Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Met 3b > PCOS > Flashcards

PCOS Flashcards

1
Q

PCOS

A

A set of symptoms seen in women due to increased levels of androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PCOS Clinical features

A 
Oligomenorrhoea
Hypermenorrhoea
Infertility
Hirsutism
Acne
Androgenic alopecia
Acanthosis nigricans
Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PCOS neuroendocrine abnormalities

A

Women with PCOS have increased pulse frequency of GnRH
Favours LH secretion over FSH–> increased LH:FSH ratio
Acts on ovarian theca cells–> increased androgen production relative to oestrogen production
Usually progesterone (released from corpus luteum after ovulation) acts to decrease GnRH pulse rate to favour FSH secretion- therefore, decreasing ovulatory events in PCOS can further exacerbate the high LH:FSH ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PCOS metabolic abnormalities

A

Hyperinsulinaemia- thought to be due to dysregulation of adipokine production + signalling from adipose tissues
High insulin levels increase the GnRH pulse frequency that favours LH secretion over FSH secretion
Excess insulin can act on skin - acts as IGF1 - promotes keratinocyte proliferation that can result in acanthosis nigricans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PCOS ovarian abnormalities

A

Cysts may appear on ultrasound - represent antral follicles that have arrested during development
Hyperandrogenism favours androgen synthesis in thecal cells + inhibits aromatisation to form oestradiol by follicular cells, which is required for follicles to complete maturation into Graffian follicles
Hyperinsulinaemia- stimulates 17a hydroxylase activity, which increases androgen synthesis in thecal cells, and elevates levels of free testosterone by decreasing the production of sex hormone behind globulin (SHBG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PCOS physical exam

A 
Hirsutism
Acne
Alopecia
Hypertension
Acanthosis nigricans
High BMI
Sweating
Oily skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PCOS investigation

A

Free testosterone= elevated
Free DHEAS= elevated
Serum androstenedione= elevated
Sex hormone binding globulin (SHBG)= decreased
LH:FSH ratio= elevated > 3 suggests PSH
Pelvic ultrasound- >12 antral follicles in 1 ovary, ovarian volume >10ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PCOS investigations to rule out other conditions

A

Serum 17-hydroxypreogesterone (>24 indicates adrenal hyperplasia)
TSH (high or low in thyroid conditions that can cause menstrual upset)
Prolactin (high levels suggests hyperprolactinaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PCOS Criteria for diagnosis- requires 2 out of 3 of following criteria

A

Irregular or absent menses (cycle >42 days)
Clinical or biochemical signs of hyperandrogenism- acne, hirsutism, alopecia
Signs on ultrasound- >12 antral follicles on one ovary, ovarian volume >10ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PCOS differential diagnosis- Thyroid dysfunction

A

Menstrual irregularity present
Symptoms of hyperandrogenaemia not present
Distinguished with TSH test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PCOS differential diagnosis- Hyperprolactinaemia

A

Can lead to menstrual upset
Mild hyperandrogenic symptoms may be present
Galactorrhoea may also be present
Distinguished by measuring prolactin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PCOS differential diagnosis- 21 hydroxylase deficient adrenal hyperplasia

A

Virtually indistinguishable in presentation

Ruled out of 17-hydroxyprogesterone <6nanomol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PCOS differential diagnosis- Cushings syndrome

A

Cortisol and androgen excess can present with hirsutism, acne, alopecia + menstrual upset
Moon face, striae, hypertension, osteoporosis, central obesity
24hr urinary free cortisol test or low dose dexamethasone suppression test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PCOS differential diagnosis- androgen secreting neoplasms

A

Autonomous androgen secretion can produce rapid appearance of hirsutism, frontal balding, increased muscle balk, deepened voice + clitoromegaly
CT adrenals + US should be done to look for a neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PCOS lifestyle changes

A

Weight loss can improve symptoms- can also help to restore menstrual cycles + allow pregnancy
Good diet + exercise should be encouraged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PCOS- improving menstrual regularity

A

Combined oral contraceptive pill- inhibits ovarian androgen production, but also increases sex hormone-binding globulin (SHBG) production
–> helps to restore menstrual irregularity
Metformin - reducing hyperinsulinaemia may reduce ovarian androgen synthesis –> can help restore menstrual regularity + induce ovulation

17
Q

Cosmetic procedures

A

Depilatory cream
Shaving
Plucking
Laser hair removal

18
Q

COCP

A

Inhibits ovarian androgen production, but also increases sex hormone-binding globulin (SHBG) production
May be enough to relieve hyperandrogenic symptoms alone

19
Q

Anti-androgens

A

If COCP not enough to relieve symptoms
Androgen receptor antagonists
5 alpha reductase inhibitors

20
Q

Androgen receptor antagonists

A

Reduces binding of androgens such as testosterone + DHT to androgen receptor to reduce symptoms
Spironolactone
Flumatide
Should not be used in pregnancy as can feminize a male foetus

21
Q

5 alpha reductase inhibitor

A

Blocks conversion testosterone –> DHT (most potent androgen) in peripheral cells to decrease symptoms
Finasteride

22
Q

Subfertility

A

Weight loss alone may help achieve ovulation
Anti-oestrogens
Gonadotrophins
Laparoscopic ovarian drilling

23
Q

Anti-oestrogens

A

Clomiphene citrate
Selective oestrogen receptor modulator that acts to inhibit oestrogen receptors in hypothalamus
This reduces negative feedback that oestrogen exerts on GnRH release
Therefore, GnRH increases which increases FSH and LH levels to induce ovulation
When combine with metformin, clomiphene more effective in inducing ovulation

24
Q

Gonadotrophins

A

Recombinant FSH can be used to promote follicle maturation
Recombinant bHCG can be used to induce ovulation
Therapy must me closely monitored with imaging + lab studies to minimise risks of multigestational pregnancy + ovarian hyperstimulation syndrome
Only used after treatment with clomiphene citrate + metformin have been proved to be unsuccessful

25
Q

Laparoscopic ovarian drilling

A

If PCOS is resistant to all other treatments –> ovarian drilling
Drilling perforations in ovary + ablating some of the theca
Help decrease androgen release to help induce ovulation

26
Q

IVF

A

Last resort

Women with PCOS have similar success and live birth rates to women without

27
Q

Controlling hyperinsulinaemia

A

Metformin- increases insulin sensiticity
When combined with ovulation induction with clomiphene citrate it increases ovulation + pregnancy rates
Controlling insulin doesn’t improve hirsutism, acne or help with weight loss

28
Q

Long term PCOS complications

A

Miscarriage- increased risk
CV disease- hyperinsuliaemia + hyperandrogenaemia can lead to dyslipidaemia- dyslipidaemia is RF for DV disease
T2DM- PCOS women have higher level insulin resistance, more prone to develop T2DM- as many as 10% develop T2DM by 4th decade
Malignancies- hyperinsulinaemia, hyperandrogenism + oligoanovulation increases risk of endometrial cancer
Psychiatric disorders- increased risk anxiety, depression, binge-eating + bipolar

Met 3b (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions