PCOS

Question 1

What is PCOS?

Answer 1

Hyper-androgenism (clinical or biochemical), oligo-/ anovulation, + polycystic ovarian morphology on ultrasound

Question 2

Describe the aetiology of PCOS

Answer 2

UNKNOWN
Genetic
Environmental factors (Obesity, lack of exercise, steroid use, insulin resistance)

Question 3

Describe the epidemiology of PCOS

Answer 3

6-8% of women of reproductive age

Question 4

List 3 risk factors for PCOS

Answer 4

FHx
Premature adrenarche
Obesity

Question 5

List 3 symptoms of PCOS

Answer 5

Menstrual irregularities
Infertility
Dysfunctional uterine bleeding

Question 6

List 4 signs of PCOS

Answer 6

Overweight/ obese
HTN is common
Oily skin/ XS sweating
Acanthosis nigricans (sign of severe insulin resistance) - velvety thickening + hyperpigmentation of skin in axilla/ neck

Question 7

What bloods should be investigated in PCOS?

Answer 7

High LH therefore increased activity of ovarian theca cells causing XS androgen production
High LH
High LH: FSH ratio
High testosterone, androstenedione + DHEA-S
Low sex hormone binding globulin

Question 8

Which conditions should be excluded when suspecting PCOS? How?

Answer 8

21-OH-deficient non-classic adrenal hyperplasia: 17-OH progesterone
Prolactinoma/ thyroid dysfunction: Serum prolactin + TSH

Question 9

Which further investigations should be performed in those with PCOS?

Answer 9

Fasting blood glucose, HbA1c, OGTT: abnormal glucose tolerance is prevalent in this population
Fasting lipid profile: identify dyslipidaemia

Question 10

What imaging may be performed in PCOS?

Answer 10

Transvaginal USS: look for ovarian follicles + an increase in ovarian volume

Question 11

List 4 conditions associated with PCOS?

Answer 11

Obesity
Insulin resistance
T2DM
Dyslipidaemia

Question 12

Why is insulin resistance considered contributory to the development of PCOS?

Answer 12

Hyperinsulinaemia results in increased ovarian androgen synthesis + reduced hepatic sex hormone binding globulin (SHBG) synthesis
This leads to an increase in free androgens (which gives rise to sx)

Question 13

Why is obesity considered contributory to the development of PCOS?

Answer 13

Causes increase in peripheral oestrogen synth from adipose tissue + decrease in peripheral sensitivity to insulin

Question 14

Why should you ask about hair thickness and distribution in suspected PCOS?

Answer 14

Women may use methods to remove hair so may not be visible

Question 15

List 3 signs of hyperandrogenism

Answer 15

Hirsuitism: thick, pigmented hair
Male-pattern hair loss
Acne: esp beyond adolescence but non-specific