22-Hirsutism Flashcards
What is a syndrome.?
Aggregate of symptoms and signs with any morbid process and constituting together the picture of the disease
What is hirsutism?
Terminal hair in a male pattern distribution
What is the clinical Rotterdam criteria for PCOS?
Hyperandrogenism ( clinical or biochemical)
Ovulatory dysfunction
PCOS morphology on US
Need 2 out 3
What is the AES clinical criteria for PCOS.?
Hyperandrogenism
Ovulatory dysfunction or PCOS morphology
What are some features of PCOS?
Obesity- not universal
Metabolic syndrome
Oligomenorrhea and infertility
Inappropriate steroid secretion( high estrone, high LH, normal or low FSH)
Hyperprolactinemia
Insulin resistance- obese and non obese patients have increase fasting insulin levels
What is the correlation between diabetes and PCOS?
Elimination of ovarian steroid secretion with a GnRH analog does not correct insulin resistance in women with PCOS
Defect in insulin is not secondary to abnormal sex steroid levels
What are the principal hormonal abnormalities associated with PCOS?
Ovarian hyperandrogenism Adrenal hyperandrogenism Abnormal gonadotropin secretion Insulin resistance Decreased SHBG
How do you treat PCOS?
Depends on the issue
Infertility
Hirsutism
Abnormal uterine bleeding
How to treat Infertility associated PCOS?
Ovulation induction is attempted only if pregnancy is desired
Therapy initiated with clomiphene citrate (SERM)
If ovulation does not occur add metformin
Aromatase inhibitors
Weight loss
How to treat oligomenorrhea associated PCOS?
Treat to prevent endometrial hyperplasia and adenocarcinoma of the uterus
Therapy done with combined oral contraceptives
How to treat hirsutism associated PCOS?
Combined contraceptives will have anti androgen effects, also add anti androgen
Spironolactone potentiates the effect of birth control
Patients treated with spironolactone should be aware that they may become ovulatory
Depilatories
Electrolysis
Laser treatment
