Pituitary Disorder Polycystic Ovarian Syndrom Flashcards
Common endocrine disorder of unknown pathophysiology affecting up to 10% of women of reproductive age.
- Characterized by
(a) Anovulation
(b) Polycystic ovaries
(c) Hyperandrogenism
Polycystic Ovarian Syndrome
Clinical findings of what issue?
(1) Menstrual disorders (anovulation / menorrhagia)
(2) Infertility
(3) Hirsutism
(4) Obesity
(5) Acne
(6) Insulin resistance, DM2, metabolic syndrome
(7) Dyslipidemia
(8) Perinatal complications if able to become pregnant
Polycystic Ovarian Syndrome
Differential Diagnosis
(1) Premature ovarian failure (will have high FSH/LH levels)
(2) Rapid weight loss or extreme exercise (FSH/LH should be normal)
(3) Recent discontinuation of hormonal birth control (anovulation may persist for >6
months)
(4) Pituitary adenoma with elevated prolactin (+/- galactorrhea)
(5) Hyper or hypothyroidism
Lab evaluation / diagnosis
_______ ratio will be abnormal (typically 2:1 to 3:1; normal is 1:1). This
abnormality disrupts ovulation.
LH/FSH
Lab evaluation / diagnosis
Order _______ and _______if clinical evidence of hyperandrogenism is present.
Free testosterone and sex hormone binding globulin (SHBG)
Lab evaluation / diagnosis
When would you order Midnight salivary cortisol or dexamethasone suppression test
clinical evidence of Cushing Syndrome is present.
Lab evaluation / diagnosis
LH / FSH ratio will be abnormal (typically 2:1 to 3:1; normal is____).
1:1
Treatment
1) ___________________ which reduce hyperinsulinism and improve chances of ovulation.
2) In _______ patients with polycystic ovarian syndrome, weight reduction and exercise are often effective in reversing the metabolic effects and in inducing ovulation.
3) Consider _______ is the above are not effective
1) Weight management and routine physical exercise
2) obese
3) Metformin
PCOS should be diagnosed / treated with advice from who
OBGYN, family practice, internal
medicine, or internal medicine.
