEA) or DHEAS (up to 90% of adrenal origin).
Where does the majority of female testosterone originate from?
It is estimated that 75% of circulating testosterone originates from the ovary (mainly through peripheral conversion of prohormones by liver, fat, and skin, but also through direct secretion)
What androgen has a higher level in premenopausal women than in men?
Androstenedione
What is the androgenic potency of androstenedione compared to testosterone?
10% of testosterone
What is the most potent androgen?
Dihydrotestosterone (DHT)
Where does dihydrotestosterone come from in women?
Intracellular conversion of testosterone by 5-alpha-reductase
Does PCOS have an effect on prolactin level?
Mild elevations in prolactin are common
How does nonclassical congenital adrenal hyperplasia present? What causes it?
Late-onset congenital adrenal hyperplasia, can present in adult women with anovulation and hirsutism and is almost exclusively due to genetic defects in steroidogenic enzyme, 21 hydroxylase (CYP21)
