Polycystic ovarian syndrome

Question 1

What is PCOS?

Answer 1

Oligomenorrhoea/amenorrhoea and hyperandrogenism.

Question 2

What is the aetiology and risk factors of PCOS? (x6)

Answer 2

• Obesity, insulin resistance, T2 DM, dyslipidaemia, premature adrenarche
• There’s also a genetic component relating to genes that regulate gonadotrophins, insulin and androgens

Question 3

What is the pathophysiology of hyperinsulinemia in PCOS?

Answer 3

Hyperinsulinemia results in increased ovary androgen synthesis and reduced hepatic SHBG (sex-hormone binding globulin) synthesis (resulting in increased free androgens)

Question 4

What is the epidemiology of PCOS: Prevalence?

Answer 4

Prevalence in 10% of women.

Question 5

What are the signs and symptoms of PCOS? (x4)

Answer 5

• Menstrual irregularities
• Infertility
• Symptoms of hyperandrogenism: hirsutism, male-pattern hair loss, oily skin, acne
• Acanthosis nigricans (sign of insulin resistance): velvety thickening and hyperpigmentation of the skin of axillae or neck

Question 6

What are the investigations for PCOS? (x1 +4 blood tests)

Answer 6

• TRANVAGINAL USS: 20 or more follicles in each ovary, measuring 2-9mm, and/or raised ovarian volume (at least 10mL) is diagnostic
• Raised testosterone, androstenedione, DHEA-S, reduced SHBG: measured in patients who do not present with hirsutism to support diagnosis
• TSH, prolactin and 12-hydroxyprogesterone should be measured in all women to exclude disorders that may resemble PCOS: thyroid dysfunction, hyperprolactinaemia and 21-hydroxylase-deficiency adrenal hyperplasia, respectively
• Raised LH, LH:FSH ratio over 3: supports PCOS diagnosis but not diagnostic
• Due to high frequency of insulin resistance and metabolic syndrome, an oral glucose tolerance test and fasting lipid panel should also be performed in all patients to evaluate metabolic risk factors.