PCOS

Question 1

Etiology of PCOS?

Answer 1

Hyperinsulinemia, insulin resistance - Diabetes type 2, Gestational diabetes
Obesity
Genetic factors

Question 2

Pathogenesis of PCOS

Answer 2

Insulin - > direct increase of LH.
High LH causes androgen synthesis - > HYPERANDROGENISM

Increased LH with a relatively low FSH - > arrested foliicle development - > cyst + reduced ovulation - > MENSTRUAL IRREGULARITIES

Question 3

Symptoms of PCOS?

Answer 3

Menstrual irregularities -
Delayed menarche, resolution of symptoms by 40
Oligomenorrhea (<9 per year), sometimes Amenorrhea

Hyperandrogenism - 
Hirsutism
Hair loss (male pattern) 
Acne 
Acanthosis Nicragans (hyperinsulinemia)

Question 4

Diagnosis of PCOS?

Answer 4

Hormones - testosterone, LH/FSH ratio
OGTT - insulin resistance
US - cysts in ovary
Clinical signs

Question 5

Treatment of PCOS

Answer 5

First line - Combined Oral Contraceptives. Estrogen opposes the androgen and reduced LH levels. Must be combined to prevent unopposed estrogen, which leads to endometrial hyperplasia.

Hyperinsulinemia treatment

1. Diet, weight loss
2. Metformin

Weight loss is very effective. Helps with fertility and symptoms

Question 6

Complications of PCOS?

Answer 6

High androgens - CVS risk (also due to hyperlipidemia in diabetes)
High unopposed estrogen - > Endometrial hyperplasia
Anovulatory infertility.