Polycystic Ovarian Syndrome

Question 1

What is Polycystic Ovarian Syndrome (PCOS)?

Answer 1

Endocrine syndrome characterized by triad of:

1. Amenorrhea* (chronic anovulation)
2. Obesity*
3. Hirsutism (androgen excess)

Question 2

What causes PCOS?

Answer 2

Insulin resistance

10% of US population

Question 3

What is the pathophysiology of PCOS?

Answer 3

Exact cause is unknown, but associated with abnormal function of hypothalmus-pituitary ovarian axis –> increased insulin & increased LH-driven increase in ovarian androgen production

Question 4

What is a risk factor to PCOS?

Answer 4

Obesity

Question 5

How would a patient with PCOS clinically present?

Answer 5

1. 2ndary amenorrhea (50%) or oligomenorrhea
2. Hirsutism
3. Type II, DM
4. Obesity

Question 6

What PE findings will be consistent with a patient diagnosed with PCOS?

Answer 6

1. Acanthosis nigrans

2. Bilateral, enlarged, smooth, mobile ovaries on bimanual exam

Question 7

What diagnostic studies should you order in a patient suspected of PCOS?

Answer 7

1. Excluse other disorders

2. Labs: testosterone level (increased)

Question 8

What disorders should you exclude before diagnosing PCOS?

Answer 8

1. thyroid (TSH)
2. Pituitary adenoma (prolactin levels)
3. Ovarian tumors
4. Cushing’s syndrome (dexamethasone suppression test)