PCOS

Question 1

PCOS criteria

Answer 1

Revised Criteria: (2 or more conditions)
1. ovulatory dysfuction
2. Hyperandrogenism
3. Polycystic ovaries Sonographic findings
12 or more follicles, >10 cm3

• Exclusion of other etiologies; CAH, Cushing’s syndrome,
androgen-secreting tumors

Question 2

Work-up

Answer 2

TSH, Prolactin, FSH, 17OHP, Testosterone, ? Salivary cortisol

Question 3

Pregnancy Complications

Answer 3

GDM
• PIH
• SGA
• Preeclampsia
• PPROM
• PTD

Question 4

Pathophys of PCOS

Answer 4

Decrease in SHBG
↑ free T leading to Hirsutism
↑ free estradiol leading to ↑Endometrial Ca risk

Question 5

Physical Finding of PCOS

Answer 5

Acanthosis Nigricans

Question 6

Looks like PCOS but viriliazation

Answer 6

Hyperthecosis of the Ovary

Greater degree of PCOS features

1. ↑ Testosterone levels
2. Hirsutism, virilization, acne
3. Hypertension
4. Chronic anovulation
5. EM hyperplasia

Question 7

letrozole

Answer 7

2.5-7.5 mg/day x5 day

better performance

Question 8

ovulation induction for PCOS

Answer 8

make sure semen analysis and necessary HSG’s are completed

Recommend lifestyle changes

Clomid 50-150 for 5 days (day 5-9)

midluteal progesterone day 22

max treatment 6 cycles

pretreat with OCP and Diet exercise - increase live birth rate

Question 9

Hirsutism

Answer 9

Ferriman-Gallwey Score- max score is 36

Question 10

Androgen labs

Answer 10

testosterones >200 (tumor)
DHEAS (>700 tumor)
17OHp- (>6 suggests CAH) 8 am
-f/u with stim test

Question 11

Treatment of PCOS

Answer 11

OCP’s (increase SHBG)
- improve in 6-12 months
Spironolactone