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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > PCOS > Flashcards

PCOS Flashcards

1
Q

What might serum free testosterone be in PCOS?

A

Elevated

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2
Q

What is polycystic ovarian syndrome?

A

Polycystic ovary syndrome (PCOS) includes symptoms of hyper-androgenism, presence of hyper-androgenaemia, oligo-/anovulation, and polycystic ovarian morphology on ultrasound.

Cause is idiopathic.

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3
Q

Risk factors for development of PCOS

A
  • Genetics
  • Smoking
  • High levels of LH - hyperandogenism
  • Hyperinsulinaemia - obesity, DM

Thought to be hereditary but gene not identified.

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4
Q

Why can those with PCOS present with diabetes?

A

Due to insulin resisntance

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5
Q

Why does someone with PCOS have increased androgen production?

A
  • Hyperinsulinaemia stimulates androgen production and inhibits production of sex hormone binding globulin - increases circulating levels fo free androgens
  • Excessive LH production
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6
Q

What disease processes are associated with PCOS?

A
  • Metabolic syndrome
  • T2DM
  • Sleep apnoea
  • Obesity
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7
Q

What are symptoms of PCOS?

A

Typical presentation: usually with oligomenorrhoea +/- hirtusim, acne and subfertility

  • Androgenic symptoms
    • ​Hirsutism,
    • Acne,
    • Scalp hair loss, alopecia
    • Central obesity
  • Oligo/amenorrhoea
  • Weight gain due to DM association
  • Acanthosis nigricans - due to insulin resistance
  • Infertility
  • First trimester miscarriage
  • Features of diabetes - polyuria, polydipsia, visual distrurbance
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8
Q

What is the following?

A

Acanthosis nigricans - related to insulin resistance

Mainly occurs in skin folds of skin (in axilla, groin and back of neck)

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9
Q

What might you see on examination of someone with PCOS?

A
  • Hirsutism, acne, alopecia
  • Hypertension
  • Acanthosis nigricans
  • Sweating/oily skin
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10
Q

What investigations would you consider doing in someone with suspected PCOS?

A
  • Bloods -
    • Diagnosis - Free testosterone, Sex hormone binding gloulin, androgen free index*, DHEAS, Fasting lipids
    • Exclude other causes of oligo/amenorrhoea - prolactin, TFTs, LH and FSH, 17-hydroxyprogesterone
  • Imaging - Pelvic USS
  • Other - OGTT

*Free androgen index = a ratio used to determine abnormal androgen status in humans. The ratio is the total testosterone level divided by the sex hormone binding globulin (SHBG) level, and then multiplying by a constant, usually 100.

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11
Q

What is DHEAS?

A

Serum dehydroepiandrosterone sulfate - may be elevated in PCOS

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12
Q

What might you find when investigating 17-hydroxyprogesterone in someone with suspected PCOS?

A

>24 nanomol/L - indicates adrenal hyperplasia/androgen secreting tumous

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13
Q

Why might you do a serum prolactin level in someone with PCOS?

A

To exclude hyperprolactinamia as a cause of amenorrhoea

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14
Q

Why might you perform TFTs in someone with suspected PCOS?

A

Exclude hypothyroidism as a cause of amenorrhoea

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15
Q

Why might you do an OGTT in someone with suspected PCOS?

A

Check for diabetes

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16
Q

Why might you perform fasting lipid in someone with PCOS?

A

Dyslipidaemia is often observed in PCOS

17
Q

What criteria are useed to make the diagnosis of PCOS?

A

Rotterdam Criteria

18
Q

What are the rotterdam criteria used to diagnose someone with PCOS?

A

PCOS should be diagnosed if two of three of the following criteria are present, as long as other causes of menstrual disturbance and hyperandrogenism are excluded:

  • Polycystic ovaries (12 or more follicles/ovarian volume > 10cm3 on US)
  • Oligo-ovulation/anovulation (ameorrhoea/oligomenorrhoea)
  • Clinical and or biochemical signs of hyperandrogenism
19
Q

What might you see on pelvic USS scan in someone with PCOS?

A
  • >/= 12 follicles measuring 2-9 mm (>5/ovary)
  • Increased ovarian volume (>10 mL)

“String of pearls”

20
Q

What might you find on LH/FSH ratio in someone with PCOS?

A

>3 suggests PCOS

21
Q

What general measures would you take in someone with PCOS?

A
  • Weight loss/exercise
  • Smoking cessation
  • Treat co-morbidities - diabetes, hypertension, dyslipidaemia, sleep apnoea

Could use orlistat

These increase SHBG (sex hormone binding globulin)

22
Q

What medical options are available as antiandrogen treatment for PCOS?

A
  • COCP - induces regular periods and mnages hirsutism
  • Spironolactone (aldoesterone agonist) (lowers androgen levels)
  • Eflornithine face cream - facial hair
23
Q

What medications can be used as endometrial protection in PCOS?

A
  • COCP
  • Progestogens
  • Mirena IUS
24
Q

What medications can be usedd to treat infertility in someone with PCOS?

A
  • Clomifene citrate
  • Metformin
25
Q

How does metformin help in PCOS?

A

Improves insulin sensitivity in the short term and may improve mentrual abnormality and ovulatory function.

Does not have significant impact on hirsuitism and acne

26
Q

How does clomifene help with infertility in someone with PCOS?

A

Induces ovulation - inhibits oestrogen negative feedback on HP axis, which leads to an increase in FSH secretion that may allow follicular maturation and ovulation

Works by occupying hypothalamic oestrogen recetpor without activating them. interferes with binding of oestradiol and thus prevents negative feedback of FSH secreation.

27
Q

What are risks with using clomifene to treat infertility?

A
  • Multiple pregnancy
  • Ovarian cancer
28
Q

What are women with PCOS at risk of with assisted conception?

A

Ovarian hyperstimulation syndrome

The ovaries may form 20 follicles or more and swell following an increase in serum levels of hCG. OHSS is a systemic disease. Vasoactive mediators are released from the hyperstimulated ovaries, causing an increase in capillary permeability. This causes fluid shift from the intravascular compartment to third space compartments such as the peritoneal or thoracic cavities. Morbidity and even mortality can then be caused by effusions (pericardial, pleural, ascites), haemoconcentration (causing increased risk of thrombosis and coagulopathy) and liver or kidney dysfunction.

29
Q

How does spironolactone help in PCOS?

A

Anti-androgen medication - receptor blocker

30
Q

How does COCP help in PCOS?

A

Oral contraceptive (OCP: cyclic oestrogen plus progestogen) therapy modestly inhibits gonadotrophin secretion, and thus gonadotrophin-sensitive ovarian androgen production, and increases hepatic production of sex hormone binding globulin (SHBG), which further decreases free testosterone

31
Q

What is recommended by NICE for treating infertility in individuals who have not responded to clomifene?

A

Ovarian drilling

32
Q

What are complications of PCOS?

A
  • Infertility (due to annovulation)
  • Pregnancy complicaitons
  • Type 2 DM
  • NAFLD
  • Metabolic syndorme (cardiovascular risks)
  • Dyslipidaemia
  • Sleep apnoea
  • Endometrial hyperplasia/cancer

NO INCREASE IN OVARIAN/BREAST CANCERS

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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