PCOS Flashcards
What is hypertrichosis?
androgen independent terminal hair in nonsexual areas (trunk and extremities)
Causes of hypertrichosis
- autosomal dominant congenital disorder
- medications
- metabolic disorder
Things to screen for in virilisation
- androgen secreting tumours of ovary or adrenal gland
- cushings syndrome
- late onset CAH
Score for hirsuitism
Ferriman-Gallwey score (0-36) 8 or higher = androgen excess
Other pathologies that can cause PCOS phenotype
- thyroid dysfunction
- CAH
- hyperprolactinaemia
- androgen-secreting tumours
- Cushings syndrome
- acromegaly
How to diagnose cushings
- 24 hour urine free cortisol >700
- overnight dexamethasone suppression test, cortisol >140
Test results in CAH
- high testosterone
- high 17-OHP
- abnormal dex suppression test
- low overnight cortisol test
Pathophysiology of PCOS
- hypersecretion of androgens by theca cells
- hypersecretion of LH = testosterone secretion by ovary
- increase of insulin secretion amplifies effect of LH
- endometrium under continuous estrogen exposure until outstrips blood supply
- peripheral aromatisation increased with greater body fat
Normal testosterone levels
0.5-3.5
When is SHBG increased?
- pregnancy
- luteal phase
- use of estrogen
- elevated TSH
- liver cirrhosis
When is SHBG decreased
- decrease in androgens
- androgenic disorders
- androgenic medications
- hyperinsulinaemia
- obesity
- prolactin
Polycystic ovaries on US
- 12 or more follicles of 2-9mm
- increased ovarian volume of >10mm
Symptoms of PCOS
- hisuitism
- acne and hyperpigmentation
- BMI>30
- insulin resistance
- oligo/amenorrhoea
- hyperandrogenism
- chronic anovulation
- infertility
Investigations in PCOS
- TSH
- PRL (mildly elevated)
- androgen levels
- GTT
- LH elevated
- fasting insulin
- US
Treatment of infertility in PCOS
- diet
- exercise
- clomiphene citrate
- metformin
- parenteral gonadotropins
- laparoscopic ovarian diathermy
When and how to give clomiphene citrate
- 50-100mg
- day 2-6 of cycle
- suspend ovulation induction if >2 follicles develop
Treatment for insulin resistance in PCOS
Metformin
Medications used to treat menstrual abnormality in PCOS
- COC
- provera
- dydrogesterone
Treatment for hirsuitism
- physical treatments (waxing etc)
Anti-androgens
- COC (dianne)
- spironolactone
Long term consequences of PCOS
- metabolic (DM, dyslipidaemia)
- CVS (atherosclerosis, MI, HPT)
- sleep apnoea
- depression and mood disorders
- cancer (endometrial, ovarian cancer)
