PCOS Flashcards
What is the different between primary and secondary amenorrhoea?
Primary: never had a period
Secondary: used to have a period
Give examples of causes of primary amenorrhoea?
- GU congenital abnormalities: Rokitansky syndrome or androgen insensitivity syndrome.
- Turners syndrome
- Secondary hypogonadism (hypothalamic/pituitary causes): Kallmans syndrome, pituitary disease.
Give examples of causes of secondary amenorrhoea?
- Ashermans syndrome
- PCOS
- Premature ovarian failure
- Pituitary prolactinoma
What is hirsutism?
Excess hair growth in a male pattern due to increased androgens and increased skin sensitivity to androgens.
What is the most common cause of hirsutism?
PCOS
What are the symptoms of PCOS?
- Anovulation: amenorrhoea, oligomenorrhea or irregular cycles
- Hyperandrogenism: hirsutism, acne, alopecia.
- Associated with metabolic abnormalities and increased risk of T2DM.
When do patients normally present with PCOS?
During adolescence.
What hormones are raised in PCOS?
Testosterone and LH
What are the advantages and disadvantages of using ultrasound in diagnosing PCOS?
Good visualization of ovarian cysts.
Around 25% of women have cysts in the ovaries so doesn’t always mean PCOS.
Describe gonadotrophin in PCOS?
Increased LH concentration and there is increased LH receptors in PCOS ovaries so there is increased androgens.
Decreased FSH and low but content levels results in continuous stimulation of follicles without ovulation. Also decreased conversion of androgen to oestrogen in granulose cells.
What androgens are increased in PCOS?
Testosterone
Androstenedione
DHEA-5
Why is DHEA-5 only slightly increased in PCOS?
As it is mainly produced in the adrenals.
Why are androgens increased in PCOS?
Increased androgen production from theca cells under the influence of LH.
There is disordered enzyme action as there is more ovarian enzyme expression and peripheral conversion.
There is decreased SHBG so there is more biologically active free testosterone.
What are the results of insulin resistance in PCOS.
Insulin resistance means hyperinsulinaemia can occur to try compensate.
Insulin stimulate ovarian theca cells, reduces hepatic SHBG production, and therefore increases circulating androgens.
What investigations would be done to diagnose PCOS?
Confirm profile of PCOS
- Testosterone, androstenedione, DHEAs
- SHBG
- FSH/LH
Assess for other features
- T2DM
- Abnormal lipids
Exclude other pathologies.
