PCOS Flashcards
What is the most common cause of infertility in women?
PCOS
What is happening pathophysiology-wise in PCOS?
LH:FSH ratio is out of whack
>2
Which hormone oversensitivity secretion is occurring in PCOS?
DHEA-S
TESTOSTERONE
Androstenedione
What are the four pillars of PCOS pathophysiology which explain the visualized S/Sx?
Hypothalamic-Pituitary abnormalities (LH:FSH >2)
Hyperandrogenism
Estrogen abnormalities (tonic prod. of estradiol)
Insulin resistance
How do elevated levels of insulin interact with PCOS females leading to increased androgen secretion?
Insulin stimulates androgen production by thecal cells of the ovaries in PCOS women
What are the high risk groups for PCOS?
Oligo-ovulatory infertility
Obesity +/- insulin resistance
Diabetes (Type 1, 2, GDM)
Relatives w/ PCOS
What S/Sx should raise your suspicion of PCOS?
Amenorrhea
Menstrual irregularities
Androgen excess
T/F
A definitive Dx can be made of PCOS with an U/S with multiple cysts visible on the ovaries.
FALSE
U/S IS NOT SUFFICIENT ENOUGH TO MAKE Dx YOU NEED MORE TO PROVE THE METABOLIC / ANDROGEN IMBALANCE
What is the typical presentation of an individual with PCOS?
Sleep apnea
Nonalcoholic steatohepatitis (NASH)
Dyslipidemia (
What are the NIH criteria for PCOS?
Menstrual irregularity
Clinical or biochemical evidence of hyperandrogenism
R/o other causes of menstrual irregularity
~~Congen. adrenal hyperplasia
~~Androgen secreting tumors
~~Hyperprolactinemia
What are the Rotterdam Criteria for Dx?
Need 2 of the following
~~Polycystic ovaries
~~Ovulatory dysfunction
~~Evidence of androgen XS
What is the diagnostic criteria for PCOS in adolescents?
Abnormal uterine bleeding pattern
Hyperandrogenism (above adult normal range w/ severe acne)
How can you evaluate menstrual irregularity?
<9 menses / yr
Anovulatory cycles
Testing –> TSH, hCG, LH/FSH (to r/o ovarian failure), Prolactin
What lab values would you order and look at for the hyperandrogenism aspect of PCOS?
ELEVATED FREE TESTOSTERONE
~~Most sensitive test~~
DHEA-S +/- androstenedione to r/o adrenal origin
Your PT w/ suspected PCOS has been referred to you with sets of labs already ordered. The results are in; what would you expect to see on Lipid panel and glucose if the PT is + PCOS?
Dyslipidemia: (FASTING LIPIDS)
High LDL
High Triglycerides
Low HDL
Glucose intoleranceWhat should your differential for PCOS include / rule out?
Congenital Adrenal Hyperplasia
21-hydroxylase deficiency
Cushing’s Syndrome
Virilizing tumors, anabolic steroids
How would you rule out Acquired Congenital Adrenal Hyperplasia if higher on your differential?
Blood 17-hydroxyprogesterone
>200 ng/dL suggestive
Confirm w/ ACTH
What are the therapeutic goals for PCOS patients when managing their care?
Reduce serum androgens
Improve reproduction function
Lower the risk of insulin related complications
Promote weight loss (diet and exercise)
What is the primary drug therapy for PCOS PTs?
Oral Contraceptives!
~~Increases sex hormone binding globulin
~~Decreases androgen
Oral contraceptives w/ progestin and reduced androgens (i.e. YAZ)
Antiandrogens –> Spironolactone (6months to visualize effect
If fertility is an important concern of PTs; what therapy should you prescribe your PCOS PT?
Weight Loss is massively important
Clomiphene
Metformin (off label) reduces testoterone
TZD (off label) reduces Testosterone
How do Metformin and TZD individually contribute to glucose control as well?
Metformin 500mg BID –> Suppress hepatic glucose output (also provides endometrial protection)
TZDs –> Improves glucose uptake
What are some long-term consequences of PCOS which must be considered and managed with PTs w/ PCOS?
Endometrial / Ovarian CA
Diabetes
CAD (2 to 5x risk)
