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443-SRH and MSK > PCOS > Flashcards

PCOS Flashcards

1
Q

what disease is considered both repro and endocrine disorder

A

PCOS

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2
Q

4 characteristics of PCOS

A

Ovulatory and menstrual dysfunction, hyperandrogenism, polycystic ovaries, insulin resistance

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3
Q

what is the most common endocrine disorder in women of repro ge

A

PCOS

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4
Q

features of PCOS

A

irreg + infrequent menstrual cycle, anovulatory, androgenic- hirsutism, acne, obesity (50-80% obese), insulin resistance, metabolic sx, increased risk of infertility, endometrial hyperplasia (with risk of endometrial cancer)

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5
Q

etiology of PCOS (4 suspects)

A

Complex polygenic disorder influenced by environmental factors (ex- obesity)
famHx- esp with first degree relatives with Hx PCOS or T2D
Insulin resistance and compensatory hyperinsulinemia can lead to enhanced androgen production in ovaries, ↑free T lvls (↓SHBG)
↑ androgen lvls can also cause insulin resistance

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6
Q

diagnosis of PCOS requires

A

meeting 2 of 3 criteria:
Presence of hyperandrogenism (clinical/ biologic)
Ovulatory dysfunction
Polycystic ovaries

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7
Q

what are the 5 repro abnormalities of PCOS

A

↑ pulse freq of GnRH = ↑LH in early follicular phase (no ovulation, abnormal pituitary fxn)

↑ ovarian androgens (testosterone, androstenedione)- abnormal steroidogenesis

Dysfunction of ovarian follicle maturation (lack of dominant ovarian follicle) = ↓ovulation

Accumulation of small follicles in the ovaries = development of cysts

Overall ↑T = can ↑ conv to E = endometrial hyperplasia + no ovulation = ↑ building

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8
Q

metabolic abnormalities of PCOS

A

insulin resistance
impaired glucose tolerance, diabetes, metabolic syndrome

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9
Q

50% of pts with PCOS have family hx of ____, _____, or both

A

PCOS
DM

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10
Q

when does PCOS usually start?

A

teen years, usually at menarche

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11
Q

T or F: clitoromegly is common in PCOS

A

F- more if there is a T secreting tumor

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12
Q

progression of hirsutism in PCOS is
1. slow
2. fast

A

1

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13
Q

what is the most common cause of hirsutism in women?

A

PCOS

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14
Q

what labs may be ordered for PCOS

A

Testosterone- total and free
DHEAS
LH;FSH ratio in follicular phase
prolactin if amenorrheic
progesterone
antimullerian hormone

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15
Q

what is the diagnostic test for PCOS

A

pelvic ultrsound

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16
Q

what is AMH and how does it related to PCOS

A

Antimullerian hormone (AMH): hormone released from developing follicles- lvls are high in PCOS due to large number of follicles being developed at one time

17
Q

what is the first step for any PCOS tx

A

weight loss if obese BMI =>30 = lifestyle for 3-6mths

18
Q

why is weight loss the first step for PCOS tx

A

Wt loss of 5-10% body mass can help trigger ovulation, improve cycles and sx, improve response to fertility medications

19
Q

how to treat irregular cycles from PCOS

A

similar to anovultory UB
CHC 1st, if CI or inadequate try progesterone PO, DMPA, or LNG IUS
metformin

20
Q

what is metformin used for in PCOS

A

to treat irregular cycles

21
Q

how does metformin work to restore cycles

A

Can also induce ovulation, ↑ insulin sensitivity, improve lipid profile

22
Q

how long for metformin to work for PCOS

A

up to 6mths

23
Q

can metformin be used LT for PCOS

A

yes for women with COS and impaired glucose tolerance or T2D that doesn’t respond to lifestyle mod
Possible use LT for CVD benefits in PCOS but confirmatory data lacking

24
Q

T or F: metformin may have clinical effects on hirsutism from PCOS

A

F- unlikely

25
Q

how to treat hirsutism from PCOS

A

CHC or antiandrogens +/- eflornithine

26
Q

what antiandrogen is first line for hirsutism from PCOS? what else is used?

A

spironolactone often combo with CHC
finasteride if spironolactone and CHC not effective

27
Q

how long for antiandrogens to work for hirsutism from PCOS

A

up to 6mths

28
Q

what should women on antiandrogens also be on?

A

reliable contraception

29
Q

eflornithine hydrochloride MOA

A

irreversible inhibitor of ornithine decarboxylase = no ornithine to putrescine = slows terminal hair growth but does not remove hair

30
Q

how long for eflornithine to work in decreasing hair growth

A

~1mth

31
Q

what NHP may be used in PCOS

A

myoinositol

32
Q

myo-inositol MOA

A

Acts similar to an insulin sensitizer- membrane associated sodium dependent inositol cotransporter GLUT4- decreases hyperinsulinemia
Improves ovarian function, ↓LH/FSH, ↓T lvls

33
Q

monitoring parameters for PCOS

A

Reassess in 3 mths
For hirsutism- pts on anti androgens may take up to 6 mths or longer
Discuss expected benefits with pt + be realistic

443-SRH and MSK (24 decks)

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