PCOS

Question 1

mnemonic

Answer 1

Hyperandrogenism

Amenorrhoea

Irregular periods/ insulin resistance

Reduced fertility

Question 2

diagnostic criteria?

Answer 2

must have 2/3 of:

• hyperandrogenism ie hirsutism, acne
• oligoovulation OR anovulation
• polycystic ovaries on US

Question 3

other features?

Answer 3

• insulin resistance –> diabetes
• hypercholesterolaemia
• CVD
• endometrial hyperplasia/cancer
• acanthosis nigricans

Question 4

where does acanthosis typically occur and what is it linked to?

Answer 4

• in body creases / folds
• insulin resistance

Question 5

why does endometrial hyperplasia occur?

Answer 5

oestrogen causes endometrium to proliferate but no ovulation= no progesterone therefore no shedding of endometrium–> hyperplasia

Question 6

what are the consequences of insulin resistance?

Answer 6

• more insulin release
  
  • insulin promotes androgen release
  • halt development of follicles
  • suppresses sex hormone binding globulin

Question 7

Ix?

Answer 7

• Bloods
  
  • testosterone
  • LH & LH:FSH
  • Prolactin
  • TSH
  • SHBG
• TVUS- gold standard
• OGTT for diabetes

Question 8

blood results?

Answer 8

• Testosterone raised
• LH raised
• LH:FSH raised
• prolcatin may be elevated

Question 9

findings on US?

Answer 9

diagnostic criteria:

• ovarian volume >10cm³
• 12 or more developing follicles in one ovary

may also have follicles lining periphery of ovary = string of pearls appearance

Question 10

Mx?

Answer 10

• wt loss - V IMPORTANT
  
  • if BMI>30, can consider orlistat - lipase inhibitor
• anti-androgen- COCP
• endometrial protection
  
  • COCP/progesterones ie mirena coil, cyclical progestogens
• infertility
  
  • wt loss/ clomifene +/- metformin
  • IVF
  • laparoscopic ovarian drilling

Question 11

how is OCP confer anti-androgen effects?

Answer 11

• stops ovarian androgen secretion as it inhibits gonadotrphin secretion
• increases hepatic production of SHBG