Polycystic Ovary Syndrome Flashcards
1
Q
What is PCOS?
A
- PCOS was first described in 1935 by American gynecologists Irving Freiler Stein and Michael Leventhal
- Stein and Leventhal’s report titled “Amenorrhea associated with bilateral polycystic ovaries” described patients who showed features of polycystic ovaries, hyperandrogenism, and menstrual irregularities
- Polycystic Ovarian Syndrome (PCOS) also referred to as Stein-Leventhal syndrome is one of the most common endocrine disorders affecting women of reproductive age.
- It is a heterogeneous disease characterized by androgen excess (hyperandrogenism) and menstrual irregularities.
- Many women presenting with PCOS have obesity (defined as a body mass index ≥ 30 mg/m2) and insulin resistance, which is a reduced biological response to insulin.
-It is now recognized as a major risk factor for the development of type 2 diabetes mellitus.
•5 - 15% women affected depending on the diagnostic criteria used
2
Q
Diagnosis of PCOS
A
- The diagnosis of PCOS begins with a thorough history and physical examination.
- Clinicians should focus on the patient’s menstrual history, any fluctuations in the patient’s weight, and other findings (e.g., hair in a male patter distribution, excessive acne).
- Patients should also be asked about factors related to common comorbidities of PCOS.
- The Endocrine Society advises clinicians to diagnose PCOS using the 2003 Rotterdam.
3
Q
Dagnosis of PCOS - Rotterdam Criteria
A
- hypergonadism
- menstrual irregularity
- polycystic ovaries on ultrasound
2/3 needed!
4
Q
Other Diagnostic Guidlines
A
•There are a number of other abnormalities associated with PCOS including overweight/obesity, hypertension and insulin resistance. However, these conditions/diseases are not included in the diagnostic guidelines.
5
Q
PCOS Pathophysiology
A
- Genetic and environmental (lifestyle) factors
- Strong interplay between endocrine and metabolic factors
- Patients with PCOS typically have increased LSH relative to FSH
6
Q
Biochemical/Laboratory Criteria
A
- Elevated serum levels of luteinizing hormone, testosterone and DHEA-S (dehydroepiandrosterone sulfate)
- PCOS patients will show either normal or low levels of folliclestimulating hormone
7
Q
Pelvic Ultrasound
A
•12 follicles of a diameter ranging between 2 and 9 mm develop on one or both ovaries and/or the ovarian volume in at least one ovary exceeds 10 ml (10cm3)
8
Q
Cysts
A
- A polycystic ovary shows many follicles of a diameter ranging between 2 and 9 mm. The follicles group mainly round the periphery of the ovary
- “Cysts” are antral follicles (secondary follicle) which have arrested in development
- Polycystic ovaries are present in 20-30% of women and are not essential for the diagnosis of PCOS. The “cysts” in polycystic ovaries are not true cysts, but rather antral follicles which have arrested in development.
9
Q
A
10
Q
A
11
Q
Hirsutism/Acne
A
- Excess androgens may cause excess hair growth in a male pattern distribution and acne.
- Excess androgens may cause excess hair growth in a male pattern distribution
- Hirsutism: 70% of PCOS patients
- The Ferriman-Gallwey scale is used for hirsutism.
- A score of 1 to 4 is given for nine areas of the body.
- A total score less than 8 is considered normal, a score of 8 to 15 indicates mild hirsutism, and a score greater than 15 indicates moderate or severe hirsutism.
- A score of 0 indicates absence of terminal hair.
12
Q
Obesity
A
- In adult women, a waist circumference greater than or equal to 88 cm (35 inches) defines abdominal obesity
- Overweight is defined as a body mass index (BMI) of 25.0 to less than 30.0 kg/m2 and obesity is defined as a BMI of 30.0 kg/m2 or greater
- Obesity is present in approximately 50% of patients with PCOS
- The obesity in women with PCOS is due to both an increase in visceral fat and subcutaneous fat.
- Obesity in women with PCOS is due to both an increase in visceral fat and subcutaneous fat
13
Q
Risk Factors for PCOS
A
- Family history of PCOS
- Premature adrenarche
- Low birth weight
- Fetal androgen exposure
- Excess insulin
- Low grade inflammation
- Sedentary Lifestyle
- Diet
14
Q
Insulin Resistance
A
- 70% of patients with PCOS exhibit metabolic abnormalities, including insulin resistance and hyperinsulinemia
- Insulin resistance occurs when tissues such as adipose tissue, liver and skeletal muscles do not respond to insulin. This results in a compensatory increase in the secretion of insulin by the pancreas, causing hyperinsulinemia.
- Insulin resistance and compensatory hyperinsulinemia are also risk factors for other metabolic diseases, including type 2 diabetes and atherosclerosis (PCOS patients typically exhibit dyslipidemia).
- Insulin resistance is a risk factor for many diseases, including PCOS, type 2 diabetes and metabolic syndrome
15
Q
A
16
Q
A
19
Q
A
20
Q
A
28
Q
A
