PCOS Flashcards
causes of hirsutism
· PCOS
· Androgen producing tumor
· Metabolic syndrome
· Adrenal adenoma/carcinoma
· Exogenous testosterone
· Aromatase deficiency
· Ovotestis DSD
mech of PCOS
exact mechanism has not been well defined
- ovary has insulin receptors and IGF receptors
■ It has been suggested that insulin has a stimulatory effect on CYP17α. - In the adrenals:
■ Some studies have shown that insulin increases secretion of 17α-hydroxyprogesterone and DHEAS in response to ACTH. - Insulin directly inhibits SHBG production increase the circulating bioavailable androgen level.
- Insulin decreases IGFBP-1 increase free IGF-1 act in similar manners to insulin
mgmt pcos
1) Estrogen-progestin oral contraceptive
- Progestin suppresses LH and thus ovarian androgen production; it also antagonizes the endometrial proliferative effect of estrogen
- Estrogen increases SHBG reducing bioavailable androgen
2) Progestin therapy
-For endometrial protection as progestin antagonizes the endometrial proliferative effect of estrogen
3) Metformin
-Use metformin if the woman also has T2DM or IGT who fail lifestyle modification
- If menstrual irregularity who cannot take or do not tolerate HC metformin is second line
- Metformin likely plays its role in improving ovulation induction in women with PCOS through a variety of actions, including reducing insulin levels and altering the effect of insulin on ovarian androgen biosynthesis, theca cell proliferation, and endometrial growth.
4) Spironolactone
- Anti-androgen – antagonist of the androgen receptor
5) GnRH agonists
- Suppress LH and FSH secretion suppression of ovarian hormone production – for hirsutism treatment
- Need to “add-back” estrogen-progestin therapy for bone protection
PCOS - dx of exclusion - what to r/o
· Pregnancy
· POI
· Hypothyroidism
· HyperPRL
· Cushing syndrome
· Androgen producing tumor
· Adrenal adenoma/carcinoma
· Exogenous testosterone
· Aromatase deficiency
· Ovotestis DSD
RF for PCOS
Premature adrenarche
LGA
SGA
Exposure to GDM in utero
