Patho- Exam 2- PCOS

Question 1

What are two common non neoplastic and functional lesions of the ovaries?

Answer 1

Functional ( benign ) cysts and tumors , these are normal in females to a certain degree

Question 2

The ova develop in the cortical lesion, why is this important clinically?

Answer 2

That if cyst form they will be in the cortex and budge outward, they could rupture into the peritoneum.

Question 3

Follicle Cysts (Cystic follicles)

Answer 3

Follicle Cysts are so common, they are considered normal

Question 4

What are the possible Pathogenesis of Follicle Cysts ?

Answer 4

Unruptured graafian follicles or Follicles which ruptured and seal off immediately

Question 5

What are the graafian follicles?

Answer 5

Unruptured follicles with a lot of granulosa cells and estrogen in the antrum, but It never has the LH surge that causes the release of the egg, instead it just gets larger in size which will cause increased pain.

Question 6

What are some Characteristics of Follicle Cysts?

Answer 6

Occur in multiples
Contain Clear serous fluid
May be associated with increased estrogen production

Question 7

Luteal Cysts

Answer 7

Luteal Cysts

Question 8

Are Luteal Cysts common/ normal?

Answer 8

Granulosa luteal cysts are normally in the ovary

Question 9

What are Luteal Cysts lined with and what do they look like?

Answer 9

Lined with luteinized granulosa cells: bright yellow

Question 10

What is a possible outcome of a Luteal Cysts?

Answer 10

Occasionally rupture: peritoneal manifestations

Question 11

When Luteal Cysts are chornic or old what do they look like?

Answer 11

Old hemorrhage and fibrosis look like endometirotic cysts.

Question 12

Polycystic ovarian syndrome

Answer 12

Polycystic ovarian syndrome

Question 13

Polycystic ovarian syndrome is aka as:

Answer 13

Stein-Leventhal syndrome

Question 14

Polycystic ovarian syndrome is considered a Heterogeneous disorder, what does this mean?

Answer 14

There is a number of thing going on/ wrong at once.

Question 15

What is the size of the ovaries in Polycystic ovarian syndrome ?

Answer 15

Ovaries 2X size

Question 16

What happeneds to the cortex during Polycystic ovarian syndrome ?

Answer 16

Thick fibrotic cortex- as the cyst is forming the ovarie has to restructure its self

Question 17

What is the etiology of Polycystic ovarian syndrome ?

Answer 17

Unclear etiology- has to do with genetic mutations and or the environmental influances.

Question 18

what does Polycystic ovarian syndrome Manifests with?

Answer 18

Numerous cystic follicles
Ovulatory dysfunction: anovulation
Androgen excess: hirstuism
Obesity : 40% - DMII plays a role in PCOS but not in everyone

Question 19

What is the Pathogenesis of Polycystic ovarian syndrome ?

Answer 19

Current theory: complex genetic trait with variants &

environmental factors

Question 20

What is the pathogenesis of Polycystic ovarian syndrome ?

Answer 20

the start of PCOS is a defect up in the hypothalamus and ant pit resulting in a lot of LH compaired to FSH which will stimulate thecal cells to produce a lot of androgens which will cause the follicle to arrest , premature follicular atresia, you get multiple cyst and they never release an egg so you have an Anovulatory state. The increased androgens also leads to Hyperandrogenism leads to hirsutism, acne, alopecia

Androgens cause:
Premature follicular atresia
Multiple follicular cysts
Anovulatory state
Hyperandrogenism leads to hirsutism, acne, alopecia

Question 21

What is the genetic mutation that leads to PCOS?

Answer 21

There is a genetic mutation that leads to an increase in frequency of GNRH paulses
This goes to the anterior pit gland, causing a lot of LH ( not as much FSH)
This goes to the ovaries
FSH: causes proliferation and a little estrogen production
LH: the HUGE amount affects the thecal cells and turns on the enzyme for androgen production.

The increased androgens will cause 3 things,
Increased hair, acne, alopecia
In the body androgens are converted to estrogen
Stop follicular growth (androgens stop follicular growth!)

Question 22

What effect does increased estrogen have?

Answer 22

It will go to the uterus and cause proliferation and thinking→ DUB→Hyperplasia→Endometiral CA.

Question 23

How does Obesity affect PCOS?

Answer 23

People with DMII have a lot of insulin, the insulin just does not work, the insulin does turn on an enzyme in the thecal cells to produce more androgens.

Question 24

So why does metfromin work for people with PCOS?

Answer 24

Metformin increases insulin sensitivity, causing insulin levels to go down, less available to stimulate the thecal cells, and therefore the symptoms of PCOS decrease

Question 25

What urine test can you do for PCOS?

Answer 25

There will be increased LH in the urine in patients with PCOS

Question 26

Review of the pathogenenisis of PCOS (From TBBs notes)

Answer 26

Accelerated GnRH activity with heightened pituitary response
Accelerated GnRH caused by ??
Insulin & IGFs
Rapid frequency of pulses favors LH
Frequency is not affected by BMI (only amplitude is) therefore BMI does not influence LH release
Excess LH activity in urine and plasma of women with PCOS
LH receptor is overexpressed in thecal and granulosa cells from polycystic ovaries
Genetic variants of the LH-beta subunit found in PCOS patients