PCOS Flashcards
Diagnostic criteria for PCOS?
Hyperandrogenism, ovulatory dysfunction, polycystic ovaries (in one or both ovaries, either 12+ follicles measuring 2-9mm or increased ovarian volume (greater than 10cm3)
Facts on androgens?
75% testosterone made in ovary. Secretes androstenedione and dihydrotestosterone=most potent androgen, results primarily from intracellular 5-alpha reduction of testosterone.
What are 3 treatments for hirsutism?
Spironolactone, Flutamide, Finasteride
What is spironolactone?
androgen-R antagonist. Aldosterone antagonist and diuretic. Can cause menstrual irregularity.
- SE: vomiting, dizziness, bleeding, mastalgia
What is finasteride?
Finasteride: inhibits 5-alpha reductase (which converts testosterone into DHT-most potent androgen). Teratogenic in male fetuses.
What is flutamide?
Flutamide=androgen-R agonist. Common side effect=dry skin, rarely hepatitis.
How do you evaluate pt who you suspect has PCOS? What diagnostic tests
History (obesity, meds, details about hair growth, menstrual history). Physical exam (abdominal circumference, acne
TSH, testosterone, 17-OHP, a1c, DHEAS (Adrenal tumor). Pelvic US.
What is an objective measurement of hirsutism?
Examination of androgen-sensitive skin areas such as the face, chest, abdomen, and back provide an assessment of the degree of hirsutism and can be used to chart patient progress over time; Ferriman–Gallwey scoring can be done if desired. Modified Ferriman–Gallwey Figure 2 scoring evaluates nine areas of the body; a score greater than 8 is indicative of hirsutism
How do you manage pCOS
1st line=OCPs (inhibits ovarian androgen production, incr sex hormone binding globulin which decreases testosterone). Add anti-androgen (spinolactone) if minimal response after 6mo (need contraception)–know the mechanism of action. Know names.
What is workup and management of non-congenital CAH?
Defective conversion of 17-OHP. Mediated by 21-alpha hydroxylase, mutations in CYP gene.
Less severe form than classic.
AR inheritance.
Diagnosed by 17-OHP >200. Confirmed w/ ACTH stimulation test
Treat like PCOS. Use OCPs. If desired fertility, give glucocorticoid therapy (prednisone 5mg/d) and can add Clomid. Steroids have SE.
What are risk factors for steroid abuse?
Describe signs of anabolic steroid use in women?
What are adverse health effects due to steroids?
Are there any legitimate clinical sues for anabolic steroids?
Competitive athlete, family/friends w/ steroid use, social pressures, depression, use of other illicit substances
Irregular menses, hirsutism, male pattern hair growth, voice deepening, acne, clitoromegaly, infertility, mood changes
Serum lipids, glucose tolerance, heart disease, VTE. How do you treat steroid abuse? Education, counseling, help w/ withdrawal.
Cachexia related to chronic disease: i.e. HIV.
