PCOS

Question 1

What are the causes of amenorrhea?

Answer 1

• Congenital abnormality in mullerian development (isolated defect in androgen insensitivity syndrome, 5-alpha-reductase deficiency, SRY gene is gene that makes you male on Y chromosome so if missing will look female)
• Congenital defect of urogenital sinus development (agenesis of lower vagina, imperforate hymen)
• Other (intrauterine adhesions, Asherman syndrome)

Question 2

What are the causes of hirsuitism?

Answer 2

• Ovarian androgen suppression (COCP/Dianette)
• Adrenal androgen suppression (glucocorticoid)
• Androgen receptor antagonist (spironolactone)
• 5 alpha reductase inhibition (finasteride/spironolactone)
• Topical inhibitors (eflornithine)

Question 3

What are the features of PCOS?

Answer 3

• Clinical and/or biochemical signs of hyperandrogenism with oligo- and/or anovulation
• Reduces indulin sensitivity (increased insulin to glucose load, stimulates ovarian thecal cells to produce androgens, insulin releases hepatic SHBG, increase in free testosterone)
• Best treatment is calorie restriction
• Bariatric surgery also shown to be beneficial as reduces weight
• In theory metformin improves insulin sensitivity and leads to ↓LH levels, ↑SHBG and hence ↓FAI