PCOS Flashcards
What is PCOS
A multisystem reproductive-metabolic disorder with unexplained hyperandrogenic chronic anovualtion
What are the processes that are disrupted by PCOS?
Nueorednocrine dysfunction
follicular maturetion
hyperandrigenism
extraovarain conversion of androgens to estrogens
What are the neuorendocrine impacts of PCOS?
Increased LH due to increase GnRH and insulin
Decreased FSH due to increased estrogen and inhibi
What is the impact of PCOS on follicular maturation?
Only partial in luteinized thecal cells that produce inhibin decreased FSH)
Decreased FSH = follicle growth but follicles arrested in development
What is the impact of PCOS on androgens?
Hyperandrogenism
-LH stimulates stroma and theca cells = increased ovarian andorgen production
-Increase in adrenal DHEAS
Extraovarian conversion of androgens to estrogen by adipose tissue
What are the hormonal levels of:
LH
FSH
estrogen
insulin
SHB
in PCOS
LH= increased
FSH= normal/decreased
estrogen = normal/increased
insulin.= increased
SHB= decreased
what are the signs and symptoms of PCOS?
Hyperandrogenism –> hirsutism
Menstrual cycle irregularties
Infertility (chronic anovualtion)
Metabolic dysfunction
Ovarian changes
What are the metabolic dysfunctions associated with PCOS?
impaired glucose tolerance, acanthosis nigricans (thickening and darkening of skin), dyslipidemia (increased LDL, decreased HDL) and obesity
What are the Ovarian changes associated with PCOS?
ultrasound ( enlarged ovaries, multiple cystic follicles, hyperplasia of theca and central stoma)
follicle dynamics (normal development to the mid-antral stage, then arrest, majority undergo atresia, granulosa layer thins at follicle enlarges and an absent corpa lutea).
primary causes of PCOS
CNS defect
Ovarian defect
Hypothalamic defect
Insulin resistance
Genetic factors
What are the immediate and long-term consequences of PCOS?
Immediate
Hirsutism and acne
Irregular menstruation
Anovulatory infertility
Obesity
Long term
Endometrial cancer (estrogen –> proliferative phase)
CVD
HTN
Diabetes
Dyslipidemia
Describe some of the treatments for PCOS
Screen for CVD risk
Weight loss: decrease extraovarian estrogen production
COC: P lowers LH, E lowers FSH (arrest follicle development)
Anti-androgens
Clomiphene citrate: blocks hypothalamic E2 receptor to normalize FSH and LH release = ovulation
Metformin: inhibits hepatic glucose output = decreased insulin secretion
what are the goals of treatment for PCOS?
- reversing signs and symptoms of androgen excess
- establish cyclic menstruation
- prevent endometrial cancer
- restore fertility
- alleviate metabolic and endocrine disturbances
What does the histology of
a) post-menopasual
b) PCOS
ovary look like?
a) no follicles and corpora albincantia
b) thecal and stroma hyperplasia
thin granulosa cell layer
Explain the hormonal control of chronic anovualtion in PCOS
Decreased FSH –> follicle maturation –> decreased estradiol-17B –> chroic anovulation.
