PCOS Flashcards
Vitamins/Minerals/Supplements
Vitamin D = IR, lipid metab, hyperandrogenism
Myo-inositol = metabolic profile
CoEnzyme q10 + Vitamin E = glucose homeostasis and hyperandrogenism
Magnesium + vitamin E = inflammatory markers
Omega 3 = IR and Lipid profile
Probiotics
Prevention of weight gain (exercise) in adol
Adol: 60 mins/day x 3x/week
Prevention of weight gain (exercise)
150min/week moderate intensity or 75min/week vigorous - include strength training on 2 non-consecutive days
Weight loss
: 250min/week moderate intensity or 150min/week vigorous intensity - include strength training involving major muscle groups 2 non-consecutive days
risk factors
- Genetic (DENND1A, THAD) mothers with PCOS, PCOM is AD inherited, metabolic syndrome, serum T and SHBG
- Endocrine disruptors (PCB, BPA, phthalates, dioxins)
- Ethnicity
- DM
- Obesity/insulin resistance
- Oligo-ovulatory infertility
pregnancy related complications
- Early and recurrent pregnancy loss
- PES
- GDM
- PTB
- Neonatal admission to ICU
long term health consequences
- DM, CVD
- EM hyperplasia, EMCA
- Infertility
- NAFLD
- Sleep disturbances (OSA): i
- Anxiety/depression
rotterdam criteria
Irregular menses
- hyperandrogenism (clinical/biochemical)
- PCO (defined as >10ml3 ovarian volume or >12 follicles 2-9mm if <8mHz UTZ or >25 if >8mHz UTZ transducer PER OVARY
NIH criteria
1 and 2
AE-PCOS criteria
1 and 2 or 2 and 3
diagnostics and normal values
75G OGTT, Lipid profile, TV-UTZ (if >8 years from menarche), EM bx as needed
DDx
PRL - N: 10-25 ng/ml
TSH - N: 0.45-4.5 U/L
17-OHP:
N: <200 ng/dl
Serum testosterone >150 ng/dl
CT scan
24-hour urine-free cortisol
Overnight dexamethasone suppression test N: <1.8mg/dl
Serum fasting insulin
N: <20-30 mU/ml
Ddx
Cushing
HyperPRL
Thyroid disease
HAIR-AN
Androgen-secreting tumor
NCCAH
Clomiphene Resistance
Failure to ovulate after max 150mg x 3 cycles
Infertility Tx
- Ovulation induction with CC or Letrozole
- 1st line: letrozole
- 2nd line: Gonadotropins
- 3rd line: IVF
MOA metformin
biguanide OHA, dec hepatic glucose production, decrease intestinal glucose uptake and inc peripheral insulin sensitivity, inhibits lipolysis, may cause vitB12 deficiency
Tx hirsutism
Hirsutism
- Mild, focal (shave, pluck, wax, electrolysis, or laser)
- COCs
- Antiandrogens (Spironolactone 50-100mg BID, Finasteride 5mg OD, Flutamide 250mg OD*)
- Elfornithine 13.9% topical cream
When to bariatric surgery
BMI >35 with one or more severe complications that is expeted to improve with weight loss + failed lifestyle change
MOA inositol
involved in glucose metabolism: transport of glucose and its conversion to glycogen reduced insulin resistance
Clomiphene Failure
Failure to achieve pregnancy even if ovulating x 6 cycles
MOA GLP-1
GLP-1 analogs (liraglutide, semaglutide)
Inhibit pancreatic secretion of glucagon, inc insulin secretion and improved insulin signaling, appetite suppression thru central effects
Irregular menses defined for adolescents
Irregular menses - based on years post menarche
<1 yr - part of normal pubertal transition
>1 year - >90 days
>1 yr but <3 years, cycle <21d or >45d
>3 years, cycle <21d or >35d
Cushing SSx
must have Ssx:
severe fatigue
muscle weakness
atrophy of skin and subcu
purple striae on abdomen
acanthosis nigricans
hyperpigmentation
hypertension, dm, cognitive impairment
normal insulin levels post OGTT
Fasting: <20 mu/ml
1hr: 80-100 mu/ml
2hr: <90 mu/ml
HAIR-AN Ssx
Acanthosis nigricans, skin tags in neck groin axillae, beneath boobies
Obesity
Hyperandrogenism
No insulin receptor defects
Ovarian hyperthecosis - distinct clusters of luteinized theca cells (review histology)
HAIR-AN insulin levels
> 300mu/ml
Offspring of women with PCOS are at risk for
- Inc risk of autism, ADHD
MOA EDC to our system (3)
they are ingested thru contamination of the food chain
inhaled in house dust
occupational expocusre
