PCOS Flashcards
1
Q
What is hypertrichosis?
A
androgen independent terminal hair in nonsexual areas (trunk and extremities)
2
Q
Causes of hypertrichosis
A
- autosomal dominant congenital disorder
- medications
- metabolic disorder
3
Q
Things to screen for in virilisation
A
- androgen secreting tumours of ovary or adrenal gland
- cushings syndrome
- late onset CAH
4
Q
Score for hirsuitism
A
Ferriman-Gallwey score (0-36) 8 or higher = androgen excess
5
Q
Other pathologies that can cause PCOS phenotype
A
- thyroid dysfunction
- CAH
- hyperprolactinaemia
- androgen-secreting tumours
- Cushings syndrome
- acromegaly
6
Q
How to diagnose cushings
A
- 24 hour urine free cortisol >700
- overnight dexamethasone suppression test, cortisol >140
7
Q
Test results in CAH
A
- high testosterone
- high 17-OHP
- abnormal dex suppression test
- low overnight cortisol test
8
Q
Pathophysiology of PCOS
A
- 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
9
Q
Normal testosterone levels
A
0.5-3.5
10
Q
When is SHBG increased?
A
- pregnancy
- luteal phase
- use of estrogen
- elevated TSH
- liver cirrhosis
11
Q
When is SHBG decreased
A
- decrease in androgens
- androgenic disorders
- androgenic medications
- hyperinsulinaemia
- obesity
- prolactin
12
Q
Polycystic ovaries on US
A
- 12 or more follicles of 2-9mm
- increased ovarian volume of >10mm
13
Q
Symptoms of PCOS
A
- hisuitism
- acne and hyperpigmentation
- BMI>30
- insulin resistance
- oligo/amenorrhoea
- hyperandrogenism
- chronic anovulation
- infertility
14
Q
Investigations in PCOS
A
- TSH
- PRL (mildly elevated)
- androgen levels
- GTT
- LH elevated
- fasting insulin
- US
15
Q
Treatment of infertility in PCOS
A
- diet
- exercise
- clomiphene citrate
- metformin
- parenteral gonadotropins
- laparoscopic ovarian diathermy
