PCOS Lecture Powerpoint

Question 1

Most common endocrine disorder of women and most common cause of infertility

Answer 1

PCOS

Question 2

PCOS pathophysiology

Answer 2

Hypothalamic pituitary abnormalities resulting in altered LH action increasing the LH:FSH ratio >2 and increased sensitivity to androgens (hyperandrogenism) including androstenedione, DHEA-S, and testosterone, and also see insulin resistance (50-70% are hyperinsulinemic and at risk for pre-diabetes and overt type 2 diabetes

Question 3

PCOS and insulin

Answer 3

Due to genetic and environmental factors, ovaries and thecal cells in ovaries that make estrogen and a little bit of testosterone are very sensitive to higher insulin levels and insulin serves as a co-gonadotropin so that instead of LH stimulating these cells insulin does instead to see increased androgen production by the ovaries

Question 4

High risk groups for PCOS (4)

Answer 4

• oligo-ovulatory infertility
• obesity and insulin resistance
• diabetes type 2 (typically)
• family members with pcos

Question 5

Not every obese woman develops ___, and not every ___(same) woman is obese

Answer 5

PCOS

Question 6

PCOS presenting signs/symptoms (9)

Answer 6

• Secondary amenorrhea (rule out pregnancy)
• other menstrual irregularities
• androgen excess (hirsutism, acne, male pattern baldness)
• obesity
• cystic ovaries (usual but not diagnostic)
• glucose intolerance
• metabolic syndrome
• Nonalcoholic steatohepatitis (NASH) (very common cause of cirrhosis in US)
• miscarriage risk

Question 7

PCOS diagnostic criteria NIH

Answer 7

• Menstrual irregularity
• clinical or biochemical evidence of hyperandrogenism
• ruling out other causes of menstrual irregularity

Question 8

PCOS diagnostic criteria Rotterdam

Answer 8

2 of the following

• Evidence of androgen excess
• Ovulatory dysfunction
• polycystic ovaries

Question 9

Most sensitive test for hyperandrogenism in PCOS eval

Answer 9

Free testosterone first thing in morning

Question 10

Look for other causes than PCOS when you have these 3 things

Answer 10

• Sudden onset or worsening of symptoms
• onset 3rd decade of life or later
• signs of virilization (frontal balding, severe acne, clitoromegaly, muscle mass, deepening voice)

Question 11

PCOS differential diagnosis (4)

Answer 11

• Congenital adrenal hyperplasia
• Cushing’s syndrome
• Virilizing tumors
• Anabolic steroids

Question 12

Test to rule out acquired congenital adrenal hyperplasia in a suspected PCOS patient

Answer 12

Test for 17 hydroxyprogesterone elevation

Question 13

Goals of PCOS therapy

Answer 13

Depends on patient goals (reduce serum androgen, improve repro function, promote weight loss)

Question 14

PCOS therapeutic options (6)

Answer 14

• Birth control pills to lower free testosterone (Yaz)
• Antiandrogens (spironolactone)
• Metformin
• weight loss
• clomiphene (80% ovulate in response to this allowing almost 50% to conceive)
• bariatric surgery (curative)

Question 15

Labs to order for insulin sensitizer therapy in PCOS (5)

Answer 15

• Free testosterone
• fasting lipids
• BMP
• DHEA-S
• LFT