Polycystic ovarian syndrome: features and investigation

Question 1

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Question 2

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Question 3

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Question 4

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Question 5

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Question 6

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Question 7

x

Question 8

features of PCOS ?

Answer 8

subfertility and infertility

menstrual disturbances: oligomenorrhoea and amenorrhoea

hirsutism,

acne (due to hyperandrogenism)

obesity

acanthosis nigricans (due to insulin resistance)

Question 9

what feature in PCOS is occasionally associated with v high androgen levels and confidently make a diagnosis for PCOS ?

Answer 9

Clitoromegaly is seen occasionally

Question 10

what criteria is used to make definitive diagnosis of PCOS ?

Answer 10

Rotterdam criteria - 2 of the 3

1) infrequent or no ovulation

2) clinical and/or biochemical signs of hyperandrogenism

3) polycystic ovaries on ultrasound scan, in one or both ovaries and/or increased ovarian volume > 10 cm³)

Question 11

how does infrequent or no ovulation manifest as in PCOS ?

Answer 11

infrequent or no menstruation

Question 12

what are the clinical signs of hyperandrogenism

Answer 12

hirsutism / acne / Clitoromegaly

Question 13

what are the biochemical signs of hyperandrogenism

Answer 13

elevated levels of total or free testosterone

Question 14

polycystic ovaries on ultrasound scan (defined as ?

Answer 14

≥ 12 follicles (measuring 2-9 mm in diameter
in one or both ovaries and/or increased ovarian volume > 10 cm³

Question 15

what are the baseline investigation that should be performed in PCOS ?

Answer 15

FSH,
LH,

prolactin,

TSH,

testosterone, sex hormone-binding globulin (SHBG)

impaired glucose tolerance

Question 16

what can be seen in LH and FSH in PCOS ?

Answer 16

raised LH:FSH ratio is a ‘classical’ feature but is no longer thought to be useful in diagnosis

Question 17

prolactin levels in PCOS ?

Answer 17

normal or mildly elevated

Question 18

testosterone levels in PCOS ?

Answer 18

normal or mildly elevated -

however, if markedly raised consider other causes!!!!!!

Question 19

sex hormone-binding globulin (SHBG) levels in PCOS ?

Answer 19

normal to low in women with PCOS