Polycystic Ovary Syndrome

Question 1

Define Polycystic Ovary Syndrome

Answer 1

Characterised by hyper-androgenism, oligo/anovulation and polycystic morphology on ultrasound

Question 2

Aetiology of Polycystic Ovary Syndrome

Answer 2

Unknown

Inherited as a common complex disorder (70%)

Environmental factors (diet, obesity etc.) and genetic variants (possibly gonadotrophin, insulin and androgen synthesis, secretion and action) influences development

Hyperinsulinemia → increased ovarian and androgen synthesis and reduced hepatic SHBG synthesis

Question 3

Risk factors for Polycystic Ovary Syndrome

Answer 3

Family history of PCOS
Premature adrenarche
Obesity
Low birth weight, foetal androgen exposure, environmental endocrine disruptors

Question 4

Epidemiology of Polycystic Ovary Syndrome

Answer 4

Most common cause of infertility in women

Affects 6-8% women of reproductive age in the US

Question 5

Symptoms of Polycystic Ovary Syndrome

Answer 5

Amenorrhoea/oligomenorrhoea
Infertility
Hirsutism (terminal hairs on upper lip, chin, chest, back, abdomen, thigh, butt (androgen-dependent))
Acne
Increased BMI
(Alopecia
Oily skin - Hyper-hidrosis and/or seborrhoea)

Question 6

What are the manifestations of Polycystic Ovary Syndrome in men

Answer 6

Excessive hairiness
Premature male-pattern baldness
Elevated levels of dehydroepiandrosterone sulfate
Abnormal hormonal responses to dynamic testing
Aberrations in insulin sensitivity and secretion

Question 7

Signs of Polycystic Ovary Syndrome

Answer 7

Hirsutism 
Hypertension
Male pattern hair loss 
Acne
Acanthosis Nigricans (hyperinsulinaemia)

Question 8

Investigations for Polycystic Ovary Syndrome

Answer 8

Serum total and free testosterone: Elevated
Serum DHEAS: Elevated
Pelvic USS: >12 follicles in each ovary (2-9mm diameter) | ± ovarian volume >10ml

Basal body temp. monitoring: Biphasic patterns indicates ovulation

Serum 17-hydroxyprogesterone: Normal (exclude adrenal hyperplasia)
Serum prolactin: Normal (exclude hyperprolactinaemia)
TFTs: Normal (rule out thyroid dysfunction
Oral glucose tolerance test: Variable (Exclude DM)
Fasting lipid panel: Dyslipidaemia (raised cholesterol, LDL, triglycerides, reduced HDL)
Serum androstenedione: Elevated
Luteal phase progesterone measurement: 6.4-25.4 nmol/L indicates ovulation occurred
Serum LH and FSH: LH/FSH ratio >3 suggests PCOS