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Year 3 - Met3b > Polycystic Ovarian Syndrome > Flashcards

Polycystic Ovarian Syndrome Flashcards

1
Q

What is the definition of PCOS

A

Polycystic ovary syndrome is a condition that affects how the ovaries work.

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2
Q

what is the Rotterdam criteria for PCOS

A

 i)Clinical hyperandrogenaemia
 ii) oligomenorrhoea (less than 6-9 menses per year)
 Iii) 12 or more polycystic ovaries on ultrasound. Or ovaries greater than 10ml

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3
Q

What is the criteria used for diagnosis of PCOS

A

Rotterdam criteria

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4
Q

What is the most common cause of hirsutism

A
  • PCOS
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5
Q

What is PCOS characterised by

A

1) multiple small cysts within the ovary representing arrested follicular development
2) excess androgen production from the ovaries (and to a lesser extent from the adrenals)

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6
Q

What conditions is PCOS associated with

A
  • Hyperinsulinaemia and insulin resistance - prevalence of T2DM is 10 times higher than in normal women
  • hypertension, hyperlipidaemia and increased cardiovascular risk - metabolic syndrome is 2-3 times higher in PCOS
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7
Q

What are the clinical features of PCOS

A
  • Hirsutism
  • Age and speed of onset – usually begins around time of menarche and increases slowly and steadily in teens and twenties
  • Menstruation – most people will have some disturbance, typically oligo-/amenorrhoea
  • Weight – many people are overweight or obese; this worsens the underlying androgen excess and insulin resistance, and inhibits the response to treatment
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8
Q

why do they think insulin resistance is caused in PCOS

A
  • insulin resistance due to hyperinsulinaemia
  • decreased SHBG levels
  • increased free androgens
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9
Q

What is SHBG

A

sex hormone binding globulin
- SHBG is a protein made by your liver. It binds tightly to 3 sex hormones found in both men and women. These hormones are estrogen, dihydrotestosterone (DHT), and testosterone.

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10
Q

What investigations do you use in PCOS

A
  • serum total testosterone
  • other androngens
  • 17a-hydroxprogesterone
  • gonadotrophin levels
  • oestrogen levels
  • ovarian ultrasound
  • serum prolactin
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11
Q

What happens to serum total testosterone in PCOS

A
  • often elevated
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12
Q

describe the hormones of PCOS

A
  • Raised LH with normal FSH, Raised Testosterone (with or without reduced SHBG)
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13
Q

What symptom does raised testosterone cause in PCOS

A
  • acne

- infertility hirsutism

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14
Q

what are the differential diagnosis to PCOS

A
  • Exclude thyroid dysfunction, congenital adrenal hyperplasia, hyperprolactinaemia, androgen-secreting tumours.
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15
Q

What happens to gonadotrophin level in PCOS

A
  • LH hyper secretion in PCOS
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16
Q

What happens to oestrogen levels in PCOS

A
  • oestradiol is usually normal in PCOS but oestrone are elevated due to peripheral conversion
17
Q

What does ovarian ultrasound show in PCOS

A
  • used to identify cysts, thickened capsule and hyperchogenic stroma in PCOS
18
Q

what happens to serum prolactin in PCOS

A
  • mild hyperprolactinaemia common in PCOS but <1500mU/L
19
Q

How do you manage hirsutism as a symptom of PCOS

A

local - hair removal, eflornithiine cream

Systemic

  • Oestrogens (COCP) – should be used first unless CI
  • Cyproterone lactate 50-100mg daily – produces amenorrhoea so only given for days 1-14 of each cycle
  • Spironolactone 200mg daily – antiandrogen activity
  • Finasteride 5mg daily - 5α-reductase inhibitor; prevents formation of DHEA in the skin
  • Flutamide – less commonly used due to hepatic SEs
20
Q

How do you manage menstrual distrubance in PCOS

A
  • cyclical oestrogen/progesterone
  • metformin 500mg tablets - reduced hyperinsulinaemia, may improve menstrual cycles, ovulation and hirsutism, promote weight loss
21
Q

How do you manage sub fertility in PCOS

A
  • Clomifene 50-100mg daily – given daily on days 2-6; effective in 75% in achieving ovulation; not used for longer than 6 cycles due to increased risk of ovarian cancer
  • Low-dose FSH – used for non-responders to clomifene
  • Metformin – on its own may improve ovulation and achieve conception
22
Q

What investigations do you use in PCOS

A
  • Pelvic ultrasound – multiple cysts on the ovaries
  • FSH, LH, Prolactin, TSH and testosterone are useful investigations
  • Check for impaired glucose tolerance

Year 3 - Met3b (26 decks)

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