PCOS Lecture Powerpoint Flashcards
Most common endocrine disorder of women and most common cause of infertility
PCOS
PCOS pathophysiology
Hypothalamic pituitary abnormalities resulting in altered LH action increasing the LH:FSH ratio >2 and increased sensitivity to androgens (hyperandrogenism) including androstenedione, DHEA-S, and testosterone, and also see insulin resistance (50-70% are hyperinsulinemic and at risk for pre-diabetes and overt type 2 diabetes
PCOS and insulin
Due to genetic and environmental factors, ovaries and thecal cells in ovaries that make estrogen and a little bit of testosterone are very sensitive to higher insulin levels and insulin serves as a co-gonadotropin so that instead of LH stimulating these cells insulin does instead to see increased androgen production by the ovaries
High risk groups for PCOS (4)
- oligo-ovulatory infertility
- obesity and insulin resistance
- diabetes type 2 (typically)
- family members with pcos
Not every obese woman develops ___, and not every ___(same) woman is obese
PCOS
PCOS presenting signs/symptoms (9)
- Secondary amenorrhea (rule out pregnancy)
- other menstrual irregularities
- androgen excess (hirsutism, acne, male pattern baldness)
- obesity
- cystic ovaries (usual but not diagnostic)
- glucose intolerance
- metabolic syndrome
- Nonalcoholic steatohepatitis (NASH) (very common cause of cirrhosis in US)
- miscarriage risk
PCOS diagnostic criteria NIH
- Menstrual irregularity
- clinical or biochemical evidence of hyperandrogenism
- ruling out other causes of menstrual irregularity
PCOS diagnostic criteria Rotterdam
2 of the following
- Evidence of androgen excess
- Ovulatory dysfunction
- polycystic ovaries
Most sensitive test for hyperandrogenism in PCOS eval
Free testosterone first thing in morning
Look for other causes than PCOS when you have these 3 things
- Sudden onset or worsening of symptoms
- onset 3rd decade of life or later
- signs of virilization (frontal balding, severe acne, clitoromegaly, muscle mass, deepening voice)
PCOS differential diagnosis (4)
- Congenital adrenal hyperplasia
- Cushing’s syndrome
- Virilizing tumors
- Anabolic steroids
Test to rule out acquired congenital adrenal hyperplasia in a suspected PCOS patient
Test for 17 hydroxyprogesterone elevation
Goals of PCOS therapy
Depends on patient goals (reduce serum androgen, improve repro function, promote weight loss)
PCOS therapeutic options (6)
- Birth control pills to lower free testosterone (Yaz)
- Antiandrogens (spironolactone)
- Metformin
- weight loss
- clomiphene (80% ovulate in response to this allowing almost 50% to conceive)
- bariatric surgery (curative)
Labs to order for insulin sensitizer therapy in PCOS (5)
- Free testosterone
- fasting lipids
- BMP
- DHEA-S
- LFT
