Path of Polycystic Ovarian Synd. Flashcards
3 NIH criteria for PCOS?
Hyperandrogenemia.
Chronic amenorrhea or oligomenorrhea.
Not caused by other defined disorder.
What’s the most common endocrine disorder affecting women of child-bearing age?
Polycystic Ovarian Syndrome (PCOS)
What is the criterion that the Rotterdam criteria have in addition to those of the NIH?
Polycystic ovaries on ultrasound.
Which criterion is most important?
The hyperandrogenemia criterion (can be symptomatic or measured free T). Many adolescents will have irregular periods with polycystic ovaries but not progress to PCOS.
2 features of oligo-ovulation / anovulation in PCOS?
Less than 6-9 menses / yr.
Low mid-luteal progesterone levels.
What 2 endocrine disorders that could cause oligo-ovulation / anovulation must be ruled out when making PCOS Dx?
Hypothyroidism
Hyperprolactinemia
3 clinical features of hyperandrogenemia?
Hirsutism
Acne
Male-pattern baldness
Which androgens are measured when working up PCOS?
Testosterone
DHEA
What’s the definition of “polycystic” ovaries?
12 or more follicles seen on ultrasound that are above a certain size. Presence in single ovary is sufficient.
Simplistic model for what’s going on in PCOS?
Non-dominant follicles are more responsive to FSH.
Does PCOS have any racial differences?
Seems to be more severe in African Americans.
Is obesity part of the PCOS diagnosis? What’s obesity got to do with with PCOS?
Nope. But obesity/metabolic symptom and PCOS are correlated……
How is GnRH release different in PCOS?
Higher frequency -> favors LH release more.
How is feedback different in PCOS?
Hypothalamus is less sensitive to sex hormone feedback.
What’s a hypothesis as to the etiology of PCOS?
Increased exposure to androgens may decrease sensitivity feedback in the HPO axis.
How is the response to FSH different in granulosa cells in PCOS?
Granulosa cells make more estrogen in response to FSH.
How do numbers of germ cells compare in PCOS vs. normal?
More germ cells in the ovaries of women with PCOS.
What’s insulin got to do with PCOS?
Theca cells are more sensitive to insulin -> androgen production.
Insulin resistance is tissue selective (i.e. not in the ovaries) and is highly prevalent in PCOS population.
What’s a sign of insulin resistance often seen in PCOS?
Acanthosis nigricans - black, velvety skin.
What causes the insulin resistance in PCOS?
Post-receptor mechanisms, so far as we know.
(decreased activity of a serine kinase -> decreased phosphorylation of a serine in the cytoplasmic domain of the insulin receptor…)
Genetics of PCOS?
Polygenetic: lots of candidate genes with a small effect.
Treatment for infertility caused by PCOS? How well does it work?
Clomiphene followed by FSH if necessary.
Seems to work pretty well - study shown had about 70% pregnancy at 2 years. (but it’s hard to say how infertile women were to begin with)
What’s risk to patient with PCOS who does get pregnant?
Higher risk for eclampsia, gestational diabetes, pre-term birth, and perinatal mortality.
4-5 treatments for PCOS?
OCPs / cyclic progesterone
Anti-androgens (topical or systemic)
Weight loss
Insulin-sensitizing (agent)
