Polycystic ovary syndrome

Question 1

Brief pathology of PCOS

Answer 1

excess androgens produced by theca cells

hyperinsulinaemia/high LH can cause this

Question 2

presentation of PCOS - who gets it?

Answer 2

women in puberty to mid 20s
5-15% at reproductive age
(33% have polycystic ovaries on USS)

Question 3

PCOS presentation - symptoms and signs

Answer 3

oligomenorrhoea
infertility
acne
hirsutism (male pattern hair, upper lip, perinipple, snail trail)
alopecia

obsese
sleep apnoea
mood swings, low mood, anxiety

Question 4

what is acanthosis nigrans

Answer 4

darkened skin under axilla - sign of insulin resistance

Question 5

3 Rotterdam criteria for diagnosis of PCOS

Answer 5

polycystic ovaries on USS
biochemical/clinical signs of hyperandrogenism
oligomenorrhoea

Question 6

investigations for suspected PCOS

Answer 6

testosterone levels
LH/FSH levels - LH typically at least double FSH in PCOS
USS of ovaries

then TFTs
prolactin
24h urinary cortisol
GTT
CAH tests - U&Es etc

Question 7

treatment for PCOS - general measures

Answer 7

lose weight

Question 8

treatment of PCOS to tackle symptoms

Answer 8

COCP/mirena to prevent endometrial hyperplasia

co-cyprindrol =dianette - for acne, hirsutism (it is half anti-androgen, half pro-oestrogen)
metformin

Question 9

treatment of PCOS if wanting to conceive

Answer 9

clomifene +metformin

ovarian drilling