PCOS

Question 1

Comment on insulin levels. High/low

Answer 1

High insulin

Question 2

What does the high insulin and androgen levels cause?

Answer 2

• cause granulosa cells to become less functional
• Follicle arrest
• Anovulation

Question 3

What drives the excessive androgen production?

Answer 3

increased LH levels which drive theca cells to increase androgens

Question 4

Consequence of high LH?

Answer 4

Hirsutism

Question 5

Consequence of low FSH?

Answer 5

Anovulation

Question 6

US appearance

Answer 6

more than 10 subcapsular follicles 2-8mm

Question 7

Oestrogen levels in PCOS

Answer 7

usually low but can be normal

Question 8

SHBG levels?

Answer 8

reduced

as it is normally increased by oestrogens

Question 9

Progesterone in PCOS?

Answer 9

low

Question 10

PCOS and endometrial cancer?

Answer 10

increased endometrial hyperplasia and cancer risk

due to lack of progesterone

Question 11

Treatment of PCOS

Answer 11

Lifestyle modifications
COCP
Anti-androgens
Metformin

Question 12

Anti-androgens in the treatment of PCOS

Answer 12

1) Cyproterone Acetate (oral tablet)

inhibits binding of testosterone & 5 alpha dihydrotestosterone to androgen receptors

2) Spironolactone (oral tablet)
anti mineralocorticoid and anti androgen properties