Polycystic ovarian syndrome

Question 1

Define:

Answer 1

Hormonal disorder characterised by oligomenorrhoea/amenorrhoea and hyperandrogenism (clinical or biochemical).

Question 2

What is PCOS associated with:

Answer 2

o Obesity
o Insulin resistance
o Type 2 diabetes mellitus and insulin resistance
o Dyslipidaemia

Question 3

Aetiology/risk factors:

Answer 3

• Environmental factors
• Genetic variants
• Hyperinsulinaemia results in increased ovarian androgen synthesis and reduced hepatic sex hormone binding globulin (SHBG) synthesis
• This leads to an increase in free androgens (which gives rise to the symptoms)

Question 4

Symptoms:

Answer 4

•	Menstrual irregularities 
•	Dysfunctional uterine bleeding 
•	Infertility 
•	Symptoms of hyperandrogenism:
o	Hirsuitism
o	Male-pattern hair loss 
o	Acne

Question 5

Signs:

Answer 5

• Hirsuitism
• Male-pattern hair loss
• Acne
• Acanthosis nigricans (sign of severe insulin resistance) - velvety thickening and hyperpigmentation of the skin of the axillar or neck

Question 6

Investigations:

Answer 6

•	Bloods
o	High LH 
o	High LH: FSH ratio 
o	High testosterone, androstenedione and DHEA-S 
o	Low sex hormone binding globulin 

Other things to test for:
o	Hyperprolactinaemia 
o	Hypo/hyperthyroidism
o	Congenital adrenal hyperplasia (check 17OH-progesterone levels) 
o	Cushing's syndrome 

Look for impaired glucose tolerance/T2DM:
o Fasting blood glucose
o HbA1c

Fasting lipid profile

Transvaginal USS: look for ovarian follicles and an increase in ovarian volume