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REI Stuff > PCOS > Flashcards

PCOS Flashcards

1
Q

Vitamins/Minerals/Supplements

A

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

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2
Q

Prevention of weight gain (exercise) in adol

A

Adol: 60 mins/day x 3x/week

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3
Q

Prevention of weight gain (exercise)

A

150min/week moderate intensity or 75min/week vigorous - include strength training on 2 non-consecutive days

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4
Q

Weight loss

A

: 250min/week moderate intensity or 150min/week vigorous intensity - include strength training involving major muscle groups 2 non-consecutive days

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5
Q

risk factors

A
  • 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
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6
Q

pregnancy related complications

A
  • Early and recurrent pregnancy loss
  • PES
  • GDM
  • PTB
  • Neonatal admission to ICU
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7
Q

long term health consequences

A
  • DM, CVD
  • EM hyperplasia, EMCA
  • Infertility
  • NAFLD
  • Sleep disturbances (OSA): i
  • Anxiety/depression
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8
Q

rotterdam criteria

A

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

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8
Q

NIH criteria

A

1 and 2

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9
Q

AE-PCOS criteria

A

1 and 2 or 2 and 3

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10
Q

diagnostics and normal values

A

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

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10
Q

Ddx

A

Cushing
HyperPRL
Thyroid disease
HAIR-AN
Androgen-secreting tumor
NCCAH

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11
Q

Clomiphene Resistance

A

Failure to ovulate after max 150mg x 3 cycles

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11
Q

Infertility Tx

A
  • Ovulation induction with CC or Letrozole
  • 1st line: letrozole
  • 2nd line: Gonadotropins
  • 3rd line: IVF
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12
Q

MOA metformin

A

biguanide OHA, dec hepatic glucose production, decrease intestinal glucose uptake and inc peripheral insulin sensitivity, inhibits lipolysis, may cause vitB12 deficiency

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12
Q

Tx hirsutism

A

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

12
Q

When to bariatric surgery

A

BMI >35 with one or more severe complications that is expeted to improve with weight loss + failed lifestyle change

12
Q

MOA inositol

A

involved in glucose metabolism: transport of glucose and its conversion to glycogen  reduced insulin resistance

13
Q

Clomiphene Failure

A

Failure to achieve pregnancy even if ovulating x 6 cycles

14
Q

MOA GLP-1

A

GLP-1 analogs (liraglutide, semaglutide)
Inhibit pancreatic secretion of glucagon, inc insulin secretion and improved insulin signaling, appetite suppression thru central effects

15
Q

Irregular menses defined for adolescents

A

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

16
Q

Cushing SSx

A

must have Ssx:
severe fatigue
muscle weakness
atrophy of skin and subcu
purple striae on abdomen
acanthosis nigricans
hyperpigmentation
hypertension, dm, cognitive impairment

17
Q

normal insulin levels post OGTT

A

Fasting: <20 mu/ml
1hr: 80-100 mu/ml
2hr: <90 mu/ml

17
Q

HAIR-AN Ssx

A

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)

18
Q

HAIR-AN insulin levels

A

> 300mu/ml

19
Q

Offspring of women with PCOS are at risk for

A
  • Inc risk of autism, ADHD
19
Q
A
20
Q

MOA EDC to our system (3)

A

they are ingested thru contamination of the food chain

inhaled in house dust

occupational expocusre

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