Pituitary Disorder Polycystic Ovarian Syndrom

Question 1

Common endocrine disorder of unknown pathophysiology affecting up to 10% of women of reproductive age.
-Characterized by
(a) Anovulation
(b) Polycystic ovaries
(c) Hyperandrogenism

Answer 1

Polycystic Ovarian Syndrome

Question 2

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

Answer 2

Polycystic Ovarian Syndrome

Question 3

Differential Diagnosis

Answer 3

(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

Question 4

Lab evaluation / diagnosis
_______ ratio will be abnormal (typically 2:1 to 3:1; normal is 1:1). This
abnormality disrupts ovulation.

Answer 4

LH/FSH

Question 5

Lab evaluation / diagnosis
Order _______ and _______if clinical evidence of hyperandrogenism is present.

Answer 5

Free testosterone and sex hormone binding globulin (SHBG)

Question 6

Lab evaluation / diagnosis
When would you order Midnight salivary cortisol or dexamethasone suppression test

Answer 6

clinical evidence of Cushing Syndrome is present.

Question 7

Lab evaluation / diagnosis
LH / FSH ratio will be abnormal (typically 2:1 to 3:1; normal is____).

Answer 7

1:1

Question 8

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

Answer 8

1) Weight management and routine physical exercise
2) obese
3) Metformin

Question 9

PCOS should be diagnosed / treated with advice from who

Answer 9

OBGYN, family practice, internal
medicine, or internal medicine.