Flashcards in Polycystic Ovary Syndrome (PCOS) Deck (21)
What is PCOS?
An androgen excess disorder associated with a constellation of signs and symptoms that can present in a variety of ways
What is the diagnostic criteria for PCOS?
-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
What does anti-mullerian hormone (AMH) do?
Inhibits initial follicle recruitment and FSH dependent growth and selection
What is AMH's relationship with PCOS?
Can be elevated
What is obesity's role in PCOS?
It is not part of the diagnosis, but is related to it
What is the adipose distribution in PCOS pts?
Same total trunk fat, higher central abdominal fat
What is the hypothal role in PCOS?
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
What is the pituitary role in PCOS?
Erratic GnRH release causes increased LH release (LH>FSH)
What is the ovary role in PCOS?
-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
What is the role of insulin in PCOS?
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
What is a clinical symptom of insulin resistance?
-Raised, velvety, hyperpigmentation of skin
-Axila, neck, intertrigenous areas
What is genetics role in PCOS?
Polygenic inheritance, familial association
What are the reproductive complications of PCOS?
-Premature adrenarche (androgen production)
-Infertility: treatment with Clomiphene and FSH is effective
What are the metabolic complications of PCOS?
-Impaired glucose tolerance
-Type 2 diabetes
What are the cancer complications of PCOS?
-Inc rate of endometrial cancer 5 fold
What are the psychiatric complications of PCOS?
MDD, BED, etc
What are the during pregnancy complications of PCOS?
Pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, pre term birth, perinatal mortality
What is the treatment for PCOS?
-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
What is the most common cause of anovulation
What is themost common endorcine disorder in repro aged women?