POLYCYSTIC OVARIAN SYNDROME

Question 1

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

Answer 1

Polycystic Ovarian Syndrome.

Question 2

Clinical findings of a patient with Polycystic Ovarian Syndrome

Answer 2

(1) Menstrual disorders (anovulation / menorrhagia)
(2) Infertility
(3) Hirsutism
(4) Acne
(5) Insulin resistance, DM2, metabolic syndrome
(6) Dyslipidemia
(7) Perinatal complications if able to become pregnant

Question 3

Lab evaluation / diagnosis of a patient with Polycystic Ovarian Syndrome

Answer 3

(1) LH / FSH ratio (classically 2:1 to 3:1)
(2) TSH
(3) Hgb A1c and fasting glucose
(4) Prolactin
(5) Free testosterone and sex hormone binding globulin (SHBG) if clinical evidence of hyperandrogenism is present.
(6) Midnight salivary cortisol or dexamethasone suppression test if clinical
evidence of Cushing Syndrome is present.

Question 4

Treatment of a patient with Polycystic Ovarian Syndrome

Answer 4

(1) Weight management and routine physical exercise which reduce
hyperinsulinism and improve chances of ovulation.
(2) Metformin if above is not effective.
(3) Contraceptive counseling as #1 and/or #2 may result in resumption of ovulation.
(4) Combined Oral Contraceptives (COC: estrogen/progesterone combination)
(a) Via negative HPG feedback, COC medications reduce hyperandrogenism
(b) Must evaluate for venous thromboembolism risk due to increased risk with COC use
(c) If COC are contraindicated, may consider Spirinolactone for androgen
suppression, however due to teratogenicity will need alternate contraception
(5) If desiring pregnancy: above plus clomiphene (analog of gonadotropin
releasing hormone) which will increase FSH which will increase chances of
ovulation.

Question 5

PCOS should be diagnosed / treated with advice from who

Answer 5

OBGYN, family practice,

internal medicine, or internal medicine.