Polycystic Ovarian Syndrome Flashcards
Rotterdam criteria for PCOS
- There are three and you only need two:
- Hitsory of irregular menses
- Physical or laboratory signs of hyperandrogenism
- Polycystic ovaries
Physical exam findings frequently associated with insulin resistance
- Hidradenitis suppuritiva
- Difficulty losing weight
- Skin tags
- Keratosis pilaris
- Acanthosis nigricans
Keratosis pilaris
Dry, rough patches and tiny bumps, usually on the upper arms, thighs, cheeks or buttocks.
Use of AMH in assessing for PCOS
- AMH is secreted in proportion to the # of remaining eggs
- SO. . . high AMH for someone’s age indicates a history of anovulation
- This is seen in PCOS due to low FSH
- The medical term for this is “premature ovarian insufficiency”
Tests for evaluating laboratory evidence of hyperandrogenism
- Total testosterone
- Free testosterone
- DHEA sulfate
What not to order: DHEA (without the sulfate) and LH/FSH (only on tests)
Baseline tests for evaluation of oligomenorrhea
- Pregnancy test
- Prolactin
- TSH
Problem-based pharmacotherapy guide for PCOS
___ looks a lot like PCOS
Non-classical congenital adrenal hyperplasia looks a lot like PCOS
Largely because it doesn’t manifest until later in life, individuals are phenotypically female, and it also invovles hyperandrogenism
Normal DHEAS in a man vs a woman
- Woman: DHEAS < 100 is normal
- Man: DHEAS 100-450 is normal
Interpreting DHEAS in a woman presenting with a chief complaint of hyperandrogenism
- DHEAS < 100 – normal
- DHEAS 200-400 – Likely PCOS
- DHEAS >500 – Likely CAH
Primary vs secondary premature ovarian insufficiency
- Primary: Not enough viable eggs, so menopause will set in early. Characteristically LOW AMH on lab testing.
- Secondary: Eggs are viable, but there is chronic anovulation. Characteristically HIGH AMH on lab testing.
Ideal OCPs for women with PCOS
- Standard estrogen dosage – ethinyl estriol 35 mcg
- Low, non-androgeneic progesterone dosage – norgestimate or drospirenone
“Ring of pearls”
Term used to describe the apperance of the cysts in PCOS
The obesity-hirsuitism feedback loop in PCOS
The key fact here is that high-level estrone is a positive stimulator of LH in PCOS
If you think someone has PCOS, what sequence of lab tests should you order?
If physical exam is normal or mild, but patients is concerned about hirsuitism, trial with one of the following medications for 6 months is reasonable:
- sdfa
- If this fails to improve symptoms, then hormonal workup (DHEAS, prolactin, TSH, ACTH, cortisol, IGF1, 17-HP) is warranted
Percentage of andorenic hormone (DHEAS, androstenedione, testosterone) that comes from the ovaries vs the adrenals vs the periphery
Hyperthecosis
Most severe form of PCOS
Rapid virilization, hirsuitism, male-pattern balding, and deepening of the voice. High DHEAS and testosterone. Difficult to treat with OCP alone and more difficult to achieve ovulation.
