PCOS Flashcards
What is PCOS?
Endocrine disorder characterized by ovulatory dysfunction, hyperandrogenism and polycystic ovaries
How do you diagnose PCOS?
Diagnosis of exclusion
Rotterdam criteria need 2/3
Oligomenorrhea or amenorrhea
clinical or lab hyperandrogenism
polycystic ovaries (12 or more follicles)
What can PCOS increase your risk for?
Insulin resistance
nonalcoholic fatty liver disease
Slee apnea
Metabolic syndrome
Overall cardiovascular disease and diabetes
What is the evaluation for suspected PCOS?
Vitals
Weight
signs of hyperandrogenism
Labs showing hyperandrogenism
ruling out secondary causes of hyperandrogenism
Evaluation for metabolic dysfunction (diabetes and lipids)
Pelvic ultrasound (evaluate ovaries and endometrium)
What labs should be ordered to assess for hyperandrogenism in PCOS?
TSH
Prolactin
17OHP
Total and free testosterone ( if hirsutism)
How do you assess for diabetes in patients with PCOS
2hr glucose tolerance test
or
Fasting glucose with HbA1c
> 200= type 2 diabetes
What does 17OHP test for when obtaining the lab for PCOS evaluation?
nonclassical CAH due to 21 hydroxylase deficiency
What are clinical signs of hyperandrogenism?
Hirsuitism
Acne
Male pattern hair loss
How do you diagnose the metabolic syndrome?
Elevated BP (130/85)
Increased waist circumference (35+)
Elevated fasting glucose (>100)
Reduced HDL (<50)
Elevated triglycerides (>150)
What pregnancy things are women with PCOS at increased risk for?
Ovarian hyperstimulation
Multifetal pregnancy
GDM
Hypertensive disorders
Differential for PCOS?
PCOS
Thyroid disorders
Prolactin disorder
Primary ovarian failure
Hypothalamic dysfunction
NCCAH
Androgen secreting tumor
acromegaly
How do you test for non classical CAH?
Fasting 17OHP level in the follicular phase of menstrual cycle or random
Random level <4= normal
Fasting level <2= normal
If there is a elevated 17OHP level when testing for nonclassical CAH what is the next step?
ACTH stimulation test
How does weight loss impact PCOS?
As little as 5% weight loss can help to regular menstrual cycles and decrease metabolic abnormalities
What are lifestyle modifications for PCOS?
DIet and exercise
What type of diet modification is recommended for PCOS?
caloric restriction
Management of PCOS to treat menstrual irregularities?
Combined hormonal contraceptives
Progestin contraceptives
Management of PCOS to reduce risk of cardiovascular disease or diabetes?
Lifestyle modifications
Metformin
Management of PCOS for ovulation induction?
Clomiphene
Letrozole
What is letrozole and what is the dose used for ovulation induction?
Aromatase inhibitor
2.5mg/day starting on day 5 for 5 days
What is clomiphene and what is the dose used for ovulation induction?
Antiestrogen
50mg/day starting on day 5 for 5 days
Management of PCOS for hirsutism?
Antiandrogen + combination hormonal contraceptives
What are the anitandrogens used for hirsutism treatment?
Spironolactone
Flutamide
Finesteride
What medication has been FDA approved for treatment of hirsuitism?
Efluorthine
What are nonpharmocologic treatments for hirsutism?
Mechanical hair removal
Laser hair removal
What is spironolactone and what is the mechanism of action for hirsutism?
Diuretic and Androgen receptor antagonist
Mechanism of action= inhibition of ovarian and adrenal steroidogenesis, competes for androgen receptor in hair follicles, inhibits 5alpha reductase
What is the dose of spironolactone for hirsutism and what are side effects?
25mg BID
Orthostatic hypotension
hyperkalemia
increased menstrual cycles
What is flutamide and what is the mechanisms of action for hirsutism?
Androgen receptor agonist
What is the dose for flutamide and side effects?
125mg/day
dry skin
What is finasteride and what is the mechanism of action?
Antiandrogen that works by inhibiting 5 alpha reductase
What is the dose for finasteride?
1mg daily
What is efluorithine for hirsutism?
A cream applied twice daily to the face that works by inhibiting enzyme orthinine decarboxylase
