4: Hyperandrogenic Disorders (PCOS) Flashcards
T/F Glitazones lower glucose levels by increasing the utilization of glucose, which decreases hepatic glucose synthesis. Because of this, they are recommended when metformin does not work.
False. They are not recommended for use in PCOS.
What is the hallmark feature of PCOS?
Menstrual irregularity
_____ is a pure antiandrogen without progestogenic effects that has shown some benefit in treating hirsutism. Unfortunately, this medication is associated with hepatotoxicity that can cause liver failure and rarely death. It is not recommended for hirsutism treatment.
Flutamide is a pure antiandrogen without progestogenic effects that has shown some benefit in treating hirsutism. Unfortunately, this medication is associated with hepatotoxicity that can cause liver failure and rarely death. It is not recommended for hirsutism treatment.
In contrast to hirsutism, circulating androgens can also cause this.
Alopecia
If a virilizing tumor is suspected but an adnexal mass is not palpable, what is the procedure?
Transvaginal US. If no ovarian tumor is identified, adrenal CT should be performed. Routine adrenal imaging should be avoided because it can lead to unnecessary evaluation of nonfunctioning adrenal masses (incidentalomas).
A rapid progression of which PCOS symptoms is cause for concern for a possible androgen-producing tumor?
- Increased libido
- Increased muscle bulk
- Voice deepening
- Breast atrophy
- Clitoromegaly
Why would bleeding be heavy in PCOS?
Bleeding is generally irregular and unpredictable, and can be heavy as a result of continuous estrogenic stimulation of the endometrium and resultant endometrial hyperplasia.
Onset of breast development.
Thelarche
How long does it take for COC use to help with PCOS?
The maximal effect of COCs on acne is usually observed within 2 months. In contrast, the maximal effect on hair growth may take as long as 9 to 12 months for its realization because of the length of the hair growth cycle. COCs as monotherapy may be insufficient to treat hirsutism.
A dose of 5 mg/day is effective in treating hirsutism without engendering any adverse effects.
Finasteride
T/F Insulin resistance in PCOS is a problem of obesity.
False. Insulin resistance occurs in both normal-weight and overweight women with PCOS, but its frequency and magnitude are increased in obese women with PCOS.
These medications work by inhibiting gonadotropin secretion and subsequent ovarian hormone secretion, which results in not only a slowing of hair growth, but also severe estrogen deficiency.
Gonadotropin-releasing hormone (GnRH) analogs
T/F Insulin resistance can contribute to hyperandrogenism.
True. Increased insulin levels stimulate androgen production in the ovaries, both in isolation and by potentiating LH, and suppress SHBG production in the liver. A vicious cycle is created in which the elevated androgens and insulin suppress SHBG synthesis, resulting in an increase in free testosterone, which in turn exacerbates the insulin resistance.
T/F Women with PCOS are unable to conceive without fertility interventions.
False. More than half of women with PCOS are fertile (i.e., they will become pregnant within 12 months of trying), although it may take them longer to conceive.
When would the criteria for polycystic ovaries not apply in women with PCOS?
Women who take COCs because they can modify ovarian morphology.
T/F Antiandrogens are effective in the treatment of hirsutism. When used with COCs, they are more effective than either med alone.
True
Why has PCOS been designated a non-modifiable risk factor for PCOS?
Women with PCOS have:
- 2x the odds of impaired glucose intolerance
- 4x the odds of DMT2
Cycle length greater than 199 days.
Amenorrhea
What are the major circulating androgens found in women?
- Dehydroepiandrosterone sulfate (DHEA-S)
- Dehydroepiandrosterone (DHEA)
- Androstenedione
- Testosterone
- Dihydrotestosterone (DHT), which is the active metabolite of testosterone.
What scale is used to measure hirsutism and what number corresponds with it?
- Ferriman-Gallwey
- 8 or greater in general
- 9 or greater for Mediterranean
- 2 or greater for Asian
Finasteride is considered when COCs and spirolactone are ineffective for hirsutism. However, it must be used with contraceptives. What sort of teratogenic effect does it have?
Affect the development of the genital tract in male fetuses.
How does SHBG play a role in PCOS?
The bioactivity and androgenicity of testosterone are determined by sex hormone–binding globulin (SHBG). Circulating testosterone is bound to SHBG, which is produced in the liver. It is normal for approximately 80% of circulating testosterone to be bound to SHBG, 19% to be loosely bound to albumin, and the remaining 1% to be left unbound. The unbound, free testosterone is mainly responsible for androgenicity, although the fraction associated with albumin makes some contribution to this condition. SHBG levels are increased by estrogens and thyroid hormone, and suppressed by androgens and insulin. Therefore, in the presence of high levels of thyroid hormone or estrogen, more testosterone is bound, making less biologically available. If SHBG is suppressed or androgen production increases, the amount of free (unbound) testosterone will increase without necessarily increasing the total testosterone level, and the woman may develop symptoms of hyperandrogenism. Thus, because of the interplay among SHBG, insulin, thyroid hormone, estrogen, and androgen production, the total testosterone concentration may remain in the normal range, with symptoms reflecting only the decreased binding capacity of the SHBG and the increased percentage of unbound testosterone.
When trying to diagnose PCOS, which labs tests are necessary?
All women who have hyperandrogenism with ovulatory dysfunction should have:
- serum prolactin (r/o hyperprolactinemia)
- serum thyroid-stimulating hormone (TSH) (r/o thryoid disorders)
- fasting lipid profile (increased risk for lipid disorders)
- 2-hour oral glucose tolerance test (increased risk for DMT2)
- free testosterone (some agree, some think to reserve only for mod/severe hirsutism, sudden/rapid hirsutism, and signs of virilization)
- 17-OHP (r/o congential adrenal hyperplasia)
- Anti-Mullerian hormone (AMH) (esp when accurate US is not available. 4.5+ ng/mL are associated with PCOS).
- Women who have hyperandrogenism signs but regular menstrual cycles should have a serum progesterone level (between days 20-24 of cycle).
- Women who have signs of Cushing syndrome (buffalo hump, moon face, abd striae) need screening: 1 mg of dexamethasone orally between 11 p.m. and 12 a.m., and then drawing a serum cortisol at 8 a.m. the next morning. Values less than 1.8 mcg/dL are considered normal.
What are the most common side effects of metformin and which is the most serious?
- The most serious side effect of metformin is the development of lactic acidosis, although this is rare.
- Vitamin B12 deficiency can also occur.
- Gastrointestinal side effects, which are more common, include nausea, abdominal discomfort, diarrhea, and anorexia
Treatment of PCOS.
- Lifestyle modifications:
- Healthy diet
- Weight loss. Most important strategy for weight loss is decreased calories.
- Exercise. 30+ minutes/day.
- Mechanical hair removal
- Pharmacological management:
- COCs (1st-line pharm treatment)
- Progestins
- Antiandrogens (Spironolactone, Finasterid, Flutamide)
- Topicals (Eflornithine/Vaniqa)
- GnRH analogs (Leuprolide)
- Insulin-sensitizing agents (Metformin)
Which is the most potent androgen?
Testosterone
What is the progestin dose in PCOS?
- Women who need contraception can use the levonorgestrel-releasing intrauterine system (LNG-IUS), progestin-only pills (POPs), the depot medroxyprogesterone acetate injection, or the subdermal implant.
- Women who do not need contraception can take a dose of 5 to 10 mg medroxyprogesterone acetate or 200 mg micronized progesterone daily for the first 14 days of each month.
- Progestational therapy alone will not treat hirsutism, however.
When should a woman be referred to an endocrinologist?
- If diagnostic testing reveals that a woman has congenital adrenal hyperplasia, HAIR-AN syndrome, Cushing syndrome, hyperprolactinemia, or androgen-producing tumors, she should be referred to an endocrinologist.
- Consultation should also be considered for women who are refractory to treatment for PCOS.
- Clinicians who are not experienced in the management of metabolic syndrome should seek appropriate consultation for treating women with PCOS who meet the criteria for metabolic syndrome.
Premature _____ may be a consequence of hyperinsulinemia.
Premature adrenarche may be a consequence of hyperinsulinemia.
Hyperandrogenism is both a complex endocrine disorder and a _____ problem.
Hyperandrogenism is both a complex endocrine disorder and a cosmetic problem.
When is virilization most concerning for neoplasm?
If the onset is sudden or the progression is rapid.
What is the etiology of the S/S of PCOS?
The symptoms of hyperandrogenism—that is, hirsutism, acne, alopecia, and frequently, anovulation—can all be traced to an increase in androgen levels, a decrease in production of SHBG, or an increase in 5α-reductase activity in the skin and hair follicles that has caused an initial stimulus to androgen-sensitive areas and subsequently acts to sustain continued sensitivity.
S/S include:
- hirsutism
- acne
- androgenic alopecia
- menstrual irregularity
- subfertility/infertility
PCOS
What is a limitation of the Ferriman-Gallwey scale?
Many women with hirsutism are using a form of hair removal. Assessment of the types and frequency of hair removal methods can be more useful for assessment and follow-up of the response to therapy.
T/F PCOS can be prevented by maintaining normal weight.
False. PCOS cannot be prevented.
What is an important sequela of polymenorrhea?
Iron-deficiency anemia
T/F Metformin is recommended for routine treatment in PCOS.
False. It should be considered for women with impaired glucose intolerance whose weight does not respond to diet and exercise or whose weight is normal, such that weight loss is not appropriate.
Why do the ovaries produce more androgen in PCOS?
Most of the increased androgen production seen with PCOS occurs in the ovaries as a result of increased LH stimulation, as increased LH pulse frequency stimulates ovarian theca cell production of androgens.
Which hormone is responsible for clinical expression of androgen stimulation in many androgen-sensitive tissues (skin, pilosebaceous unit, hair follicles)?
DHT. Conversion of testosterone to DHT is accomplished by 5α-reductase, an enzyme that is present in these target tissues. Racial and ethnic differences have been noted both in the number of hair follicles present on the body and in the degree of 5α-reductase activity present in the hair follicles. The sensitivity of the hair follicle to the effect of androgens depends on the degree of 5α-reductase activity and is genetically predetermined. In women who are genetically predisposed to excessive 5α-reductase activity, even normal levels of androgen can stimulate hair growth, leading to idiopathic hirsutism.
T/F While not mandatory for diagnosis, women who have polycystic ovaries meet diagnostic criteria for PCOS.
False. Women who do not meet the diagnostic criteria for PCOS can have polycystic-appearing ovaries on ultrasound.
Onset of pubic hair.
Adrenarche
What types of ovulatory disfunction happen in PCOS and which is most common?
- Oligomenorrhea (most common)
- Amenorrhea
- Polymenorrhea
T/F Rates of depressive disorders, anxiety disorders, and binge eating are higher among women with PCOS than among those without the condition.
True
T/F Insulin resistance increases the risk for both impaired glucose tolerance and type 2 diabetes.
True
When would you use total instead of free testosterone testing and what does this indicate?
When suspicion of a tumor is present. Levels of 150 ng/dL or greater (100 in postmenopausal women) need evaluation for an androgen-producing tumor.
Virilization presenting in pregnancy should raise the suspicion for a _____.
Virilization presenting in pregnancy should raise the suspicion for a luteoma—a condition that is an exaggerated reaction of the ovarian stroma to normal levels of chorionic gonadotropin and not a true tumor.
When should endometrial biopsy be used?
Longstanding anovulation. The decision to perform an endometrial biopsy should not be based on a woman’s age, as endometrial cancer can be encountered in young anovulatory women. It is the duration of exposure to unopposed estrogen that is critical, rather than the woman’s age.
What med is useful for both hirsutism and androgenic alopecia?
Spironolactone (antiandrogen). It works by inhibiting testosterone from binding to its receptors, thereby inhibiting its action. The usual dose is 50 to 100 mg twice daily, with the effects being dose dependent. It can take 6 months or longer to see the full clinical effect from this therapy. Side effects may include lightheadedness, dizziness, fatigue, diuresis, and increased risk of hyperkalemia. Spironolactone may also cause menstrual irregularity when used as monotherapy. Combination therapy with COCs reduces this side effect, and improves clinical response.
Women normally produce amounts of testosterone in the range of 0.2 to 0.3 mg per day, 50% of which is derived from the peripheral conversion of _____.
Women normally produce amounts of testosterone in the range of 0.2 to 0.3 mg per day, 50% of which is derived from the peripheral conversion of androstenedione.
Women with PCOS have what additional risk factors during pregnancy?
- Preeclampsia
- Gestational diabetes
- Preterm birth
What is the morphology of a polycystic ovary?
- One or both ovaries with 25 (used to be 12) or more follicles measuring 2 to 9 mm in diameter
and/or
- Increased ovarian volume of more than 10 mL
T/F Regular menses do not rule out the possibility of oligo-anovulation.
True. Subclinical menstrual dysfunction, in which women have regularly occurring menses but chronic anovulation, is common in individuals with PCOS.
Why is Eflornithine HCl 13.9% (Vaniqa) used in PCOS and what is the dose?
- Facial hirsutism
- Apply to affected areas BID. Noticable improvement in 6-8 weeks.
What is the most common pattern of alopecia in PCOS?
Diffuse alopecia that includes hair loss at the vertex and crown with preservation of the frontal hairline, although bitemporal and frontal hair loss can be seen with more severe hyperandrogenemia.
_____ is an oral antihyperglycemic agent whose primary mechanisms of action are inhibition of hepatic glucose production and increased peripheral insulin sensitivity.
Metformin is an oral antihyperglycemic agent whose primary mechanisms of action are inhibition of hepatic glucose production and increased peripheral insulin sensitivity.
A product of the interaction between circulating androgens, local androgen concentrations, hormonal variables including insulin resistance, and the sensitivity of hair follicles to androgens.
Hirsutism
T/F The severity of hirsutism correlates with the severity of androgen excess, and women with significant biochemical hyperandrogenemia present with obvious hirsutism.
False. The severity of hirsutism does not correlate with the severity of androgen excess, and women with significant biochemical hyperandrogenemia may present with only mild or no hirsutism
T/F Though not recommended for all women with PCOS, metformin is recommended in pregnancy to help reduce the risk of gestational diabetes.
False. Although metformin may prove beneficial during pregnancy by reducing the risk of gestational diabetes mellitus, evidence is insufficient to recommend its routine use during pregnancy.
How does hyperinsulinemia play a role in the etiology of PCOS?
By stimulating ovarian androgen production and decreasing serum SHBG concentrations. Obesity further complicates the condition by increasing insulin resistance due to excess adiposity.
What is the recommended dose and type of COC?
- A COC with a 20 to 35 mcg dose of ethinyl estradiol and a nonandrogenic progestin component is recommended.
- Formulations containing desogestrel, norgestimate, or drospirenone are commonly used because of their low androgenic effects.
- Drospirenone functions as an androgen receptor agonist. Its dose in COCs (3 mg) is equivalent to approximately 25 mg of spironolactone, which may not be enough for hirsutism treatment, but should be considered if additional spironolactone is given due to the potential for hyperkalemia with such therapy
What luteal phase progesterone level is considered oligo-anovulatory?
Less than 3 ng/mL
T/F The solid luteoma is associated with a normal pregnancy and is usually bilateral.
False. The solid luteoma is associated with a normal pregnancy and is usually unilateral.
While not recommended for this, why has metformin been used in the past to help with fertility?
Metformin has been shown to increase ovulatory frequency.
_____ inhibits 5α-reductase activity, which blocks the conversion of testosterone to DHT in the skin.
Finasteride inhibits 5α-reductase activity, which blocks the conversion of testosterone to DHT in the skin.
What is the most common source of increased testosterone?
Ovaries. Adrenal causes are rare.
If the mother is virilized as a result of the luteoma, there is a 60% to 70% chance that her female fetus will show some signs of _____. The luteoma does not cause other maternal effects and regresses postpartum. Virilization may be recurrent in subsequent pregnancies
If the mother is virilized as a result of the luteoma, there is a 60% to 70% chance that her female fetus will show some signs of masculinization. The luteoma does not cause other maternal effects and regresses postpartum. Virilization may be recurrent in subsequent pregnancies
Why are obese women thought to have the greatest risk for endometrial cancer?
Women who are obese are thought to be at the greatest risk of developing endometrial cancer because the peripheral conversion of androgens to estrogen occurs in adipose tissue.
What is the etiology of acne in PCOS?
Androgen stimulation of the pilosebaceous unit can cause enlargement of the sebaceous glands and increased secretion of sebum, leading to acne.
What is the primary precaution with antiandrogens?
They must be used with contraception because of their teratogenic effect.
Which increased risk factors for CV disease occur in PCOS?
Women with PCOS have been found to have an excess of numerous biochemical inflammatory and thrombotic markers of cardiovascular disease, including:
- Circulating cytokines and pro-arthrogenic factors, such as C-reactive protein, homocysteine, vascular endothelial growth factor, and plasminogen activator inhibitor-1.
- Increased systemic inflammation associated with endothelial vascular dysfunction.
- Higher incidence of coronary artery calcification.
What 3 alterations cause obesity to interfere with normal ovulation?
- Increased peripheral aromatization of androgens, resulting in chronically elevated estrogen concentrations
- Decreased levels of hepatic SHBG, resulting in increased circulating concentrations of free estradiol and testosterone
- Insulin resistance, leading to a compensatory increase in insulin levels that stimulates androgen production in the ovarian stroma, resulting in high local androgen concentrations that impair follicular development
Two women come into your office. One has hirsutism. One has alopecia. Which one is more likely to have PCOS?
The woman with hirsutism. The majority of women who present with hirsutism will be found to have PCOS, whereas only 10% of women who present with alopecia alone will be found to have PCOS. Thus, isolated alopecia is not a clear marker of hyperandrogenemia.
Approximately half of women with PCOS are obese, and obesity increases the risk for developing PCOS. Where does this obesity usually occur?
Typically the obesity occurs in the abdominal region (android obesity or “apple shape”), with an increase in the waist–hip ratio (WHR), as opposed to the lower body (gynoid obesity or “pear shape”).
What causes virilization?
This condition may indicate the presence of one of the less common causes of hyperandrogenism, such as adrenal or ovarian tumor, congenital adrenal hyperplasia, or hyperthecosis. It may also be associated with severe hyperinsulinemia.
Excessive terminal hair growth in women occurring in anatomic areas where the hair follicles are most androgen sensitive.
Hirsutism
T/F Polycystic ovaries are a mandatory sign of PCOS.
False. They are not required if other diagnostic criteria are met.
Why would PCOS cause a woman to have no idea when menses will begin?
Due to a lack of premenstrual symptoms, which is a clinical indicator of anovulation.
How do DHEA-S, DHEA, and androstenedione work to cause androgenic effects?
DHEA-S, DHEA, and androstenedione must be converted to testosterone to cause androgenic effects.
T/F While dyslipidemias are typically more severe in women with PCOS who have a higher body mass index (BMI), the prevalence of dyslipidemias is higher in women with PCOS regardless of BMI than in women without PCOS.
True
T/F The hyperandrogenic state is associated with cardiometabolic dysfunction and psychological distress. As a result, hyperandrogenism is a driver for dyslipidemias, hypertension, diabetes mellitus, and mood disorders, in addition to infertility/subfertility and clinical signs of hyperandrogenemia.
True
What is the dose for metformin and what are the contraindications?
- The usual dose of metformin is 1,500 to 2,550 mg per day, with the dose being started low (500 mg per day) and then gradually increased over 4 to 6 weeks.
- It is contraindicated in cases of impaired renal function, congestive heart failure, hepatic dysfunction, sepsis, or history of alcohol abuse.
Name the 4 phenotypes of PCOS.
- Androgen excess + ovulatory dysfunction
- Androgen excess + polycystic ovarian morphology
- Ovulatory dysfunction + polycystic ovarian morphology
- Androgen excess + ovulatory dysfunction + polycystic ovarian morphology
Why does PCOS increase risk of endometrial cancer?
Chronic, unopposed estrogen stimulation of the endometrium
Is routine screening for insulin resistance in PCOS recommended?
No. Routine screening for insulin resistance is not recommended due to the lack of a uniformly accepted test.
T/F Obesity in PCOS causes worsened outcomes.
True. Women with PCOS who are obese are more likely to develop impaired glucose tolerance, type 2 diabetes, hypertension, dyslipidemias, and estrogen-dependent tumors than women with PCOS who are of normal or low weight.
A theca-lutein cyst or hyperreactio luteinalis is usually bilateral and is seen with trophoblastic disease or with _____. Maternal virilization occurs in 30% of pregnancies affected with a theca-lutein cyst, but does not carry any risk of fetal masculinization.
A theca-lutein cyst or hyperreactio luteinalis is usually bilateral and is seen with trophoblastic disease or with the high human chorionic gonadotropin levels associated with a multiple gestation. Maternal virilization occurs in 30% of pregnancies affected with a theca-lutein cyst, but does not carry any risk of fetal masculinization.
T/F Women with PCOS often develop improved menstrual function with age, and evidence indicates that women with PCOS have prolonged reproductive function and increased ovarian reserve when compared to women who do not have PCOS. Age may improve other manifestations of PCOS, including ovarian morphology and serum testosterone levels.
True
Which of these is not a differential diagnosis for androgen disorders?
- PCOS
- Adrenal hyperplasia
- Androgen-producing tumors
- Cardiovascular disease
CV disease. It is a potential sequela.
What is the most common hyperandrogenetic and endocrinopathic condition in women of reproductive age?
PCOS
T/F Menstrual irregularity is common soon after menarche but warrants investigation if it persists for more than 2 years.
True
Diagnosis of PCOS is one of exclusion. What are the criteria for diagnosis according to Rotterdam (most endorsed b/c it contains broader criteria) and Androgen Excess and PCOS Society?
- Rotterdam:
- Exclusion of other etiologies and 2/3:
- Oligo- or anovulation
- Hyperandrogenism
- Polycystic ovaries
- Exclusion of other etiologies and 2/3:
- Androgen Excess and PCOS Society:
- Exclusion of other etiologies and both of:
- Hyperandrogenism (hirsutism and/or hyperandrogenimia)
- Ovarian dysfunction (Oligo-anovulation and/or polycystic ovaries)
- Exclusion of other etiologies and both of:
How do circulating androgens cause alopecia?
- Miniaturization of androgen-sensitive scalp hair (decreased density)
- Reduced scalp coverage (decreased volume)
T/F Women with PCOS have increased risk for DVTs and should be carefully questioned before using COCs.
True. Women with PCOS should be questioned about additional risk factors for venous thromboembolism.
Cycle length of 35-199 days.
Oligomenorrhea
If a woman is experiencing virilization during pregnancy, a pelvic ultrasound can be very helpful in making the diagnosis. If a solid unilateral ovarian lesion is present, _____ is likely.
If a woman is experiencing virilization during pregnancy, a pelvic ultrasound can be very helpful in making the diagnosis. If a solid unilateral ovarian lesion is present, malignancy is likely.
T/F PCOS is related to an increased risk for endometrial, breast, and ovarian cancers.
False. Although some data collected in earlier studies suggested the possibility of a link between PCOS and ovarian cancer, a recent meta-analysis reveals no increased risk for ovarian or breast cancer in women with PCOS.
PCOS puts women at increased risk for which 3 diseases?
- Endometrial cancer
- DMT2
- Cardiovascular disease
Why is ovulation impaired in PCOS?
The lower FSH levels found in women with PCOS impair follicle maturation and ovulation.
Women with PCOS have more than 3x the odds of developing metabolic syndrome. What are the diagnostic criteria?
Three or more of the following:
- Waist circumference ≥ 88 cm (35 in.)
- Triglycerides ≥ 150 mg/dL or drug treatment for elevated triglycerides
- HDL-C < 50 mg/dL or drug treatment for reduced HDL-C
- Systolic BP ≥ 130 mm Hg and/or diastolic BP of ≥ 85 mm Hg or drug treatment for hypertension
- Fasting glucose ≥ 100 mg/dL or drug treatment for elevated glucose
When do irregular cycles in PCOS usually begin?
Menarche, but they can occur after a regular cycle.
Which medications might be the cause of PCOS-like symptoms instead of PCOS?
- Testosterone
- Anabolic steroids
- Danazol
- Certain progestins
- Glucocorticoids
- Valproic acid
What are the benefits of using progestin in PCOS?
Prevent endometrial hyperplasia and cancer .
What causes increased LH pulse frequency?
The increased LH pulse frequency is caused by increased gonadotropin-releasing hormone (GnRH) pulse frequency, which also causes follicle-stimulating hormone (FSH) levels to be at the low end of the normal range.
_____ is characterized by clitoral hypertrophy, severe hirsutism, deepening of the voice, increased muscle mass, breast atrophy, and male pattern baldness.
Virilization is characterized by clitoral hypertrophy, severe hirsutism, deepening of the voice, increased muscle mass, breast atrophy, and male pattern baldness.
Which ovulatory disfunction causes more significant endocrinopathies (more severe hyperandrogenemia, increased serum LH and cortisol levels, and increased incidence of hyperinsulinemia)?
Amenorrhea
GnRH analogs may be no more effective than COCs and antiandrogens. They are expensive and require injections and estrogen therapy. Who should they be reserved for?
Severe hyperandrogenemia (such as ovarian hyperthecosis) that has not responded to COCs and antiandrogens.
Primary mechanism of action is inhibition of the enzyme ornithine decarboxylase in human skin, which slows the rate of hair growth.
- Eflornithine HCl 13.9% (Vaniqa)
- It is not a depilatory and hair growth returns after discontinuation.
T/F A randomized controlled trial investigated the effect of electro-acupuncture and physical exercise on hyperandrogenism and oligo-anovulation in women with PCOS and found that both low-frequency electro-
acupuncture and physical exercise improved hyperandrogenism and oligo-anovulation in women with PCOS better than no intervention, and low-frequency electro-acupuncture was superior to physical exercise.
True
What are the biochemical features of women with PCOS?
- Predominantly anovulatory
- Typically maintain relatively steady levels of gonadotropins and sex steroids instead of experiencing the fluctuations in these levels characteristic of the normal menstrual cycle.
- Serum concentrations of luteinizing hormone (LH) are higher d/t increased pulse frequency and amplitude (1 pulse/hour).
- FSH levels are at the low end of the normal range d/t GnRH and increased estrone levels resulting from peripheral conversion of increased androstenedione.
- Increased LH:FSH ratio.
