PCOS Flashcards
What is PCOS characterised by?
insulin resistance hyperandrogenaemia low SHBG polycystic ovaries failure of ovulation most overweight oligo/amennorhhea hirsuitism-male pattern baldness infertility
Pathogenesis of PCOS?
exact cause unknow, familial agggregation seen in many so likely a polygenic disorder
ovarian and adrenal hyperandrogenism
insulin resistance and adipose tissue androgen production
LH excess due to increased frequency and amplitude of GnRH spikes, likely due to anovulation and low prog
Diagnosis of PCOS?
made on rotterdam criteria, 2/3 of:
Oligo/amennhorea
Hyperandrogenism (biochem or clinical)
Polycystic ovaries on US
PLUS exclusion of other causes of androgen excess
other causes of androgen excess?
CAH acromegaly cushings androgen secreting tumour insulin resistance syndromes
What is acanthosis nigricans?
Dark velvety skin in body creases, commonest cause is insulin resistance, also seen in PCOS
what challenges are there to pregnancy in PCOS?
other than conception, GDM and HTN risk is 10x increased in PCOS
also with IVF increased risk of ovarian hyperstimulation syndrome so multiple lutenized cysts
Ix in PCOS?
Biochem:
plasma levels of testosterone (if v high think tumour)
SHBG- usually low
LH/FSH ratio (raised in 2/3)
Screen for complications: hba1c, lipid abnormalities
Exclude any underlying pathologhy eg prolactin, 17ohp level
US the ovaries: bilaterally polycystic with endometrial thickness
anovulation will occur if endometrial thickness >10mm
Management of PCOS? (broad)
Will depend on the PT goals, 4 broad areas to target: wt loss hirsuitism fertility oligo/amennhorea
Screen for CVS disease
Weight loss in PCOS?
will improve insulin sensitivity, reduce hyperandrogenism, restore menstrual regularity/fertility
vital for low risk preg
ideally in specialist wt loss centres
Treatment of amenorrhea?
want a withdrawal bleed every 3 months to prevent endometrial hyperplasia risk
COP if fertility isnt an issue
Anti ndrogenic component preferred (yasmin) but beware if fat as VT risk
if not medroxyprogesterone acetate 10mg for 7 days ever 3 months will give bleed
Hirsuitism treatment in PCOS?
slow improvement and variable response, laser is the best but dolla and not on NHS
Cream: ethlornithine- ornithine decarboxylase inhib. assess at 3-4 mo and stop if nothing
systemic antiandrogens: require OCP as C/i in preg
spironolacton, cryproterone acetate, flutamide, finasteride
restoration of fertility in PCOS?
weight loss, metformin, clonefine citrate if anovulatory but only for 6 months
then assisted conception unit/ivf
What is androgen insensitivity syndrome and how does it present?
spectrum of disorders due to mutations in AR. Complete are 46XY females with femal genitalia, short vagina, no uterus, prostate or pubic hair. gynaecomastia.
Present with primary amennorhea, elevated LH+Test, inguinal hernia
What is 5AR deficiency and how does it present?
46XY females again as lack of virilisatin- cannot convert T to DHT. Appear female with abdo testes
presentation: 1o amenorrhea, virilisation at puberty, gender change in some cultures
