Path of Polycystic Ovarian Synd.

Question 0

3 NIH criteria for PCOS?

Answer 0

Hyperandrogenemia.
Chronic amenorrhea or oligomenorrhea.
Not caused by other defined disorder.

Question 1

What’s the most common endocrine disorder affecting women of child-bearing age?

Answer 1

Polycystic Ovarian Syndrome (PCOS)

Question 2

What is the criterion that the Rotterdam criteria have in addition to those of the NIH?

Answer 2

Polycystic ovaries on ultrasound.

Question 3

Which criterion is most important?

Answer 3

The hyperandrogenemia criterion (can be symptomatic or measured free T). Many adolescents will have irregular periods with polycystic ovaries but not progress to PCOS.

Question 4

2 features of oligo-ovulation / anovulation in PCOS?

Answer 4

Less than 6-9 menses / yr.

Low mid-luteal progesterone levels.

Question 5

What 2 endocrine disorders that could cause oligo-ovulation / anovulation must be ruled out when making PCOS Dx?

Answer 5

Hypothyroidism

Hyperprolactinemia

Question 6

3 clinical features of hyperandrogenemia?

Answer 6

Hirsutism
Acne
Male-pattern baldness

Question 7

Which androgens are measured when working up PCOS?

Answer 7

Testosterone

DHEA

Question 8

What’s the definition of “polycystic” ovaries?

Answer 8

12 or more follicles seen on ultrasound that are above a certain size. Presence in single ovary is sufficient.

Question 9

Simplistic model for what’s going on in PCOS?

Answer 9

Non-dominant follicles are more responsive to FSH.

Question 10

Does PCOS have any racial differences?

Answer 10

Seems to be more severe in African Americans.

Question 11

Is obesity part of the PCOS diagnosis? What’s obesity got to do with with PCOS?

Answer 11

Nope. But obesity/metabolic symptom and PCOS are correlated……

Question 12

How is GnRH release different in PCOS?

Answer 12

Higher frequency -> favors LH release more.

Question 13

How is feedback different in PCOS?

Answer 13

Hypothalamus is less sensitive to sex hormone feedback.

Question 14

What’s a hypothesis as to the etiology of PCOS?

Answer 14

Increased exposure to androgens may decrease sensitivity feedback in the HPO axis.

Question 15

How is the response to FSH different in granulosa cells in PCOS?

Answer 15

Granulosa cells make more estrogen in response to FSH.

Question 16

How do numbers of germ cells compare in PCOS vs. normal?

Answer 16

More germ cells in the ovaries of women with PCOS.

Question 17

What’s insulin got to do with PCOS?

Answer 17

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.

Question 18

What’s a sign of insulin resistance often seen in PCOS?

Answer 18

Acanthosis nigricans - black, velvety skin.

Question 19

What causes the insulin resistance in PCOS?

Answer 19

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…)

Question 20

Genetics of PCOS?

Answer 20

Polygenetic: lots of candidate genes with a small effect.

Question 21

Treatment for infertility caused by PCOS? How well does it work?

Answer 21

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)

Question 22

What’s risk to patient with PCOS who does get pregnant?

Answer 22

Higher risk for eclampsia, gestational diabetes, pre-term birth, and perinatal mortality.

Question 23

4-5 treatments for PCOS?

Answer 23

OCPs / cyclic progesterone
Anti-androgens (topical or systemic)
Weight loss
Insulin-sensitizing (agent)