Polycystic Ovary Syndrome

Question 1

What anatomical problems can cause amenorrhoea?

Answer 1

Congenital (abnormality in mullerian development)
- isolated defect in androgen insensitivity syndrome
- 5-alpha-reductase deficiency
- vanishing testes syndrome
- defect in SRY
Congenital defect of urogenital sinus development
- agenesis of the lower vagina
- imperforate hymen
Other
- intrauterine adhesions
- Asherman syndorme

Question 2

What hormones can have an effect on GnRH release from the hypothalamus?

Answer 2

Leptin
- positive effect
Ghrelin
- negative effect
Prolocatin
- negative effect
Testosterone (caused by PCOS)
- negative effect

Question 3

How is PCOS diagnosed?

Answer 3

Typically a diagnosis of exclusion

Shows increased testosterone

Question 4

What are the differential diagnoses for PCOS?

Answer 4

Congenital adrenal hyperplasia
Cushing’s
Virilising tumour

Question 5

What tests should you do if you suspect PCOS?

Answer 5

Bloods
- FSH, LH
- oestrogen
- SHBG (oestrogen carrier)
- testosterone 
- prolactin 
- TSH, fT4
Additional tests
- 17-OH progesterone 
- US ovaries 
- overnight dexamethsone suppression test (for Cushing's)

Question 6

What is the definition of polycystic ovary syndrome?

Answer 6

Clinical and/or biochemical signs of hyperandrogenism
Oligo- and/or ovulation
Cysts are not specific enough to be used as a diagnostic tool

Question 7

Describe how obesity/genetics can lead to PCOS.

Answer 7

Obesity and genetic factors lead to insulin resistance
This increases insulin secretion
- acts on liver to decrease SHBG production (less sex hormones can be bound)
- acts on ovaries to increase androgen production
This increases free testosterone in the blood
Causes an/oligo-ovulation hirsuitism

Question 8

How is PCOS syndrome treated?

Answer 8

Lose weight (improves insulin sensitivity)
Insulin sensitser drugs
- metformin (good forh helping with weight loss)
Bariatric surgery

Question 9

What pregnancy related complications are women with PCOS more likely to have?

Answer 9

GDM
Preterm labour
Pregnancy induced hypertension
Pre-eclampsia

Question 10

What are the possible long-term consequences of PCOS?

Answer 10

T2DM
Dyslipidaemia 
- hypercholesterolaemia
- HDL
CV disease
- early atherosclerosis
- coronary atherosclerosis 
Endometrial hyperplasia/cancer
- anovulatory women have unopposed oestrogen

Question 11

What is the pharmacological treatment of hirsutism?

Answer 11

Ovarian androgen suppression 
Adrenal androgen suppression 
- glucocortioid 
Androgen receptor antagonist 
- spironolactone 
5-alpha reductase inhibition 
- spironolactone 
Topical inhibitors interfere with follicle development
- eflornithine