Gametes - PCOS Case Flashcards
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CAH =
Congenital adrenal hyperplasia
Female Athlete Triad
hypothalamic amenorrhea
high level of intensity of exercise reduces body fat to a level so low that menstruation could be affected
aldosterone, cortisol, tesotosterone and estradiol production
what happens if someone is lacking the enzyme 21-OH
cannot produce aldosterone, cannot produce cortisol
-ve feedback on anterior pituitary to stop it overproducing ACTH
No -ve feedback so lots of ACTH
ACTH present, DHEA can still be produced as well as testosterone
CAH
No 21-OH enzyme, don’t produce cortisol but will overproduce adrenal androgens
Not enough cortisol -> hypoglycaemia
weak and dizzy between meals (cortisol maintains blood glucose levels) ⇒ muscle wastage
Pathophysiology of PCOS
metabolic and reproductive endocrine disorder
most common cause of female infertility
causes of PCOS
obesity
excess of ovarian androgen production
hyperinsulinemia (T2D)
intrauterine environment
genetic factors
hypothalamic-pituitary-ovarian axis
how might PCOS present
Excess insulin - both androgens and oestrogen, stimulates keratinocytes to hyper divide - increased proliferation
Insulin and IGF-1 linked to this increase in keratinocyte proliferation
genetic studies of PCOS
increased prevalence of PCOS related traits in siblings with indications for an autosomal dominant model of inheritance
prevalence - 51-66% in 1st degree relatives
genes associated with increased risk of PCOS
CYP11a
HSD17B5
D19S884
CYP11a
cholesterol - pregnenalone
HSD17B5
androstenedione - testosterone
D19S884
PCOS susceptibility locus - associated with insulin resistance
INSR
insulin receptor has been validated as a risk locus for PCOS
intrauterine environment and PCOS
2nd trimester amniotic fluid testosterone levels are elevated in female foetuses of PCOS vs normal mothers
the apparent of IU milieu in poorly controlled diabetics who end with stillborn foetuses showed ovarian changes similar to those seen in PCOS
link between androgen excess in utero and the maternal environment remains unclear