PCOS Flashcards
PCOS aka
Stein Leventhal syndrome
PCOS.?
Excessive androgen production from Ovary
Features of PCOS
Hirsutism , Male pattern baldness, inc LDL , Dec HDL and Risk of Heart diseases .
PCOS is MC in
Obese female
E1 : E2 ratio in Females with PCOS
2:1
E2 : E1 raion in Females with PCOS
1:2
normal FSH : LH levels
FSH < LH
FSH : LH in PCOS
1 : 2 or 1 : 3
LH surge in PCOS
Absent - Consistently high levels of LH
inc LH in Early part of cycle leads to
Anovulation and Theca cell hypertrophy - Inc androgen levels.
Infertility, Absent or reduced progesterone and Necklace pattern on USG
After puberty, Granulosa cell of small Follicles produce
Anti Mullerian Hormone.
In PCOS , No corpus luteum and Dec progesterone causes
Secondary amenorrhea and Anovulatory or Irregular cycles.
Insulin Resistance in PCOS manifests as
Acanthosis Nigricans
Acanthosis Nigricans
Hyper pigmented skin in axillary area or nape of the neck
Investigations for Insulin resistance
Serum fasting glucose levels / Serum fasting insulin levels
IF < 4.5 = Insulin resistance
Hormones INC in PCOS
Estrogen LH , Androgens LDL AMH
Hormones DEC in PCOS
Progesterone
FSH
HDL
SHBG
TSH, Prolactin and inhibin level in PCOS
normal
Diagnosis of PCOS
Rotterdam criteria
Rotterdam criteria
Any 2 of the following .
1) Hyperandrogenism - Hirsutism - Biochemically high levels
2) Ovulatory dysfunction - Anovulatory or irregular cycles or amenorrhea
3) USG evidence - > 12 follicles ,< 1 cm in size follicle, Volume >10cc
Obesity is a diagnostic criteria for PCOS - T or F
False.
LDL : HDL is not a diagnostic criteria for PCOS. T or F
True
MC age group for PCOS
reproductive age group
PCOS is rare in which age group
Prepubertal
Risk Factor for Prepubertal PCOS
Early onset of Adrenarche
Obesity with Acanthosis
LBW
Heterosexual Precocious puberty .
Necklace pattern on USG is not a diagnostic criteria for PCOS . T or F
True
Ovaries can appear normal on USG in PCOS. T or F
true
HAIR - AN syndrome
HyperAndrogenism
Insulin Resistance
Acanthosis Nigricans
Metabolic X syndrome.
Abdominal obesity TGL > 150 mg/dl HDL <50 mg/dl BP >130/85 mmHg FBS - 110-126 mg/dl 2hr PP - 140 -199 mg/dl any 3 of the 5 should be present
Syndromes associated with PCOS
HAIR - AN and Metabolic X syndrome.
Complications of PCOS - Short term
Infertility
Hirsutism and irregular cycles
Long term complications of PCOS - Long Term
Heart disease,
Hyper - Estrogenic conditions
DM, Obesity complications.
Non - alcoholic Steatohepatitis
Mx of PCOS
1st step - weight reductio Insulin resistance DOC - Metformin Irregular cycles - OCP Hirsutism - OCP Infertility - Letrozole > clomiphene citrate > Bromocriptine `
DOC in PCOS for Infertility
Letrozole > C.C
DOC for infertility in obese and insulin resistance PCOS
Letrozole > CC + Metformin
DOC in PCOS infertility with inc Prolactin levels
CC + Bromocriptine
2nd line of MX in Infertility in PCOS
HMG or Laparoscopic Ovarian drilling.
3rd line in Mx of infertility in PCOS
Pulsatile GnRH
S/E of Ovulation inducing drugs
OHSS, Multifetal pregnancy and menopause like symptoms
Disadvantage of laparoscopic drilling
Premature ovarian failure
Clomiphene citrate - Combination
enclomiphene + zuclomiphene
Max dose of CC
100 mg/day
CC - how is it given in ovulation induction
Given from D2-D6 or D5- D9
Then stopped - on D10 - follicular monitoring
Wait for follicles to reach 18-20 mm -
then on day 18 give Inj HCG - ovulation trigger
32-36 hrs later - Ovulation.
S/E of CC
Menopause like symptoms
OHSS, Multifetal pregnancy, Inc risk of Ovarian cancer
When should CC be stopped
Visual symptoms
Letrozole - MOA
Aromatase inhibitor
Estrogen Antagonist
CC- MOA
Estrogen Antagonist
thick endometrium and thin cervical mucus seen in which ovulation inducing drug
Letrozole
Thin endometrium and Thick cervical mucus is seen in which Ovulation inducing drug
CC
