Polycystic Ovary Syndrome (PCOS)

Question 1

What is PCOS?

Answer 1

An androgen excess disorder associated with a constellation of signs and symptoms that can present in a variety of ways

Question 2

What is the diagnostic criteria for PCOS?

Answer 2

Hyperandrogenism

• Inc hair, acne, male pattern baldness
• Inc free testosterone, total testosterone or DHEAS of ovarian origin
• Estrogen is present, but not cyclic

Ovarian Dysfunction: oligo-anovulation (less than 6-9 menses/yr or low mid-luteal progesterone levels), Polycystic ovary ovulation (“string of pearls” follicles on ultrasound or enlarged on laparoscopic exam)

Exclusion of other androgen excess or releated disorders

Question 3

What does anti-mullerian hormone (AMH) do?

Answer 3

Inhibits initial follicle recruitment and FSH dependent growth and selection

Question 4

What is AMH’s relationship with PCOS?

Answer 4

Can be elevated

Question 5

What is obesity’s role in PCOS?

Answer 5

It is not part of the diagnosis, but is related to it

Question 6

What is the adipose distribution in PCOS pts?

Answer 6

Same total trunk fat, higher central abdominal fat

Question 7

What is the hypothal role in PCOS?

Answer 7

Erratic (rapid and freq) pulsatility of GnRH leads to inc LH pulse amplitude and frequency so LH>FSH.

This could be due to a primary hypothal problem or increased androgen levels leading to decreased hypothalamic sensitivity to negative feedback by E and P

Question 8

What is the pituitary role in PCOS?

Answer 8

Erratic GnRH release causes increased LH release (LH>FSH)

Question 9

What is the ovary role in PCOS?

Answer 9

• Granulosa cells are more responsive to FSH and increase estrogen production
• Increased density of small pre-antral Follicles (higher initial population of primordial follicles, or a slower rate of loss by atresia)
• Follicles are more responsive to FSH and mature further than normal. Thus, no follicle becomes dominant and there is an arrest of ovulation
• Increased LH levels cause theca cells to produce more androgens

Question 10

What is the role of insulin in PCOS?

Answer 10

Many pts have insulin resistance leading to an increase in the production of insulin. There is no structure abnormality, no change in receptor number, no alteration in insulin binding affinity though. Increased insulin acts on the ovary to further increase androgen production

Question 11

What is a clinical symptom of insulin resistance?

Answer 11

Acanthosis Nigricans

• Raised, velvety, hyperpigmentation of skin
• Axila, neck, intertrigenous areas

Question 12

What is genetics role in PCOS?

Answer 12

Polygenic inheritance, familial association

Question 13

What are the reproductive complications of PCOS?

Answer 13

• Premature adrenarche (androgen production)
• Menstrual irregularities
• Hirsuitism
• Acne
• Infertility: treatment with Clomiphene and FSH is effective

Question 14

What are the metabolic complications of PCOS?

Answer 14

• Insulin resistance
• Obesity
• Impaired glucose tolerance
• Type 2 diabetes
• Dyslipidemia
• CVD

Question 15

What are the cancer complications of PCOS?

Answer 15

-Inc rate of endometrial cancer 5 fold

Question 16

What are the psychiatric complications of PCOS?

Answer 16

MDD, BED, etc

Question 17

What are the during pregnancy complications of PCOS?

Answer 17

Pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, pre term birth, perinatal mortality

Question 18

What is the treatment for PCOS?

Answer 18

• OCPs or cyclic progesterone to regulate menses
• Anti-androgens or topical treatments for acne and facial hair
• Weight loss to dec complications (esp in pregnancy)
• Insulin sensitizing agents

Question 19

What is the most common cause of anovulation

Answer 19

PCOS

Question 20

What is themost common endorcine disorder in repro aged women?

Answer 20

PCOS

Question 21

What do we rule out before we can say it’s PCOS?

Answer 21

Hypothyroidism and hyperprolactemia