Lecture 10 - PCOS: CV & hormones Flashcards
- what does PCOS stand for?
- it is the most common what?
- affects __-___% of premonopausal female depending on what?
Polycystic ovary syndrome
- most common female endocrinopathy (hormonal disorder)
- 6-20% depending on diagnostic criteria
the _________ criteria define PCOS as ______ of the _____ criteria
- which critera?
Rotterdam criteria –> 2 of 3
1. anovulation/oligo-ovulation/menstrual irregularities
2. polycystic appearing ovaries
3. clinical and/or biochemical hyperandrogenism = elevated testosterone (in 80% of women with PCOS)
what are the 4 things that count as menstrual irregularities?
- oligomenorrhea: less than 10 menstruations/year
- amenorrhea: absence of menses for greater than 6 months
- oligo-ovulation: infrequent or irregular ovulation
- anovulation: failure to release an egg
what are the 2 characteristics when looking for polycystic appearing ovaries?
- how can you know?
- higher volume of follicules: 12 or more follicles
- bigger diameter: 2-9mm follicles
- through transvaginal ultrasound
- what are clinical manifestation of hyperandrogenism? (3) –> limitations?
- what are biochemical manifestations of hyperandrogenism?
CLINICAL:
1. hirsutism (amount of hair you have)
2. acne
3. alopecia (hair loss)
- compare patient with images on a chard = very subjective, doesnt take into account ethnicity or genetics
BIOCHEMICAL (in blood)
1. free testosterone
2. free androgen index
- is PCOS associated with short or long term health consequences?
- what are the consequences? (4 big categories + sub)
short AND long term!
METABOLIC:
- insulin resistance + diabetes + dyslipidemia + obesity
REPRODUCTIVE:
- infertility + irregular periods
CARDIOVASCULAR:
- hypertension + endothelial dysfunction + arterial stiffness + elevated MSNA
PSYCHOLOGICAL:
- depression + anxiety + eating disorders + decreased quality of life
*all the consequences are interrelated!
what does data show about blood pressure in women with PCOS? (2)
- trend toward higher systolic blood pressure (doesn’t mean hypertensive) in women with PCOS
- animal models of PCOS support elevated blood pressure in PCOS, typically below guideline levels for antihypertensive treatment (130-139/80-89 ish)
what is endothelial dysfunction?
- is a marker for what? why?
- is an independent predictor for what?
- endothelium (inner of arteries) is unable to maintain vascular equilibrium/homeostasis –> increased vasoconstrictors (ET-1) + decreased vasodilators (nitric oxide)
- marker of early atherosclerosis (plaque build up in lining of arteries) –> chronic inflammation + atherosclerotic plaques –> adverse changes in vascular structure and function
- independent predictor of future cardiovascular events (heart attack, stroke…)
how to assess endothelial dysfunction? Explain steps
- through a flow mediated dilation (FMD) test!
- commonly used in research
1. baseline measurement of brachial artery through ultrasound (3min)
2. inflate cuff to block blood flow –> ischemia below cuff: distal vasculature dilates, decreasing vascular resistance
3. cuff releases –> dramatic increase in blood flow
4. shear stress –> endothelium releases vasodilators and NO –> healthy artery dilates
*researcher looks at blood flow amounts + machine measures how much the artery dilates (can’t see with naked eye) - the more it dilates, the healthier the patient is
what do studies show about endothelial dysfunction in PCOS? (2 studies)
- meta-analysis
- endothelial function quantified as FMD
- brachial artery FMD is impaired in PCOS –> impaired around 3% - her own study:
- lean healthy = high FMD response (median = 10% FMD)
- lean PCOS = low FMD (median = 5%)
- obese healthy = moderate (median = 7.8% ish)
- obese PCOS = not THAT much lower than control (6.8% FMD)
*lean women with PCOS might have more significant endothelial dysfunction than their obese counterparts
what is MSNA?
- explained pathway figure –> elevated SNS vs decreased SNS can lead to what health measure?
- elevated sympathetic activity leads to what?
muscle sympathetic nerve activity
- measure of SNS (fight or flight nervous system
1. central integration site/cortex & brainstem innervate sympathetic preganglionic neuron which innervates postganglionic neuron
2. release of neurotransmitters –> innervates skeletal smooth muscle
a) increase SNS = vasoconstriction = favors increase mean arterial pressure (MAP)
b) decrease SNS = vasodilation = favors decrease MAP
- is a hallmark of myriad disease states
how to increase SNS?
- vs decrease SNS?
INCREASE:
- holding breath, exercise, put hands in cold water, getting scared
DECREASE:
- heat, meditate/slow breathing
what does data say about MSNA in PCOS women?
females with PCOS generally have elevated MSNA
what are the 3 cardiovascular consequences of PCOS?
- what drives this increase in CVD risk?
- females with PCOS generally have elevated blood pressure
- females with PCOS have impaired endothelial function (inside of artery ish –> increase BP)
- females with PCOS generally have elevated MSNA (outside of artery –> leads to vasoconstriction = increase BP)
- hormones! –> androgens likely contribute to increased cardiovascular risk in females with PCOS
what is hyperandrogenism?
- present in ___-___% women with PCOS
- associated with 2 main categories + sub
high testosterone levels
- present in 60-80%
1. METABOLIC consequences
2. CARDIOVASCULAR consequences:
- blood pressure increases as free androgen index increases
- endothelial dysfunction –> % FMD decreases as free testosterone increases
- elevated sympathetic outflow –> MSNA increases as [testosterone] increases
