PCOS

Question 1

def

Answer 1

oligomenorrhoea/amenorrhoea & hyperandrogenism

often associated with insulin resistance, T2DM, dyslipidaemia

Question 2

aetiology

Answer 2

combination of environmental & genetic factors
hyperinsulinaemia causes increased ovarian synthesis & reduced hepatic SHBG synthesis which results in increased free androgens

Question 3

what is SHBG

Answer 3

sex-hormone binding globulin

Question 4

epi

Answer 4

most common cause of infertility

Question 5

history

Answer 5

menstrual irregularities (oligomenorrhoea or amenorrhoea)
uterine bleeding
infertility

symptoms of hyperandrogenism

• hirsutism
• male-pattern hair loss
• acne

Question 6

examination

Answer 6

• hirsutism
• male-pattern hair loss
• acne
• acanthosis nigricans which is a sign of sever insulin resistance

Question 7

investigations

Answer 7

1 bloods
-high LH
-high LH:FSH ratio (>3) (day 3 on menstrual cycle)
-high testosterone, androstenedione & DHEA-S
-low SHBG
2 exclusion tests for hyperprolactinaemia, hypo/hyperthyroidism, cushings
3 impaired glucose tolerance/T2DM
4 Transvaginal USS
->12 follicles in each ovary
-measure 2-9mm +/ increased ovarian volume >10ml