Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 - GOSH > Polycystic Ovarian Syndrome > Flashcards

Polycystic Ovarian Syndrome Flashcards

1
Q

What is PCOS and what are the characteristic features?

A
  • a common condition causing metabolic + reproductive problems in women
  • the characteristic features are:
  1. multiple ovarian cysts
  2. hyperandrogenism
  3. insulin resistance
  4. infertility
  5. oligomenorrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is meant by anovulation and oligoovulation?

A

anovulation:

  • the absence of ovulation

oligoovulation:

  • irregular, infrequent ovulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is meant by amenorrhoea and oligomenorrhoea?

A

amenorrhoea:

  • the absence of menstrual periods

oligomenorrhoea:

  • irregular, infrequent menstrual periods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the criteria used to diagnose PCOS?

A

Rotterdam criteria

a diagnosis requires at least 2 of the 3 key features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What features are included in the Rotterdam criteria?

A

oligoovulation / anovulation:

  • presents with absent or irregular menstrual periods

hyperandrogenism:

  • presents with hirsutism / acne

polycystic ovaries on US:

  • presence of 12 or more follicles on a single ovary
  • or an ovarian volume of > 10 cm3

at least 2 of the 3 criteria must be present for diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the typical presenting features of PCOS?

A
  • oligomenorrhoea / amenorrhoea
  • hirsuitism
  • acne
  • obesity
  • infertility
  • hair loss in a male pattern

around 70% patients with PCOS are obese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most significant complication of PCOS and its implications?

A
  • it is associated with insulin resistance + diabetes
  • this may present with acanthosis nigricans
  • increased risk of cardiovascular disease + hypercholesterolaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is acanthosis nigricans?

A
  • thickened, rough skin found in the axilla or on the elbows
  • it can also occur on the neck
  • skin has a velvety texture
  • associated with insulin resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the other complications associated with PCOS?

A
  • increased risk of endometrial hyperplasia + cancer
  • obstructive sleep apnoea
  • depression / anxiety
  • sexual dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What medications can also cause hirsuitism?

A
  • phenytoin
  • ciclosporin
  • corticosteroids
  • testosterone
  • anabolic steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What other conditions can cause hirsuitism?

A
  • congenital adrenal hyperplasia
  • Cushing’s syndrome
  • ovarian / adrenal tumours secreting androgens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does insulin resistance contribute to hyperandrogenism in PCOS?

A
  • when there is insulin resistance, the pancreas has to produce more insulin to get a response from the cells of the body
  • insulin promotes the release of androgens from the ovaries / adrenal glands

!! higher levels of insulin = higher levels of androgens !!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In what other way can insulin resistance contribute to hyperandrogenism in PCOS?

A
  • insulin suppresses sex hormone-binding globulin (SHBG) production by the liver
  • SHBG binds to androgens and suppresses them
  • reduced SHBG further promotes hyperandrogenism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does insulin resistance affect the formation of polycystic ovaries?

A
  • high levels of insulin contribute to halting the development of follicles in the ovaries
  • this results in anovulation
  • and the presence of multiple partially developed follicles
  • the partially developed follicles are seen as polycystic ovaries on US
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What blood tests are required to diagnose PCOS and exclude other pathology that presents similarly?

A
  • testosterone
  • sex hormone-binding globulin (SHBG)
  • lutenising hormone (LH)
  • follicle stimulation hormone (FSH)
  • prolactin
  • thyroid-stimulating hormone (TSH)

prolactin may be mildly raised in PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What blood test results would you expect to see in PCOS?

A
  • raised LH
  • raised LH to FSH ratio
  • raised testosterone
  • raised insulin
  • normal / raised oestrogen
17
Q

Following hormonal blood tests, what investigation is performed in suspected PCOS?

A

pelvic / transvaginal USS

this is NOT reliable in diagnosing PCOS in adolescents

18
Q

What is the traditional appearance of PCOS on transvaginal US?

A
  • the follicles are arranged around the periphery of the ovary
  • this gives a “string of pearls” appearance
it is normal for premenopausal women to have multiple small cysts on their ovaries
19
Q

How is transvaginal US used to diagnose PCOS?

A
  • 12 or more developing follicles in ONE ovary

OR

  • ovarian volume of > 10cm3

increased ovarian volume can indicate PCOS even in the absence of cysts

20
Q

How is diabetes screened for in patients with PCOS?

A

oral glucose tolerance test (OGTT)

21
Q

What is involved in the OGTT?

A
  • this is performed in the morning prior to breakfast
  • the patient is given a 75g oral glucose drink
  • a fasting plasma glucose and a plasma glucose 2 hours later are meaasured
22
Q

What results of the OGTT suggest the presence of diabetes?

A

plasma glucose > 11.1 mmol/l 2 hours after the glucose drink

if plasma glucose is 7.8 - 11.1 mmol/l 2 hours after the drink, this suggests impaired glucose tolerance

23
Q

What advice is given to patients with PCOS to reduce the risks associated with obesity / diabetes?

A
  • weight loss
  • calorie-controlled diet
  • exercise
  • smoking cessation
  • antihypertensive medications if indicated
  • statins where QRISK > 10%
24
Q

What is the most significant lifestyle modification important in the treatment of PCOS?

A

weight loss

  • this can restore fertility + regular menstruation by allowing ovulation
  • improvement in insulin resistance + hyperandrogenism
  • reduces risk of diabetes, CVD + hypercholesterolaemia
25
Q

What medication can be given to help weight loss in PCOS?

A

orlistat

  • given to women with a BMI > 30
  • it is a lipase inhibitor that can prevent the absorption of fat in the intestines
26
Q

What risk factors for endometrial cancer do women with PCOS have?

A
  • obesity
  • diabetes
  • insulin resistance
  • amenorrhoea / anovulation
27
Q

Why are women with PCOS at increased risk of endometrial cancer?

A
  • normally, the corpus luteum releases progesterone after ovulation
  • when there is no ovulation, insufficient progesterone is produced
  • they continue to produce oestrogen
  • the endometrial lining continues to proliferate under the influence of oestrogen without regular shedding through menstruation
  • this results in endometrial hyperplasia
28
Q

When do women with irregular periods need to be investigated?

A
  • women with extended gaps between periods of > 3 months

OR

  • abnormal bleeding
  • are investigated with a pelvic US to assess the endometrial thickness
29
Q

What must be done prior to pelvic US to assess endometrial thickness?

A

cyclical progestogens

  • these should be given to induce a period prior to the US scan
30
Q

What is an abnormal endometrial thickness on pelvic US?

A
  • endometrial thickness should be < 10mm
  • if thickness is >10mm, women should be referred for a biopsy to exclude endometrial hyperplasia / cancer
31
Q

What are the options for reducing the risk of endometrial cancer / hyperplasia in women with PCOS?

A

mirena coil:

  • provides continuous endometrial protection

inducing a withdrawal bleed every 3-4 months:

  • can be achieved with COCP

OR

  • cyclical progestogens (e.g. medroxyprogesterone acetate 10mg OD for 14 days)
32
Q

What is the first line approach for trying to improve fertility?

A

weight loss

33
Q

What options may be initiated by a specialist to improve fertility if weight loss fails?

A
  • clomifene
  • laparoscopic ovarian drilling
  • IVF

metformin + letrozole may help to restore ovulation, but evidence to support their use is unclear

34
Q

What is laparoscopic ovarian drilling?

A
  • multiple holes are punctured in the ovaries using diathermy / laser therapy
  • this can improve hormonal profile and result in regular ovulation
35
Q

What screening test must women have if they become pregnant with PCOS?

A
  • screening for gestational diabetes
  • this involves an OGTT performed before pregnancy and at 24-28 weeks gestation
36
Q

If weight loss does not help to improve hirsutism, what medication is recommended?

A

co-cyprindiol (Dianette)

  • this is a combined oral contraceptive pill that works to treat hirsuitism + acne
37
Q

What are the side effects of co-cyprindiol?

A
  • it presents a significantly increased risk of venous thromboembolism (VTE)
  • it should not be used for more than 3 months
38
Q

What topical treatment can be used to treat facial hirsutism?

A

topical eflornithine

  • improvement is seen within 6-8 weeks
  • hirsutism will return within 2 months if it is stopped
39
Q

What is the first line treatment for acne in PCOS?

A

COCP

  • co-cyprindiol may be the best option due to its anti-androgen effects
  • however, always need to consider the increased risk of VTE

Y4 - GOSH (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions