Polycystic ovarian syndrome

Question 1

What is polycystic ovarian syndrome?

Answer 1

Heterogeneous disorder characterized by hyperandrogenism, oligoovulation/anovulation, and/or the presence of polycystic ovaries

Question 2

What is the underlying pathophysiology in PCOS?

Answer 2

Reduced insulin sensitivity in PCOS leading to hyperinsulinemia
Hyperinsulinemia causes:
Obesity
Acanthosis nigricans
Increase LH secretion
Increase androgen secretion by Theca cells
Reactive increased oestrogen secretion by adipose cells
Inhibition of sex-hormone binding globulin in liver, increase levels of free androgens and oestrogen

Question 3

What are the clinical features of PCOS?

Answer 3

Mentrual irregularities 
Obesity 
Hirsuitism  
Acanthosis nigricans 
Androgenic alopecia 
Acne

Question 4

How is PCOS diagnosed?

Answer 4

Diagnosis of exclusion
2 of 3 criteria needed:
Hyperandrogenism
Oligo-/Anovulation
Polycystic ovary on US
(Blood hormone levels) Increased testosterone, LH:FSH greater than 2:1, normal/increased oestrogen
(Evidence of metabolic disease) Hypertension, BMI, high cholesterol, type II diabetes
(Transvaginal ultrasound) Enlarged ovaries, anechoic cysts

Question 5

What are the differential diagnosis of PCOS?

Answer 5

Pregnancy 
Congenital adrenal hyperplasia
Cushing's disease
Pituitary adenoma
Androgen-secreting tumors
Thyroid disorder
Follicular insufficiency

Question 6

What is the treatment for PCOS?

Answer 6

Dependant on want to treat infertility
Treatment aim to normalise hormonal and metabolic irregularities
(Not seeking to treat infertility) Weight management + Combined oral contraceptive
(Seeking to treat infertility) (1st) Clomiphene/Letrozole (induces ovulation)
(2nd) Exogenous GnRH/Ovary drilling via laparoscopy

Question 7

What are the complications of PCOS?

Answer 7

Cardiovascular events
Miscarriage
Endometrial cancer
Type II diabetes