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BMS250 > Pathophysiology of PCOS (Week 1) > Flashcards

Pathophysiology of PCOS (Week 1) Flashcards

1
Q

What is PCOS?

A

The most common endocrine disorder in reproductive age people with uterus/ovaries characterized by irregular menstrual periods, high androgen levels, and polycystic ovaries.

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2
Q

What is the prevalence of PCOS?

A

5-15%, closer to 20% in overweight and obese populations.

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3
Q

What are the underlying mechanisms of PCOS?

A
  • Inappropriate gonadotropin secretion
  • Insulin resistance with hyperinsulinemia
  • Excessive androgen production
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4
Q

What psychological manifestations are associated with PCOS?

A

Anxiety, depression, and poor self-image.

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5
Q

What long-term health consequences are associated with PCOS?

A
  • Infertility
  • Metabolic health issues
  • Cardiovascular health issues
  • Lower quality and satisfaction of life
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6
Q

What role do NDs play in managing PCOS?

A

Patient education, prevention, diet and lifestyle support.

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7
Q

What is the significance of altered gonadotropin secretion in PCOS?

A

Leads to an increase in LH hormone secretion compared to FSH secretion, often resulting in a higher LH:FSH ratio.

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8
Q

What is the typical LH:FSH ratio in PCOS?

A

Above 2:1.

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9
Q

How does insulin resistance contribute to PCOS?

A

Leads to compensatory hyperinsulinemia and reduced glucose uptake from target cells, affecting menstrual function and androgen levels.

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10
Q

What are the clinical signs of hyperandrogenism in PCOS?

A
  • Hirsutism
  • Acne
  • Alopecia
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11
Q

What is hirsutism?

A

Excessive hair growth in androgen-sensitive areas due to elevated androgen levels.

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12
Q

What are common areas affected by hirsutism?

A
  • Upper lip
  • Chin
  • Sideburns
  • Chest
  • Lower abdomen
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13
Q

What is the role of sex-hormone binding globulin (SHBG) in PCOS?

A

Binds most sex hormones; its production is suppressed by insulin, leading to increased free androgens.

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14
Q

What is the relationship between obesity and PCOS?

A

Women with PCOS are more likely to be obese, which exacerbates insulin resistance and hyperandrogenism.

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15
Q

What are the symptoms of menstrual dysfunction in PCOS?

A
  • Amenorrhea
  • Oligomenorrhea
  • Heavy menstrual bleeding
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16
Q

What is acanthosis nigricans?

A

A thick grey-brown velvety plaque in flexure areas, a cutaneous marker of insulin resistance.

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17
Q

What factors are involved in the pathogenesis of acne in PCOS?

A
  • Blockage of the follicular opening by hyperkeratosis
  • Sebum overproduction
  • Proliferation of Propionibacterium acnes
  • Inflammation
18
Q

What is the prevalence of dyslipidemia in PCOS?

A

Close to 70%.

19
Q

What are the signs of increased androgen levels?

A
  • Hirsutism
  • Acne
  • Alopecia
  • Increased muscle mass
  • Deepening voice
  • Clitoromegaly
20
Q

What is the role of insulin resistance in the development of T2DM in PCOS?

A

Insulin resistance leads to impaired glucose tolerance and increases the risk of developing T2DM.

21
Q

What is the definition of impaired glucose tolerance?

A

Fasting glucose of 6.1-6.9 mmol/L or Hb A1c of 6.0-6.4%.

22
Q

True or False: Elevated serum androgens in PCOS can be converted to estrogen in adipose tissue.

A

True.

23
Q

What is the typical onset of menstrual irregularities in individuals with PCOS?

A

Usually begins with menarche.

24
Q

What are the common health conditions associated with insulin resistance in PCOS?

A
  • Type 2 Diabetes Mellitus (T2DM)
  • Hypertension
  • Dyslipidemia
  • Cardiovascular disease
25
Q

What is insulin resistance associated with?

A

Impaired glucose tolerance and prediabetes leading to T2DM

Insulin resistance can lead to type 2 diabetes mellitus (T2DM) if not addressed.

26
Q

What are the criteria for impaired glucose tolerance?

A

Fasting glucose of 6.1-6.9 mmol/L or Hb A1c of 6.0-6.4% or 2-hour post oral glucose tolerance test with 75 grams of glucose 7.8-11 mmol/L

These criteria help identify individuals at risk for diabetes.

27
Q

What is the prevalence of impaired glucose tolerance in obese individuals with PCOS?

A

30%

This indicates a significant risk of developing glucose intolerance in this population.

28
Q

What is the prevalence of T2DM in obese individuals with PCOS?

A

7%

This statistic highlights the increased risk of diabetes in women with PCOS.

29
Q

How does anovulation relate to insulin resistance in PCOS?

A

Those who are anovulatory tend to have a higher degree of insulin resistance than those who ovulate

This suggests that ovulatory status may affect metabolic health.

30
Q

What test should be used to screen for impaired glucose tolerance and T2DM?

A

75 grams oral glucose tolerance test

This test is the most sensitive for detecting glucose intolerance.

31
Q

What alternative tests can be used for screening if the OGTT is inconvenient?

A

Fasting blood glucose or HbA1c test

These tests are less sensitive than the OGTT.

32
Q

What are the BMI criteria for high-risk women for glucose intolerance screening?

A

BMI > 25 kg/m2 or BMI > 23 kg/m2 in Asian women

Additional criteria include a history of abnormal glucose tolerance or family history of diabetes.

33
Q

What is the increased risk of endometrial neoplasia in individuals with PCOS?

A

3-4 fold increased risk

This highlights the importance of monitoring endometrial health in women with PCOS.

34
Q

What factors increase the risk of endometrial hyperplasia in PCOS?

A

Anovulation and unopposed estrogen

Both factors contribute to the risk of developing endometrial changes.

35
Q

How do hyperandrogenism and hyperinsulinemia affect SHBG levels?

A

They decrease circulating SHBG and increase circulating estrogen

This can lead to a higher risk of endometrial issues.

36
Q

What is the relative risk of myocardial infarction in participants with PCOS compared to controls?

A

7.4 relative risk

This indicates a significant cardiovascular risk associated with PCOS.

37
Q

What complications are associated with pregnancy in women with PCOS?

A

Increased rate of early miscarriage, hypertensive disorders, gestational diabetes, and preterm birth

These complications can significantly affect maternal and fetal health.

38
Q

What psychological complications are women with PCOS at increased risk for?

A

Anxiety, depression, eating disorders, and negative body image

Mental health support is crucial for women with PCOS.

39
Q

What characterizes metabolic syndrome (METS)?

A

Insulin resistance, obesity, dyslipidemia, and hypertension

METS is a significant risk factor for cardiovascular disease and T2DM.

40
Q

What is the prevalence of metabolic syndrome in women with PCOS?

A

Approximately 45%

This prevalence is higher compared to age-matched controls.

BMS250 (15 decks)

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