PCOS

Question 1

Diagnosis

Answer 1

Diagnosis= 2 of

a. oligo-ovulation or anovulation
b. clinical/biochemicalevidence of hyperandrogenism
c. polycystic ovaries on ultrasonograms

Question 2

Pathophysiology

Answer 2

abnormal HPO axis–> inappropriate gonadotropin
release (result of, not cause)
1. Insulin resistance leads to compensatory insulin hypersecretion
2. Promotes ovarian androgen output, promote adrenal androgen output.
3. High insulin levels also suppress hepatic production of sex hormone binding globulin (SHBG), which exacerbates hyper-androgenaemia +free circulating androgens. A
4. High levels of LH->result of an increased frequency of gonadotrophin-releasing hormone pulses from the hypothalamus.
5. Incomplete follicular development which results in polycystic ovarian morphology.

Question 3

PCOS is associated with what findings

Answer 3

Menstrual irregularities
Clinical/biochemical hyperandrogenism
Obesity/insulin resistance
Subfertility

Can take months of treatment to see improvement in symptoms

Question 4

Management overview

Answer 4

1. Healthy eating, weight, physical activity
2. Menstrual irregularity->COCP (ethinylestradiol/cyproterone acetate, R/V in 3 months), medroxyprogesterone (same 12 days each month), norethisterone (same 12 days each month), mirena, metformin
3. Obesity->eating and exercise, low glycemic diet
4. Insulin resistance/T2DM->screen for diabetes w/ OGTT
5. Subfertility: Lifestyle (+weight loss) + Clomiphene (needs specialist referral) + metformin
6. CV rosl->diet, exercise, statin and ACEi

Question 5

Investigations

Answer 5

Serum total/free testosterone->elevated
DHEAS->elevated
Serum 17 hydroxy-progesterone-> +indicated adrenal hyperplasia
Serum prolactin->elevation may suggest prolactinoma
Serum TSH->thyroid disease
OGTT
Fasting lipid->+LDL, TAG, low HDL
FSH/LH

Consider USS pelvis