Polycystic Ovarian Syndrome Flashcards
What is the mode of pathology of PCOS?
Rapid GnRH pulses from the hypothalamus causes excess release of LH
LH stimulates the adrenal glands to produce excess androgens (and testosterone)
This testosterone causes abnormal follicular development in the ovaries and leads to cyst formation and oligo-ovulation
What other hormone does the excess testosterone effect?
Insulin
Increases insulin resistance leading to hyperinsulinaemia
What can insulin do to make the process worse?
Increase gonadotrophin release and stimulate androgen secretion
Typical presentation?
” An 18 y/o woman presents with hirsutism. She complains she needs to wax her upper lip twice a week. Her periods are very irregular and come every few months. She is not on contraception. “
What are the menstruative symptoms of PCOS?
Amenorrhoea and oligoovulation
Infertility
What type of cancer does PCOS increase your risk of and why?
Endometrial
- Unopposed oestrogen
What does PCOS increase your risk of in pregnancy?
Ectopic
Pre-ecclampsia
Gestational diabetes
Miscarriage
What are common symptoms PCOS sufferers present with?
Weight gain
Hirsutism
Acne
Depression
What may be responsible for the depression and weight gain in PCOS?
Linked to the thyroid but not confirmed
25% women with PCOS have hypothyroidism
Differential of PCOS?
21 Hydroxylase deficiency
Cushings
- Other clinical criteria
Androgen secreting neoplasm
- Very rare
What test can rule out 21 hydroxylase deficiency?
17-hydroxyprogesterone
- If low = 21 hydroxylase def
Investigations?
Bloods
OGTT
USS
What bloods should be done in PCOS?
Free testosterone
LH/FSH
17-hydroxyprogesterone
TFTs
Free testosterone diagnostic results?
Free testosterone >x2 normal
LH/FSH results?
LH = elevated FSH = normal
