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Gynaecology > 2: PCOS and Hirsuitism > Flashcards

2: PCOS and Hirsuitism Flashcards

1
Q

Define PCOS

A

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

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2
Q

What are 2 RF for PCOS

A

FH

Diabetes

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3
Q

What are symptoms of PCOS

A
  • Oligomenorrhoea (or amenorrhoea)
  • Hirsuitism
  • Obesity
  • Depression
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4
Q

What may be seen in PCOS

A
  • Acanthosis nigricans

- Male pattern hair distribution

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5
Q

What are the hormonal abnormalities in PCOS

A

Raised LH

Insulin resistance

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6
Q

Where is LH produced

A

Anterior pituitary gland

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7
Q

Why is LH increased in PCOS

A

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

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8
Q

What does insulin resistance cause

A

Hypersecretion of insulin

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9
Q

What does insulin do

A

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

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10
Q

What is the effect of increased androgens

A

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.

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11
Q

What criteria is used to diagnose PCOS

A

Rotterdam

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12
Q

What does the Rotterdam criteria state

A

Individual needs two of the following

  1. Oligomenorrhoea
  2. Clinical or biochemical features of hirsutism
  3. PCOS on imaging
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13
Q

How will testosterone appear in PCOS

A

Raised

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14
Q

How will SHBG appear in PCOS and why

A

Low - inhibited by insulin

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15
Q

How will LH appear in PCOS

A

Raised

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16
Q

How will FSH appear in PCOS

A

Normal

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17
Q

What is a ‘classical picture’ of PCOS

A

LF: FSH > 3:1

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18
Q

Why may TFTs be ordered in PCOS

A

Exclude hypothyroidism

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19
Q

How will ovaries present in PCOS

A

‘Ring of pearls’ appearance

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20
Q

What do women with PCOS have increased risk of

A

CVD

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21
Q

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

A
  1. Measure waist circumference
  2. QRISK 2 score
  3. OGTT
  4. BP
  5. Lipid profile
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22
Q

What score is calculated for PCOS women

A

QRISK-2

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23
Q

What does QRISK 2 predict

A

Risk cardiovascular event within next 10-years

24
Q

What should women with QRISK score >10% receive

A

Atorvastatin 20mg

25
Q

What dose of atorvostatin is given for primary prevention

A

20mg

26
Q

What dose of atorvastatin is given for secondary prevention

A

80mg

27
Q

What is the risk of oligomenorrhoea in PCOS

A

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

28
Q

What is given to treat oligomenorrhoea in PCOS

A

COCP

29
Q

What lifestyle factors are recommended in PCOS

A

Weight loss

30
Q

In severe cases of obesity in PCOS what may be used

A

Orlistat

31
Q

What is used to promote fertility in PCOS

A

Clomiphene

32
Q

Why is clomiphene limited to 6-cycles

A

Increases risk OHSS and ovarian cancer

33
Q

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

A

Metformin

34
Q

When is metformin recommended in PCOS

A

All PCOS women with BMI >25

35
Q

What is third-line for sub fertility in PCOS

A

Laparoscopic ovarian drilling

36
Q

What is first-line to manage hirsutism

A

Shaving

37
Q

What is second-line to manage hirsutism

A

Anti-androgens:
Cyproterone acetate
Spirinolactone
Finasteride

38
Q

What are 4 complications of PCOS

A

CVD
T2DM
Endometrial cancer
Miscarriage

39
Q

Define hirsutism

A

Androgen-dependent hair growth

40
Q

What pattern of hair-growth is hirsutism

A

Male-pattern

41
Q

What is hypertrichosis

A

Androgen-independent hair growth in females

42
Q

What is the most common cause of hirsutism

A

PCOS

43
Q

Give 5 other causes of hirsutism

A
  • PCOS
  • Androgen-secreting tumour
  • Cushing’s
  • CAH
  • Obesity (increase conversion androgen to oestrogen)
  • Medications
44
Q

What two medications can cause hirsuiitsm

A

Phenytoin

Corticosteroids

45
Q

When does hirsutism often onset

A

Adolescence- then worsens

46
Q

What scoring system is used for hirsutism

A

Ferriman-Galleway System

47
Q

Explain ferriman-galleway scoring system

A

Uses 8-areas each given a score 0-4

48
Q

What score on ferriman-galleway system indicates hirsutism

A

> 8

49
Q

What is severe hirsutism on scoring system

A

> 15

50
Q

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

A

If signs of androgen-secreting tumour

51
Q

What are indicators of androgen-secreting tumour

A
  • Sudden-onset hirsutism
  • Virillisation
  • Pelvic mass
52
Q

When should individual with hirsutism be referred to endocrinology

A

Suspect Cushing’s disease

53
Q

What do high levels of 17-OH progesterone indicate

A

CAH

54
Q

What is first-line for hirsutism

A

Shaving and waxing

55
Q

What is given to manage facial hirsutism

A

Topical eflornithine

56
Q

What are 3 CI to topical eflornithine

A

Pregnancy
Breast feeding
Under-19

57
Q

What medication is given to manage hirsutism

A

COCP

Gynaecology (22 decks)

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