2014 33 PCOS

Question 1

What tool should be used to diagnose PCOS?

Answer 1

Rotterdam criteria

Question 2

What are the long-term consequences of PCOS?

Answer 2

1. Gestational diabetes
2. Type 2 diabetes
3. Obstructive sleep apnoea
4. Cardiovascular disease
5. Psychological issues
6. Reduced health-related quality of life

Question 3

What screening should be considered for GDM in PCOS?

Answer 3

OGTT at 24-28/40

Question 4

How should women with PCOS be screened for T2DM?

Answer 4

1. Screen if BMI > 25 or any weight with additional risk factors
2. 2-hour post-75g OGTT
3. Annual review for impaired fasting glucose (6.1-6.9) or glucose tolerance (7.8-11.1)

Question 5

How should OSA be screened for in PCOS?

Answer 5

Ask woman & partner about snoring, fatigue, daytime somnolence

Question 6

What risk factors for CVD should be considered in PCOS?

Answer 6

1. Obesity
2. Lack of physical activity
3. Cigarette smoking
4. Personal or family hx of T2DM
5. Dyslipidaemia
6. Hypertension

Question 7

What are the cancer risks associated with PCOS?

Answer 7

1. Endometrial increased
2. No association with breast or ovarian

Question 8

How should endometrial hyperplasia/cancer risk be managed in PCOS?

Answer 8

1. In oligo/amenorrhoea, add progesterone or Miena, or induce withdrawal bleed every 3-4 months
2. TVUS if abnormal bleed or no withdrawal bleeds, ET <7mm reassuring
3. Thickened endometrium or polyp: biopsy +/- hysteroscopy

Question 9

What is the first-line risk-reduction strategy in PCOS?

Answer 9

Lifestyle modification:
Diet
Exercise
Weight loss

Question 10

What drugs can help reduce risk in PCOS?

Answer 10

1, Insulin - sensitising agents: metformin, glitazones unlicensed but safe
2. Weight - reduction drugs like orlistat can reduce hyperandrogenaemia

Question 11

When is ovarian electrocautery used in PCOS?

Answer 11

Selected cases
Normal BMI
As alternative to ovulation induction

Question 12

When is bariatric surgery used in PCOS?

Answer 12

1. BMI > 40
2. BMI > 35 with high-risk obesify-related condition
3. Standard weight loss strategies failed

Question 13

What is the prevalence of PCOS?

Answer 13

2.2-26%
Higher in South Asian than Caucasian population

Question 14

What are the Rotterdam criteria for PCOS?

Answer 14

2 out of 3 of:
1. Polycystic ovaries (12+ follicles, volume > 10cm3)
2. Oligo- or an ovulation
3. Hyper-androgen (biochemical or clinical)

Question 15

What is the recommended biochemical test for hyperandrogenism?

Answer 15

Free androgen index:
Total testosterone ÷ SHBG x 100

Question 16

What signs raise suspicion of and ovens secreting tumours & CAH?

Answer 16

1. Virilization
2. Rapidly a progressing hirsutism
3. Testosterone > 5nmol/L or twice upper limit of ref range

Question 17

How should CAH suspicion be investigated?

Answer 17

Measure 17-hydroxyprogesterone in follicular phase
Raised in CAH
If borderline, ACTH stimulation test

Question 18

How does PCOS impact on GDM prevalence?

Answer 18

Double

Question 19

What proportion of women with PCOS have insulin resistance?

Answer 19

65-80%
Independent of obesity

Question 20

What are the risks of barometric surgery?

Answer 20

0.1-1.1% mortality rate
Bowel obstruction
Infection
Oesophagitis
Nutritional abnormalities