My Ovaries Aren't Working!

Question 1

What is Polycystic ovary syndrome?

Answer 1

collection of s/s related to menstrual irregularity and excess circulating androgen

Question 2

What is NOT required for diagnosing PCOS

Answer 2

ovarian cysts

Question 3

What is the etiology of PCOS?

Answer 3

not completely understood. Likely involves genetic susceptibility and environmental exposure

Question 4

30-40% of PCOS women have what?

Answer 4

impaired glucose tolerance

Question 5

5-10% of PCOS women have what?

Answer 5

Type 2 diabetes

Question 6

What is most common genetic link seen in PCO

Answer 6

twins (monozygotic)

Question 7

What 3 patho pathways are involved in PCOS?

Answer 7

• insulin resistance
• altered gondaotropin behavior
• increased estrogen and androgen production from ovaries

Question 8

What are the 3 things used to diagnosis in PCOS (2/3)

Answer 8

• menstrual cycle irregularity
• polycystic ovaries by ultrasound
• hyperandrogensim

Question 9

What criteria is used to diagnosis PCOS

Answer 9

Rotterdam criteria or Androgen Excess Society

Question 10

What does the androgen excess society require?

Answer 10

hyperandrogensism

and one of the remaining two criteria

Question 11

Which one is casting a wider net?

Answer 11

Androgen Excess society

Question 12

Amenorrhea is defined as…

Answer 12

no menstrual cycles for three or more consecutive months

Question 13

Irregular menses is generally the result of…

Answer 13

anovulation (failed oocyte production)

Question 14

How many follicles are usually seen to meet the Rotterdam criteria

Answer 14

12 or more in each ovary, 2-9 mm in diameter or increased ovarian volume

Question 15

What are two common symptoms seen in PCOS?

Answer 15

Hirsutism

Acne

Question 16

For DDX what labs should be done in PCOS?

Answer 16

Testosterone (androgen secreting tumor)
TSH level (thyroid dysfunction)
Serum prolactin (hyperprolactinemia)
morning 17- hydroxyprogesterone level (Congenital adrenal hyperplasia)
Cortisol (Crushing Disease)

Question 17

What causes congenital adrenal hyperplasia?

Answer 17

21-hydroxylase enzymes

Question 18

How do you measure congenital adrenal hyperplasia?

Answer 18

measure morning serium 17-hydroxprogesterone levels

Question 19

How to rule out androgen secreting tumor?

Answer 19

measure serum free and total testerone level

Question 20

If pt is getting symptoms and is getting worse, what should you screen for?

Answer 20

cushing’s syndrome

Question 21

T/F everyone with PCOS is obese?

Answer 21

FLASE (20% are not)

Question 22

What is evidence of hyperandrogenism?

Answer 22

acne, hirsutism, male pattern baldness, clitoromegaly

Question 23

What should ALWAYS be done when when considering PCOS?

Answer 23

Preggo test

Question 24

What does PCOS treatment focus on?

Answer 24

immediate goals as well as reduction of long term risks

Question 25

What is the 1st txt in obese pts?

Answer 25

weight loss

Question 26

What is the best way to control symptoms?

Answer 26

combined oral contraceptives

Question 27

What is the leading cause of infertility?

Answer 27

PCOS

Question 28

Patients with PCOS have an increased risk for developing what two things?

Answer 28

Impaired glucose tolerance (30-40%)

Type 2 Diabetes (5-10%)

Question 29

Oligomenorrhea is defined as…

Answer 29

nine or fewer menstrual cycles per year

Question 30

If menstrual cycle irregularity and hyperandrogegism are present what is not needed?

Answer 30

a ultrasound to establish PCOS dx

Question 31

T/F polycystic ovaries are common in non-PCOS females?

Answer 31

True (23-57%)

Question 32

Women w/ polycystic ovaries on ultrasound and no clinical evidence of irregular menstruation or hirsutism do not need what?

Answer 32

further workup

Question 33

How is hyperandrogenism tested?

Answer 33

free and total serum testosterone

Question 34

What is evidence of insulin resistance?

Answer 34

acanthosis nigricans

Question 35

Treatment for glucose problem in PCOS?

Answer 35

Metformin