PCOS

Question 1

what is PCOS? what 4 things help categorize/Dx this?

Answer 1

common disorder of women of reproductive age

defined by… ovulatory dysfunction, hyperandrogenism, exclusion of other disorders, and possibly polycystic ovaries

Question 2

how does PCOS relate to obesity/DM?

Answer 2

its a metabolic problem linked to insulin resistance

Question 3

what must you exclude to dx PCOS?

Answer 3

other causes of hyperandrogenism… as there are many

Question 4

what type of women tend to get PCOS? young/old? fat/thin?

Answer 4

reproductive age, likely originates with obesity but CAN occur in lean women

Question 5

evidence shows that ______ and consequent ______ are pivotal in the pathogenesis of PCOS. Overall: this means..

Answer 5

decreased peripheral insulin sensitivity and consequent hyperinsulinemia
overall: a complex feedback loop that is broken (increased hormones (androgens) increases the insulin, causing insulin resistance)

Question 6

there is a suggestion of the presence of a _____ defect in PCOS

Answer 6

hypothalamic

Question 7

menstruation for PCOS pts?

Answer 7

an-ovulatory cycles that are irregular (time and flow vary)

Question 8

7 PCOS clinical features

Answer 8

acanthosis nigricans (velvety hyperpigmentation of skin - even in thin women)
acne, hirsutism and alopecia (from high androgens)
abnormal/absent periods
anovulatory infertility
central obesity

Question 9

hirsutism for PCOS

Answer 9

from androgen excess
(male-pattern hair growth in women)
* know that this can be scored

Question 10

what is the key pathogenic factor for PCOS?

Answer 10

insulin resistance

Question 11

prevalence of metabolicsyndrome in women with PCOS is __% higher than the general population

Answer 11

43%

Question 12

5 risk factors for metabolic syndrome. what is the requirement for Dx?

Answer 12

HTN: >130/85
dyslipidemia (high TriGs): >150
dyslipidemia (low HDLs): <40 for men, <50 for women
central obesity: waist >40in men, >35 in women
glucose: FBG >100
requirements for Dx: any 3 of the above

Question 13

PCOS pts have a ____ increased risk for MI

Answer 13

7 fold increased risk for MI

Question 14

1st line Txt for PCOS

Answer 14

lifestyle modification:
exercise, altered diet
weight loss (low fat, low carb)

Question 15

1st line and 2nd line meds for PCOS:

CC is oligomennorhea (infrequent periods)

Answer 15

1st: estrogen-progesterone therapy
2nd: metformin, progesterin withdrawal, weight loss

Question 16

1st line and 2nd line meds for PCOS:

CC hirsutism

Answer 16

1st: estrogen-progesterone therapy + anti-androgen (spironolactone)
2nd: hair removal

Question 17

1st line and 2nd line meds for PCOS:

CC anovulatory fertility

Answer 17

1st: clomiphene/letrozole (ovulatory stimulant med)
2nd: weight loss, metformin (helps dec. androgens), FSH injections, IVF

Question 18

PCOS txt for weight loss

Answer 18

phenteramine/amphetamines for short term

bariatric surgery for long term

Question 19

PCOS txt for insulin resistance

Answer 19

insulin sensitizing agent: metformin or TZD

Question 20

fertility medication for PCOS

Answer 20

clomiphene or letrozole

Question 21

metformin for fertility?

Answer 21

no longer preferred for fertility but does help insulin resistance and dec. excess androgens which help with fertility

Question 22

why do we have a concern for endometrial hyperplasia with PCOS? what txt would we consider for this?

Answer 22

excess estrogen puts pt at risk for endometrial cancer

- progestin/withdrawal with a pseudo menstrual period to shed the lining built up from absent/irregular periods

Question 23

hadleys first line for PCOS txt?

Answer 23

metformin and weight loss (diet and exercise)

Question 24

PCOS: providers need to recognize that the syndrome is assosciated with _______ in terms of reproductive and nonreproductive events.

Answer 24

significant morbidity

..hadley note, not really sure the significance

Question 25

providers must take precautionary measures to prevent _____ and ____ in PCOS pts

Answer 25

CVD and type 2 DM

Question 26

patho of PCOS: there is a suggestion that it is b/c of a hypothalamic defect.. what would this cause?

Answer 26

elevated LH (leutenizing hormone) levels
hyperandrogenism
anovulation

Question 27

PCOS lab findings? (in general)

Answer 27

endocrine abnormalities 
(high LH, normal FSH, higher testosterone/androgen)
*according to hadley you dont really need lab values to Dx