PCOS Flashcards
PCOS is defined by the presence of
Anovulation, polycystic ovaries on US, and clinical or biochemical hyper-adrogenism
What is though to play a role in PCOS?
Insulin resistance and genetic factors
PCOS occurence in females
Begins during puberty and affects reproductive-aged women (can occur as early as age 11)
PCOS is often associated with
Cardiovascular risk factors
PCOS is the result of
A defect in the hypothalamic pituitary-ovarian circuit which remains unknown but several theories exist
Risk factors for PCOS
-premature puberty (presence of pubic hair before age 8)
-ethnicity: Native American, latino or greek, caucasian or AA
-family hx (diabetes, insulin resistance, hyperinsulinemia, irregular menses or an ovulation, CVD)
Long term risks of PCOS
-more likely to develop T2DM in middle age
-greater incidence of coronary artery calcifications and more advanced CVD
-elevated risk of metabolic syndrome
-complications of insulin resistance
-risk of endometrial cancer
-mood disorders
-sleep apnea
Women with PCOS are more likely than normally cycling women to have
-insulin resistance
-central adiposity
-hypertension
-metabolic syndrome
-markers of clinical/subclinical atherosclerosis (CRP and homocysteine; carotid intimal-media thickness; coronary artery calcium)
-ALP associated with a greater cardiovascular risk
Other disorders to rule out in a woman with PCOS
-hyperprolactinemia
-non-classic congenital adrenal hyperplasia
-cushing syndrome
-androgen-secreting neoplasm
-acromegaly
Rotterdam diagnostic criteria for PCOS
Must have 2:
-clinical and/or biochemical hyperandrogegism (elevated levels of free or total testosterone)
-oligo-or an ovulation (infrequent or absent)
-polycystic ovaries on US
NIH criteria for diagnosis of PCOS
-clinical and/or biochemical hyperandrogenism
-oligo-ovulation or anovulation
Differential diagnoses for causes of oligomenorrhea/secondary amenorrhea (excluding pregnancy)
- hypothalamic dysfunction (35%)
- PCOS (30%)
- pituitary disease (19%)
- ovarian causes (10%)
- uterine disease (5%)
Diagnostic labs for PCOS
-CMP
-fasting lipids
-TSH with FT4 and FT3
-serum prolactin
-total and free testosterone levels
-serum hCG
-serum 17-hydroxyprogesterone level (non classic congenital adrenal hyperplasia)
Other diagnostic labs to consider obtaining for PCOS
-screening for Cushing syndrome and acromegaly
-DHEA, FSH, LH levels
-fasting insulin level, glucose tolerance test
Imaging diagnostics for PCOS
-transvaginal US
-consider abdominal and/or pelvic CT or MRI
NIH US criteria for polycystic ovaries
8-10 small follicles (2-8 mm)
Rotterdam US criteria for polycystic ovaries
12+ follicles (2-9 mm)
Management of PCOS
-weight reduction, exercise
-lipid lowering agents: statins, nicotinic acid derivatives
-insulin sensitizers: metformin, TZDs
-oral contraceptives (choose those with low androgenic activity to reduce clinical signs of hyperandrogenism; can prevent endometrial hyperplasia)
-anti-androgens: flutamide, spironolactone, finasteride (contraindicated in pregnancy)
Weight reduction education in PCOS
-5% loss: decrease insulin levels, increase fertility, reduce hirsutism/acne, and lower free testosterone levels
-500-1000 kcal/day reduction
-<30% calories from fat, <1-% calories from saturated fat
-increased consumption of fiber, whole grain breads, fruits/veggies
Exercise education in PCOS
-increases sensitivity in skeletal muscle and fat to reduce insulin levels
-aerobic exercise 30 mins/day (10,000 steps or more; 15,000 for weight loss)
-moderate-intensity exercise improves insulin resistance and dyslipidemia
Lipid target values in women with PCOS with metabolic syndrome
High risk
-LDL target: <100
-non-HDL target: <130
Lipid target values in women with PCOS with MBS and other risk factors or with T2DM, or in the presence of overt vascular and/or renal disease
High risk
-LDL target: <70
-non-HDL target: <100
Statins in women with PCOS have shown to:
-lower LDL-C levels
-diminish insulin resistance and inflammation
-lower serum free and total testosterone levels
-improve endothelial function
Statins and fibrates may be necessary if
Hypertriglyceridemia and low HDL levels present
