Ovarian disorders Flashcards
PCOS is d/t
Chronic anovulation
Polycystic ovaries
Hyperandrogenism
assoc. w/ hirsutism, obesity, glucose intolerance/DM, metabolic, dyslipid, NAFLD
PCOS path
- Abn. androgen and estrogen metabolism
- Control of androgen production is unregulated
Insulin resistance and hyperinsulinemia
Decreased adiponectin
which hormone is more effected by PCOS? LH or FSH?
LH!
FSH is downregulated by estrone
what is the role of insulin resistance and hyperinsulinemia in PCOS?
Incr’d insulin alters gonadotropin effects on ovarian function
Incr’d insulin decreases synthesis of sex hormone binding globulin and IGF
what is decreased adiponectin in PCOS
Regulates lipid metabolism and glucose levels
Insulin sensitizer
PCOS path
incr. LH –> incr. androgens
FSH production depressed
incr. androgens –> converted to estrogen via adipose tissue
incr. circulating insulin –> more androgens
clinical presentation of PCOS
Infertility Oligomenorrhea/Amenorrhea Obesity Acne Hirsutism acanthosis nigricans
dx for PCOS
ovulatory dysfx (amenorrhea) clinical/biochem signs of hyperandrogenism, polycystic ovaries
exclude: premature ovarian failure, physical stress, obesity, no hormonal contraceptives, Pituitary adenoma / hyperprolactinemia
Thyroid disorder
U/S findings for PCOS
“string of pearls”
> 12 follicles measuring 2-9mm (Rotterdam criteria)
no evidence of corpus luteum
To evaluate for hyperandrogenism, start with measuring ____ in suspected PCOS pts
total testosterone
Hyperandrogenism requires:
17 – OH progesterone DHEA-S cortisol prolactin TSH *beta HCG
+/- FPG, OGTT, A1c, lipids
Tx for PCOS
Weight loss Metformin (only pt's w/hyperinsulinemia) combo OCP's (low androgenic activity) fertility consultation provera 10mg QD x 10d life-long lifestyle modification
Hirsutism tx for PCOS
1st line: COCs
Add on therapy
Anti-androgen – spironolactone 50-100 mg BID
Topical eflornithine (Vaniqa) - Antiprotozoal
Mechanical hair removal
PCOS risks
Endometrial Hyperplasia/Carcinoma Type II diabetes Hypertension Hyperlipidemia Cardiovascular disease Stroke Infertility Metabolic syndrome Sleep apnea
eval of adnexal mass
Pre-menarchal: ovaries should not be palpable
reproductive: palp 50% of time
peri-menopausal: inr. likelihood of residual functional cysts
post-menopausal: nonpalp w/in 3 yrs of onset
what are examples of functional ovarian cysts?
Follicular Cysts
Corpus Luteum Cysts
Theca Lutein Cysts
nonfunctional ovarian neoplasm examples
Epithelial cell tumors
germ cell tumors
stromal cell tumors
functional ovarian cysts path
One of these follicles in one of the ovaries becomes the mature follicle (Graafian follicle) and contains the ovum
at time of ovulation –> Graafian follicle ruptures and the ovum is released, now the follicle is referred to as the corpus luteum
If fertilization occurs –> corpus luteum will persist and secrete progesterone to support pregnancy
characteristics of fx follicular ovarian cysts
MC
2-8cm
non-malignant
regress after 1-2 menstrual cycles
from either: failure of the mature follicle to rupture OR failure of the non-dominant follicles to undergo atresia in the presence of the mature follicle
characteristics of corpus luteum fx ovarian cyst
size = 3-11cm
usu. resolves after 1-2 menstrual cycles
following ovulation, blood accumulates within the cavity of the corpus luteum which stimulates resorption. If resorption doesn’t occur –> cyst.
Fx ovarian cyst theca lutein cyst characteristics
least common, B/L, clear straw colored fluid
elevated chorionic gonadotropin levels (hydatidiform mole, choriocarcionma)
tx underlying so cyst will regress
nonfx epithelial cell ovarian tumor: serous cystadenoma characteristics
MC epithelial cell neoplasm
30-50y/o
70% benign
tx = surg (cystectomy vs oophorectomy)
nonfx epithelial cell ovarian tumor: mucinous cystadenoma
15% malignant, can be very large
U/S findings: multilocular septations
tx = surg.
nonfx germ cell ovarian teratoma: benign cystic teratoma
Represents 40-50% of benign neoplasms
Reproductive age women (median age 30)
Malignancy rate < 1%
