PCOS Flashcards
Definition
Endocrinopathy causes menstrual irregularity and hyperandrogenism
Classic features
Irregular M/C :
oligomenorrhoea
Amenorrhea( an ovulation)
Hyperandrogenism:
Hirsutism
Acne
Male pattern of alopecia
Other signs and symptoms
Risk factors for CVD Obesity Glucose intolerance ( Type 2 DM) Dyslipidemia NASH Obstructive sleep apnea
Excess androgens
Virilization : (exaggerated masculine features)
Deepening of the voice
Clitoromegally
Mood
Depression
Anxiety
Ultrasound
Cysts in ovaries
Rotterdam criteria
2/3
Oligo/an-ovulation
Clin/Biochem features of hyperandrogenism
U/S: PCO
Lab
- Total testosterone
- 17-hydroxyprogestrone: to exclude CAH d/t 21 hydroxylase deficiency
To exclude other causes ( PCOS = diagnosis of exclusion)
- HCG
- TSH
- PRL
- LH to FSH ( 2:1)
Conditions mimic PCOS
CAH Hyperprolactinemia Androgen secreting tumour (virilization and sudden onset of worsening of sx) Hypogonadotrophic hypodonadism Thyroid disease
Drugs that affect testosterone levels
O-P combined oral
Metformin
Spironolactone
Cardio metabolic assessment
BP
BMI
fasting lipid profile
Oral glucose tolerance test/ Fasting glucose and HBA1C
Obstructive sleep apnea
Snoring
Headache in morning
Excessive day time sleepiness
Pathophysiology
Endocrine and Hormonal imbalance
PCOS increases insulin resistance
Increased insulin and LH stimulate androgen production by theca cells
Androgens converted into estrone leads to endometrial hyperplasia (unopposed estrogen)
Low HCG levels
Low FSH hence impaired development of ovarian follicles
There impaired ovulation
Increased oestrogen and low progesterone (released from CL post ovulation)
Management
COC
Progesterone for withdrawal bleeds
Metformin Dexamathesone Anti-androgens Acne Mx: Topical benzoyl peroxide with AB: clindamycin/ erythromycin topical or oral retinoids Statins
Complications
Metabolic :
Dyslipidaemia
CVD
Gynae:
endometrial hyperplasia
Obstetrics: Infertility Early miscarriages Gestational Hypertension and DM Preterm birth
