PCOS

Question 1

What are the signs and symptoms of HAIRAN Syndrome?

Answer 1

Hyperandrogenism insulin resistance acanthos nigricans

1) Hyperandrogenism
2) Insulin resistance
3) Acanthosis nigricans

Question 2

What are the levels of these hormones/proteins in PCOS women?

Testosterone
DHEAS
SHBG

Answer 2

Elevated testosterone
Elevated DHEAS
Decreased SHBG (suppression by insulin and androgens)

Question 3

Insulin resistance in PCOS women have increased risk of: (4)

Answer 3

Type 2 DM
HTN
Hyperlipidemia
Cardiovascular disease

Question 4

Signs of hyperandrogenism

Answer 4

1) Acne
2) Hirsuitism
3) Temporal alopecia

Signs that should prompt immediate w/u for androgen secreting tumor:

4) Clitoromegaly
5) Voice deepening
6) Increased muscle mass

Question 5

Definition of hirsuitism

Main cause of hirsuitism

Answer 5

1) Increased growth of terminal hairs

2) Main cause 80% of hirsuitism PCOS (second cause of hirsuitism is idiopathic)

Question 6

What scoring system is used to monitor hair level growth?

What score is consider hirsuitism?

Answer 6

Ferrimen-Galleway score
-examines 9 areas of the body
(upper lip, chin, chest, upper abdomen, lower abdomen, inner thigh, upper back, lower back, upper arms)

8 or more is considered hirsuitism
3 or more is considered hirsuitism in Asian population

Question 7

What enzyme converts testosterone to DHT?

Answer 7

5 alpha reductase

Question 8

Metabolic syndrome (4)

Answer 8

HTN
insulin resistance
hyperlipidemia
obesity

Question 9

Pregnancy loss in PCOS patients versus baseline

Answer 9

30-40% vs 15% (PCOS vs baseline population)

Question 10

Complications in pregnancy in PCOS population?

Answer 10

1) GDM
2) gHTN
3) PTL/B

Question 11

Clitoromegaly is assessed by what index?

What size is considered abnormal?

Answer 11

Clitoral Index

32 mm2

Question 12

What are the investigations for work-up of PCOS? (10)

Answer 12

1) LH/FSH/estradiol (r/o POI)
2) TSH (r/o thyroid dysfunction)
3) cortisol (cushings)
4) AMH (2-3 x higher in PCOS as it’s secreted by antral follicles)
5) Testosterone (>200 consider ovarian tumor)
6) 17 OH progesterone
7) DHEAS (>700 consider adrenal tumor–>CT/MRI)
8) Lipid profile
9) measure of insulin resistance
10) Prolactin

Question 13

3 tests endorsed by the Endocrinology society for diagnosis of Cushings disease

Answer 13

1) 24 hour urine cortisol
2) dexamethasone suppression test
3) Late night salivary cortisol levels

Question 14

Sonographic criteria for PCOS ovaries (2)

Answer 14

1) Greater than or equal to 12 antral follicles (2-9 mm)

2) volume greater than 10 mL