PCOS Flashcards
___ is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries.
PCOS
What is the Dx criteria for PCOS
Rotterdam criteria must have 2/3.... Hyperandroganism oligomenorrhea/amenorrhea PCOS on U/S
T/F: PCOS is a dx of exclusion?
T
What is the incidence of PCOS (percentage)
6.5-8%
What U/S findings suggest PCOS
12 or more follicles in each ovary
follicles are 2-9 mm diameter
___(condition) may amplify the effects of PCOS
obesity (20% are not obese)
With PCOS _____ may result in decreased levels of sex hormone-binding globulin (SHBG) and, thus, more bioavailable circulating androgen.
Insulin may have direct hypothalamic effects, like abnormal appetite stimulation and _____
hyperinsulinemia
gonadotropin secretion.
What are 4 skin d/o. that can be seen with PCOS
Hirsutism
Acne
Androgenic alopecia (to a lesser extent)
Acanthosis nigricans (dirty neck…)
A pt with PCOS is at Increased risk of insulin resistance and associated conditions such as ___ and ____
Metabolic syndrome
Nonalcoholic fatty liver disease
What conditions are risk factors for long-term metabolic sequelae of PCOS
T2DM
Cardiovascular disease
___, ___ and ___ are risk factors for endometrial cancer associated with PCOS
Chronic anovulation
Centripetal obesity
Diabetes
What else can cause androgen excess (JUST FYI)
Androgen secreting tumor exogenous androgens cushing syndrome acromegaly primary hypothalmic amenorrhea primary ovarian filure thyroid dz prolactin d/o
What is included in the w/u for PCOS? (probably FYI)
BP Waist measurement skin eval testosterone Thyroid glucose challenge lipids U/S
How can you treat PCOS?
OCP (primary tx) (low dose estrogen) progestins Insulin-sensitizing agents (metformin) lifestyle modification (Maybe a statin)
How does OCP tx for PCOS work?
Suppression of pituitary LH secretion –> suppression of ovarian androgen secretion.
Increased levels of SHBG –> decrease in free testosterone levels.
How does metformin work in the tx of PCOS?
increasing sensitivity to insulin –> lower insulin –> decrease in circulating androgen levels (also increase in SHBG) –> improved ovulation rate. (Also, improved glucose tolerance)
What lifestyle tx should a woman with PCOS make?
exercise
dietary change
wt loss
Clomiphene citrate is a ____ (class of medication) that can be used to initiate ovulation in a woman with PCOS
SERM (selective estrogen receptor modulator)
When do you begin Clomiphene citrate therapy?
What tests can you use to see if the therapy worked?
Day 3 or 5.
OPK (detects LH surge) or a day 21 progesterone.
____ (procedure) is the best tx for hirsutism in women with PCOS but ___ can help as well
laser therapy (best thing that a girl can get!)
Spironolactone (anti-androgen)
____ is an aromatase inhibitor that has been successful inducing ovulation in women with PCOS
Letrozole
