2: PCOS and Hirsuitism

Question 1

Define PCOS

Answer 1

Condition caused by raised androgens and presence of several immature follicles in the ovary

Question 2

What are 2 RF for PCOS

Answer 2

FH

Diabetes

Question 3

What are symptoms of PCOS

Answer 3

• Oligomenorrhoea (or amenorrhoea)
• Hirsuitism
• Obesity
• Depression

Question 4

What may be seen in PCOS

Answer 4

• Acanthosis nigricans

- Male pattern hair distribution

Question 5

What are the hormonal abnormalities in PCOS

Answer 5

Raised LH

Insulin resistance

Question 6

Where is LH produced

Answer 6

Anterior pituitary gland

Question 7

Why is LH increased in PCOS

Answer 7

Increase pulsatile GnRH secretion. Raised LH stimulates over-production of androgens

Question 8

What does insulin resistance cause

Answer 8

Hypersecretion of insulin

Question 9

What does insulin do

Answer 9

Decreases concentration of sex-hormone binding globulin - increasing free circulating androgens

Question 10

What is the effect of increased androgens

Answer 10

Increased androgens means there is more negative feedback and no LH surge. This means there are lots of partially developed ovarian follicles. No follicle is selected to be the dominant follicle.

Question 11

What criteria is used to diagnose PCOS

Answer 11

Rotterdam

Question 12

What does the Rotterdam criteria state

Answer 12

Individual needs two of the following

1. Oligomenorrhoea
2. Clinical or biochemical features of hirsutism
3. PCOS on imaging

Question 13

How will testosterone appear in PCOS

Answer 13

Raised

Question 14

How will SHBG appear in PCOS and why

Answer 14

Low - inhibited by insulin

Question 15

How will LH appear in PCOS

Answer 15

Raised

Question 16

How will FSH appear in PCOS

Answer 16

Normal

Question 17

What is a ‘classical picture’ of PCOS

Answer 17

LF: FSH > 3:1

Question 18

Why may TFTs be ordered in PCOS

Answer 18

Exclude hypothyroidism

Question 19

How will ovaries present in PCOS

Answer 19

‘Ring of pearls’ appearance

Question 20

What do women with PCOS have increased risk of

Answer 20

CVD

Question 21

What 5 things should be performed in PCOS to screen for cardiovascular risk

Answer 21

1. Measure waist circumference
2. QRISK 2 score
3. OGTT
4. BP
5. Lipid profile

Question 22

What score is calculated for PCOS women

Answer 22

QRISK-2

Question 23

What does QRISK 2 predict

Answer 23

Risk cardiovascular event within next 10-years

Question 24

What should women with QRISK score >10% receive

Answer 24

Atorvastatin 20mg

Question 25

What dose of atorvostatin is given for primary prevention

Answer 25

20mg

Question 26

What dose of atorvastatin is given for secondary prevention

Answer 26

80mg

Question 27

What is the risk of oligomenorrhoea in PCOS

Answer 27

Oligomenorrhoea - means anovulatory cycles are occurring. This causes exposure to unopposed oestrogen which can cause proliferation endometrium

Question 28

What is given to treat oligomenorrhoea in PCOS

Answer 28

COCP

Question 29

What lifestyle factors are recommended in PCOS

Answer 29

Weight loss

Question 30

In severe cases of obesity in PCOS what may be used

Answer 30

Orlistat

Question 31

What is used to promote fertility in PCOS

Answer 31

Clomiphene

Question 32

Why is clomiphene limited to 6-cycles

Answer 32

Increases risk OHSS and ovarian cancer

Question 33

What is given to aid menstrual disturbance and ovarian function in PCOS

Answer 33

Metformin

Question 34

When is metformin recommended in PCOS

Answer 34

All PCOS women with BMI >25

Question 35

What is third-line for sub fertility in PCOS

Answer 35

Laparoscopic ovarian drilling

Question 36

What is first-line to manage hirsutism

Answer 36

Shaving

Question 37

What is second-line to manage hirsutism

Answer 37

Anti-androgens: Cyproterone acetate Spirinolactone Finasteride

Question 38

What are 4 complications of PCOS

Answer 38

CVD T2DM Endometrial cancer Miscarriage

Question 39

Define hirsutism

Answer 39

Androgen-dependent hair growth

Question 40

What pattern of hair-growth is hirsutism

Answer 40

Male-pattern

Question 41

What is hypertrichosis

Answer 41

Androgen-independent hair growth in females

Question 42

What is the most common cause of hirsutism

Answer 42

PCOS

Question 43

Give 5 other causes of hirsutism

Answer 43

- PCOS - Androgen-secreting tumour - Cushing's - CAH - Obesity (increase conversion androgen to oestrogen) - Medications

Question 44

What two medications can cause hirsuiitsm

Answer 44

Phenytoin | Corticosteroids

Question 45

When does hirsutism often onset

Answer 45

Adolescence- then worsens

Question 46

What scoring system is used for hirsutism

Answer 46

Ferriman-Galleway System

Question 47

Explain ferriman-galleway scoring system

Answer 47

Uses 8-areas each given a score 0-4

Question 48

What score on ferriman-galleway system indicates hirsutism

Answer 48

>8

Question 49

What is severe hirsutism on scoring system

Answer 49

>15

Question 50

When should individuals with hirsutism be referred under 2W referral pathway

Answer 50

If signs of androgen-secreting tumour

Question 51

What are indicators of androgen-secreting tumour

Answer 51

- Sudden-onset hirsutism - Virillisation - Pelvic mass

Question 52

When should individual with hirsutism be referred to endocrinology

Answer 52

Suspect Cushing's disease

Question 53

What do high levels of 17-OH progesterone indicate

Answer 53

CAH

Question 54

What is first-line for hirsutism

Answer 54

Shaving and waxing

Question 55

What is given to manage facial hirsutism

Answer 55

Topical eflornithine

Question 56

What are 3 CI to topical eflornithine

Answer 56

Pregnancy Breast feeding Under-19

Question 57

What medication is given to manage hirsutism

Answer 57

COCP