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Endocrine > 1: PCOS > Flashcards

1: PCOS Flashcards

1
Q

What are four risk factors for PCOS

A
  • Smoking
  • FH
  • Obesity
  • Insulin resistance
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2
Q

What age do symptoms of PCOS usually onset

A

Adolescence to early adulthood

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3
Q

What is the main symptom of PCOS

A

Oligomenorrhoea

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4
Q

What is oligomenorrhoea

A

Less than 9-periods a year due to an ovulation

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5
Q

What can oligomenorrhoea result in

A

Sub-fertility

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6
Q

What are 6 other symptoms of PCOS

A
  • Hirsutism
  • Acne
  • Obesity
  • OSA
  • Acanthosis nigricans
  • Male-pattern balding
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7
Q

Explain pathophysiology of PCOS

A
  • Increase LH production from pituitary
  • This stimulates theca cells to produce androstenedione
  • Exceeds granuloma cells aromatase capacity
  • Excess androstenedione converted to oestrogen by adipocytes
  • Oestrogen selectively inhibits FSH
  • FSH is a continual low level and hence there is no selection of dominant follicle
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8
Q

What is first-line investigation in PCOS

A

Testosterone, Oestrogen, FSH, LH

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9
Q

How does FSH, LH present in PCOS

A

High LH:FSH

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10
Q

What is second line investigation in PCOS

A

TFT

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11
Q

Why are TFT performed

A

Exclude hypothyroidism as a differential - due to presenting similarly

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12
Q

What imaging is performed in PCOS

A

USS

TV-US

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13
Q

How do ovaries present on USS in PCOS

A

More than 12 follicle

String of pearls appearance = all follicles around outside

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14
Q

Why is transvaginal US performed

A

Exclude endometrial hyperplasia/cancer

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15
Q

If PCOS women is planning pregnancy, what should be offered

A

OGTT before 20W gestation

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16
Q

What diagnostic criteria is used in PCOS

A

Rotterdam criteria

17
Q

What does the Rotterdam criteria state

A

Individual requires two of:

  1. Oligomenorrhoea
  2. Cystic Ovaries
  3. Biochemical or clinical signs of high androgens
18
Q

What is the qualifying criteria for polycystic ovaries

A

More than 12 follicles per ovary

Ovarian volume >10cm3

19
Q

What is the criteria for oligomenorrhoea in PCOS

A

Less than nine periods per year

20
Q

When may the Rotterdam criteria not be useful

A

Teenage girls - difficult to distinguish from normal puberty

21
Q

What 2 conservative measures are indicated for treatment of PCOS

A

Weight-Loss

Smoking Cessation

22
Q

What is first-line medical treatment for PCOS

A

COCP

23
Q

Why is COCP given

A

Reduce risk of endometrial cancer due to anovulatory cycles

24
Q

What BMI is COCP contraindicated

A

BMI > 40

25
Q

Why may metformin be given in PCOS

A

Help insulin resistance and weight loss

26
Q

What medical treatment can help hirsutism and acne in PCOS

A

COCP

27
Q

What COCP is offered in PCOS

A

Co-cyprindiol (Dianette)

28
Q

What is used for hirsutism of the face

A

Topical eflornithine

29
Q

What is cyproterone

A

anti-androgen

30
Q

What else can be given in hirsuitism

A

spironolactone and finasteride

31
Q

What advice regarding fertilise should be given to patients with PCOS

A

Start family as soon as possible as sub fertility worsens with age

32
Q

What is first-line to promote fertility in PCOS

A

clomiphene

33
Q

What is the action of clomiphene

A

increases ovulation

34
Q

What is the problem with clomiphene

A

increases risk ovarian cancer and multiple pregnancy

35
Q

What is usually given in conjunction with clomiphene

A

metformin

36
Q

what cancer does PCOS increase risk of and why

A

endometrial cancer - due to unopposed oestrogen

37
Q

what should be given to avoid risk endometrial cancer in PCOS

A

COCP

38
Q

what are 7 complications of PCOS

A 
Insulin-resistance 
DM 
Dyslipidaemia
HTN 
Stroke 
MI 
Obesity

GDM
Infertility
Miscarriage

Thyroid Disease

Endocrine (20 decks)

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