PCOS Flashcards
Why is PCOS an important disorder to study? (4)
?Most prevalent medical condition in women
Systemic metabolic manifestations with multiple symptomatology: endocrine, gynaecological, diabetic, dermatological, eating disorder, psychiatric
Insulin resistance is a common feature + is likely to have life-long impact
Annual economic cost of diagnosis + treatment is $4.36billion in US (40% IR/TD2 - obesity = big issue in US)
What are polycystic ovaries? (2)
Cysts refer to follicles
12(+) small antral follicles (2-9mm)
How is PCOS a disorder of follicle growth at all stages? (5)
?Increased proportion of primordial follicles (controversial, implies greater ovarian reserve)
Increased no. of activated (primary) follicles
Arrested antral follicle growth
Lower rates of atresia
Failure of follicle secretion in some cases - anovulation
How was PCOS first described in 1935? (4)
Stein + Leventhal syndrome
Obesity, hirsutism + anovulation
In the presence of bilaterally enlarged sclerocystic (hardened) ovaires
Diagnosed by direct observation/laparotomy
How has our understanding and diagnosis of PCOS changed over time? (7)
Spectrum of presentation has led to lack of consensus regarding definition
Many women have change in morphology of ovaries (PCO) but do not necessarily have symptoms (PCOS)
Now diagnosed using US (lots of follicles arranged in classic necklace pattern) - often operator and equipment dependent
And on exclusion of disorders that mimic PCOS e.g.
CAH (21-hydroxylase deficiency -> increased 17-hydroxyprogesterone + androgens)
Hyperprolactinaemia, thyroid disease, Cushing’s syndrome
Ovarian hyperthecosis (hyperplasia of theca - nests of luteinesed theca cells) - v. rare
What is the Rotterdam Criteria and when was it introduced? (5)
2003 consensus on diagnostic criteria + LT health risks of PCOS
Diagnosis requires 2/3 criteria
1. PCO
2. Hyperandrogenism (clinical presentation or biochemical)
3. Ovulatory dysfunction
Using the Rotterdam Criteria, how does hyperandrogenism manifest itself? (5)
BIOCHEMICALLY
- assays not standardised across world/in different labs
- may use different Abs
CLINICALLY
- hirsutism, acne or male pattern baldness
- very distressing
Differences in presentations in different ethnicities
Using the Rotterdam Criteria, how do we define PCO? (2)
12(+) follicles measuring 2-9mm/increase in ovarian volume >10ml + no DF
When is it not appropriate to use TV ultrasound? (2)
In young girls/adolescents
Pregnant women
Can do trans-abdominal scanning but cannot always see the ovary
Using the Rotterdam Criteria, how is ovulatory dysfunction defined? (4)
Irregular cycles/anovulation
E.g. frequent bleeding <21 days or infrequent bleeding >35cl
Self-reporting is subjective, however
How are PCO + PCO defined by ultrasound? (3)
NORMAL - no more than 5 follicles in an ovary with a small amount of stroma in a woman with regular cycles
PCO - in at least 1 ovary, 12(+) follicles of 2-9mm arranged peripherally around an enlarged core of dense stroma (ovarian vol >10mls)
PCOS - PCO on scan plus one or more symptoms
How does ovarian morphology change during a normal cycle? (3)
Small antral follicles recruited in follicular phase
Dominant selection as FSH falls
Smaller antral follicles have experienced atresia by end of follicular phase (pre-ovulation)
How does ovarian morphology change during a PCO anovulatory cycle? (1)
No matter what stage of cycle, all follicles are the same
How does ovary morphology change during a PCO ovulatory cycle? (2)
First part of cycle is same as anovulatory but then start to get DF. However, the other smaller antral follicles remain
How prevalent is PCO? (5)
Present in:
- 32% of patients with amenorrhoea
- 87% with oligomenorrhoea
- 87% with hirsutism + regular cycles
- 75% of bulimics
- 22% of ‘normal’ population
