Polycystic ovarian syndrome 1B

Question 1

how is it characterised

Answer 1

multiple ovarian cyst, infertility, oligomenorrhoea, hyperandrogenism and insulin resistance

Question 2

what is the Rotterdam criteria for diagnosis

Answer 2

 Oligoovulation or anovulation = presenting with irregular or absent menstrual period
 Hyperandrogenism = characterized by hirsutism and acne
 Polycystic ovaries on ultrasound (or ovarian volume >10cm^3)

Question 3

what is the presentation

Answer 3

oligomenorrhoea or amenorrhoea, infertility, obesity, hirsutism, acne, hair loss in a male pattern

Question 4

other associated symptom

Answer 4

insulin resistance & diabetes, acanthosis nicigans (due to insulin resistance) , CVD, ↑cholesterol, obstructive sleep apnoea, depression and anxiety, sexual problems

Question 5

ddx

Answer 5

(remember the other causes of hirsutism) =
 medication & iatrogenic = phenytoin, ciclosporin, corticosteroid, testosterone and anabolic steroid
 ovarian and adrenal tumours that secrete androgens
 Cushing’s syndrome
 congenital adrenal hyperplasia

Question 6

what is the mechanism of insulin resistance

Answer 6

insulin resistance  ↑stimulation by pancreas to produce more insulin  ↑ in insulin produced = ↑androgens from ovaries and adrenal gland  ↑insulin = ↓sex hormone binding globulin which normally binds to androgens and suppresses their function.

Question 7

what blood test are done

Answer 7

 testosterone 
 sex hormone binding globulin 
 LH
FSH
 prolactin 
 TSH 
** remember there is raised LH and raised LH:FSH

Question 8

what other investigations are done

Answer 8

TVUS = gold standard for visualising (“string of pearls” appearance = follicles arranged around the periphery of the ovaries) and ovarian volume of >10cm^3

Question 9

what test is done to screen for diabetes in PCOS

Answer 9

oral glucose tolerance test (OGTT)

Question 10

management

Answer 10

reducing risk associated with obesity, T2DM, hypercholesterolaemia and CVD = weight loss, exercise, smoking cessation, statins, HTN meds
• Orlistat (lipase inhibitor) = may be used in women with a BMI>30 to help with weight loss

Question 11

PCOS is a major risk factor for what

Answer 11

for endometrial Ca (mirena coil, COC may be used)

Question 12

why is metformin and letrozole used

Answer 12

helps to restore ovulation under the guidance of a specialist