Ovarian pathologies Flashcards
what is PCOS?
criteria in diagnosing?
is a heterogeneous endocrine disorder that appears to emerge at puberty
in PCOS, theres an increase in the normal pulsatile of GnRH due to lack of progesterone in the luteal phase (so there no negative feedback on the hypothalamus)–> this causes an increase of LH to FSH–> theca cells releases so much androstenedione–> gets in BS & some get converted into estrone by aromatase in fat, this increase in estrogen causes negative feedback to AP to inhibit FSH and bc LH is already high, maku LH surge!–> dominant follicle stays the ovary and becomes a cyst!
Causes of PCOS (2)
unknown
- Excess luteinising hormone (LH) – This stimulates ovarian production of androgens.
- Insulin resistance – high lnsulin secretion suppress hepatic production of sex hormone binding globulin (_SHBG_), resulting in higher levels of free circulating androgens.
as testosterone is bound to SHBG, more testosterone is available in the blood in the biologically active unbound form, even though the total testosterone level may be normal or only modestly elevated
Despite the high levels of LH, the increased circulating androgens SUPRESS the LH surge. therfore follicles develop in the ovary, but are arrested at an early stage and they remain visible as “cysts” within the ovary.
Complications and clinical feautres of PCOS
Effects of hyperinsulinaemia in PCOS (3)
Reduced production (SHBG) in the liver —more testosterone available blood in the active unbound form, even though the total testosterone level may be normal or only modestly elevated
Increased androgen production — excessive insulin stimulates ovaries & adrenal glands to produce more androgens
Insulin resistance can also lead to weight gain: can make PCOS symptoms worse–> Excess body fat causes the body to produce even more insulin.
Investigations of PCOS
what is the diagnostic TEST?
FAI
high free androgen index, and is a result of suppressed SHBG levels, resulting in higher levels of free testosterone
Mx PCOS
in amenorrhoeic women, it is important to protect the endometrium from hyperplasia by inducing at least 3 bleeds per year. This can be done by using:
- Cocp (low dose).
- Dydrogesterone – a progesterone analogue. This is often used if the combined pill is contraindicated.
You can give mirena coil for endometrial protection
ovarian torsion
causes?
which ppl is it most likely to occur?
symptoms (3)
EMERGENCY!!
- Sudden onset of unilateral pelvic pain
- N & V
- the ovary can twist and untwist intermittently, causing colicky pain
ovary twists in relation to the surrounding connective tissue, fallopian tube & blood supply (the adnexa).
►►usually due to an ovarian mass larger than 5cm, such as a cyst or a tumour.
- More likely to occur with benign tumours.
- It is also more likely to occur during pregnancy.
►►can also happen with normal ovaries in young girls b4 menarche, when they have longer infundibulopelvic ligaments that can twist more easily.
Pathophysiology
Twisting of the adnexa and BS to the ovary –> ischaemia.
If torsion persists –> necrosis will occur–> function of ovary dies .
ovarian torsion
- Signs? 3
- Diagnosis? initial vs definitive?
On examination
- localised tenderness.
- a palpable mass in the pelvis,(absence of mass does not exclude the diagnosis.)
- cervical motion tenderness or excitation
Diagnosis
≈≈ Transvaginal Pelvic USS is the initial investigation of choice.
“whirlpool sign” or free fluid in pelvis and edema of the ovary.
≈≈ Doppler studies may show a lack of blood flow.
≈≈ The definitive diagnosis –> laparoscopic surgery.
ovarian torsion Mx (2)
emergency admission under gynaecology!!!
Depending on the duration and severity of the illness they require LAPROSCOPIC Sx to either:
- Un-twist the ovary and fix it in place (detorsion)
- Remove the affected ovary (oophorectomy)
The decision whether to save the ovary or remove it is made during the surgery, based on a visual inspection of the ovary. Laparotomy may be required where there is a large ovarian mass or malignancy is suspected.
Types of ovarian cysts?
Diagnosis of ovarian cyst?
Management ovarian cyst?
Complications ovarian cyst (4)
