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Endocrine > PCOS > Flashcards

PCOS Flashcards

1
Q

PCOS is defined by the presence of

A

Anovulation, polycystic ovaries on US, and clinical or biochemical hyper-adrogenism

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2
Q

What is though to play a role in PCOS?

A

Insulin resistance and genetic factors

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3
Q

PCOS occurence in females

A

Begins during puberty and affects reproductive-aged women (can occur as early as age 11)

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4
Q

PCOS is often associated with

A

Cardiovascular risk factors

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5
Q

PCOS is the result of

A

A defect in the hypothalamic pituitary-ovarian circuit which remains unknown but several theories exist

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6
Q

Risk factors for PCOS

A

-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)

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7
Q

Long term risks of PCOS

A

-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

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8
Q

Women with PCOS are more likely than normally cycling women to have

A

-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

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9
Q

Other disorders to rule out in a woman with PCOS

A

-hyperprolactinemia
-non-classic congenital adrenal hyperplasia
-cushing syndrome
-androgen-secreting neoplasm
-acromegaly

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10
Q

Rotterdam diagnostic criteria for PCOS

A

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

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11
Q

NIH criteria for diagnosis of PCOS

A

-clinical and/or biochemical hyperandrogenism
-oligo-ovulation or anovulation

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12
Q

Differential diagnoses for causes of oligomenorrhea/secondary amenorrhea (excluding pregnancy)

A
  • hypothalamic dysfunction (35%)
  • PCOS (30%)
  • pituitary disease (19%)
  • ovarian causes (10%)
  • uterine disease (5%)
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13
Q

Diagnostic labs for PCOS

A

-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)

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14
Q

Other diagnostic labs to consider obtaining for PCOS

A

-screening for Cushing syndrome and acromegaly
-DHEA, FSH, LH levels
-fasting insulin level, glucose tolerance test

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15
Q

Imaging diagnostics for PCOS

A

-transvaginal US
-consider abdominal and/or pelvic CT or MRI

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16
Q

NIH US criteria for polycystic ovaries

A

8-10 small follicles (2-8 mm)

17
Q

Rotterdam US criteria for polycystic ovaries

A

12+ follicles (2-9 mm)

18
Q

Management of PCOS

A

-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)

19
Q

Weight reduction education in PCOS

A

-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

20
Q

Exercise education in PCOS

A

-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

21
Q

Lipid target values in women with PCOS with metabolic syndrome

A

High risk
-LDL target: <100
-non-HDL target: <130

22
Q

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

A

High risk
-LDL target: <70
-non-HDL target: <100

23
Q

Statins in women with PCOS have shown to:

A

-lower LDL-C levels
-diminish insulin resistance and inflammation
-lower serum free and total testosterone levels
-improve endothelial function

24
Q

Statins and fibrates may be necessary if

A

Hypertriglyceridemia and low HDL levels present

25
Q

Nicotinic acid produces a favorable lipoprotein effect which can

A

Worsen glycemic control

26
Q

Statins are contraindicated in

A

Pregnancy, therefore contraception is required

27
Q

Insulin sensitizers in PCOS

A

Biguanides: metformin (glucophage)
TZDs: pioglitazone (actos), rosiglitazone (avandia)

28
Q

Benefits of insulin sensitizers in PCOS include

A

-reduced glucose levels and improvement in glucose profiles
-improvement in lipid and pro inflammatory profile
-restoration of ovulation and menstrual cycles
-increasing pregnancy rates
-reduced androgen production

29
Q

Anti-androgens inhibit production/action of androgens in PCOS and include

A

-combination with oral contraceptives to prevent pregnancy (due to teratogenicity) and manage side effects
-spironolactone 25-100mg BID (inhibits ovarian and adrenal steroidogenesis), can cause dehydration and hyperkalemia
-flutamide (eulexin) 125-250mg/day (helps with hirsutism)
-finasteride (proscar) inhibits 5-alpha-reductase, well-tolerated

30
Q

Aromatase inhibitors used in PCOS induce ovulation and include

A

-letrazole used off label (increased birth rates over clomiphene) FIRST LINE
-clomiphene citrate (superior treatment for an ovulation compared to metformin or placebo alone, may be used with metformin)

31
Q

Surgical interventions for PCOS to improve ovulation and pregnancy rates

A

Laparoscopy
Ovarian drilling with laser or diathermy

Endocrine (5 decks)

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