PCOS

Question 1

___ is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries.

Answer 1

PCOS

Question 2

What is the Dx criteria for PCOS

Answer 2

Rotterdam criteria 
must have 2/3....
Hyperandroganism 
oligomenorrhea/amenorrhea
PCOS on U/S

Question 3

T/F: PCOS is a dx of exclusion?

Answer 3

T

Question 4

What is the incidence of PCOS (percentage)

Answer 4

6.5-8%

Question 5

What U/S findings suggest PCOS

Answer 5

12 or more follicles in each ovary

follicles are 2-9 mm diameter

Question 6

___(condition) may amplify the effects of PCOS

Answer 6

obesity (20% are not obese)

Question 7

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 _____

Answer 7

hyperinsulinemia

gonadotropin secretion.

Question 8

What are 4 skin d/o. that can be seen with PCOS

Answer 8

Hirsutism
Acne
Androgenic alopecia (to a lesser extent)
Acanthosis nigricans (dirty neck…)

Question 9

A pt with PCOS is at Increased risk of insulin resistance and associated conditions such as ___ and ____

Answer 9

Metabolic syndrome

Nonalcoholic fatty liver disease

Question 10

What conditions are risk factors for long-term metabolic sequelae of PCOS

Answer 10

T2DM

Cardiovascular disease

Question 11

___, ___ and ___ are risk factors for endometrial cancer associated with PCOS

Answer 11

Chronic anovulation
Centripetal obesity
Diabetes

Question 12

What else can cause androgen excess (JUST FYI)

Answer 12

Androgen secreting tumor
exogenous androgens
cushing syndrome
acromegaly 
primary hypothalmic amenorrhea 
primary ovarian filure
thyroid dz
prolactin d/o

Question 13

What is included in the w/u for PCOS? (probably FYI)

Answer 13

BP
Waist measurement
skin eval
testosterone 
Thyroid
glucose challenge 
lipids 
U/S

Question 14

How can you treat PCOS?

Answer 14

OCP (primary tx) (low dose estrogen) 
progestins 
Insulin-sensitizing agents (metformin) 
lifestyle modification 
(Maybe a statin)

Question 15

How does OCP tx for PCOS work?

Answer 15

Suppression of pituitary LH secretion –> suppression of ovarian androgen secretion.

Increased levels of SHBG –> decrease in free testosterone levels.

Question 16

How does metformin work in the tx of PCOS?

Answer 16

increasing sensitivity to insulin –> lower insulin –> decrease in circulating androgen levels (also increase in SHBG) –> improved ovulation rate. (Also, improved glucose tolerance)

Question 17

What lifestyle tx should a woman with PCOS make?

Answer 17

exercise
dietary change
wt loss

Question 18

Clomiphene citrate is a ____ (class of medication) that can be used to initiate ovulation in a woman with PCOS

Answer 18

SERM (selective estrogen receptor modulator)

Question 19

When do you begin Clomiphene citrate therapy?

What tests can you use to see if the therapy worked?

Answer 19

Day 3 or 5.

OPK (detects LH surge) or a day 21 progesterone.

Question 20

____ (procedure) is the best tx for hirsutism in women with PCOS but ___ can help as well

Answer 20

laser therapy (best thing that a girl can get!)

Spironolactone (anti-androgen)

Question 21

____ is an aromatase inhibitor that has been successful inducing ovulation in women with PCOS

Answer 21

Letrozole