PCOS Flashcards

1
Q

PCOS - background

A
  1. PCOS is the most common endocrine disorder in women.
  2. Responsible for 80% of all cases of anovulatory subfertility.
  3. Estimated prevalence is 5–10% of women of childbearing age.
  4. U/S evidence of polycystic ovaries is seen in 20–30% of women.
  5. Abnormal HPO axis results from hyperinsulinaemia, which also stimulates an increase in GnRH and therefore an imbalance between LH and FSH -> derangement of E and P -> immature follicles -> no ovulation and oligomenorrhoea
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2
Q

PCOS - etiology

A
  1. Genetic (familial clustering).
  2. Insulin resistance with compensatory hyperinsulinaemia (defect on
    insulin receptor).
  3. Hyperandrogenism (elevated ovarian androgen secretion).
  4. Obesity (esp, central):
    - BMI >30 in 35–60% of women with PCOS
    - Worsens insulin resistance

Leads to…
5. Derangement of HPO axis (?)

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3
Q

PCOS - clinical features

A
  1. Irregular menstrual cycles
  2. Hirsutism
  3. Acne
  4. Obesity (often)
  5. Infertility/subfertility
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4
Q

PCOS - Rotterdam criteria for dx (3)

A

Requires the presence of two out of the following three variables and exclusion of other disorders:

  1. Irregular or absent ovulations (cycle >42 days).
  2. Clinical or biochemical signs of hyperandrogenism:
    - Acne
    - Hirsutism
    - Alopecia
  3. Polycystic ovaries on pelvic USS: ≥ 12 antral follicles on one ovary, and/or increased ovarian volume (>10mL). Based on 2014 systematic review, a much higher threshold has been proposed (=/>25 follicles), but only if clinician uses transducer frequency that provides maximal resolution. This technology is not available to most clinicians, and it is suggested that the 2003 criteria (≥ 12 antral follicles/ovary) be used
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5
Q

PCOS - ex

A
  1. BMI
  2. Signs of endocrinopathy
  3. Hirsutis, alopecia
  4. Acne
  5. Acanthosis nigricans
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6
Q

PCOS - ix`

A
  1. Basal (day 2–5): LH, FSH, TFTs, prolactin, and testosterone.
    If hyperandrogenism:
  2. Dehydroepiandrosterone sulphate (DHEAS), androstenedione
  3. SHBG.
  4. Exclude other causes of secondary amenorrhoea.
  5. Pelvic USS.
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7
Q

PCOS - long term health consequences

A
  1. Obesity
  2. Insulin resistance and metabolic abnormalities -> type II diabetes mellitus
  3. GDM
  4. Endometrial hyperplasia and endometrial carcinoma
  5. Ischaemic heart disease (but long-term studies not proven)
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8
Q

PCOS - mx

A
  1. Lifestyle modification - Weight loss through diet and exercise
  2. Improving menstrual regularity
    - Weight loss, COCP, metformin
  3. Controlling symptoms of hyperandrogenism
    - Cosmetic (depilatory cream, electrolysis, shaving)
    - Antiandrogens (e.g. eflornithin facial cream or spironolactone) - can help with acne and hirsutism; can take 6-9mo to improve hair growth; avoid pregnancy (feminises a male fetus)
    - COCP - reduces serum androgen levels by increasing SHBG levles
  4. Subfertility
    - Weight loss alone may achieve spontaneous ovulation
    - Clompihene (tx with the most evidence)
    - Can use gonadotrophins or metformin +/- clomiphene if clomiphene unsuitable or contraindicated
    - Laparoscopic ovarian drilling
    - IVF if ovulation cannot be achieved or does not succeed in pregnancy
    5.
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