Term
| What are the three criteria that patients must have (2 of 3) to be diagnosed with PCOS per the NIH? |
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Definition
1) Menstrual irregularity due to oligo/anovulation
2) Hyperandrogenism
3) Exclusion of other causes |
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Term
| What criteria did the Rotterdam study add in 2003? |
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Definition
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Term
| Define a polycystic ovary. |
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Definition
| At least 12 follicles measuring 2-9mm "the necklace sign" and increased ovarian volume >10ml. An increased amount of stroma compared to the number of follicles. |
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Term
| PCOS is an endocrine DISEASE...T or F? |
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Definition
| False-It is a SYNDROME characterized by a broad spectrum of clinical and morphological findings in women with an endocrine dysfunction. |
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Term
| Women will suffer from a type of male hair growth pattern called .........? This is caused by excess ______? |
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Definition
Hirsutism
Androgen production |
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Term
| Describe 7 complaints a patient with PCOS may present with. |
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Definition
1) Dark, thick hair growth in a male distribution
2) Male pattern balding
3) Thick coarse hair along the linea alba on abdomen
4) Acne
5) Obesity or weight gain
6) Infertility
7) Irregular or absent periods |
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Term
| What do they think is causing PCOS? |
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Definition
| Thought to be genetic variants intermixed with environmental factors. The genes thought to be altered are those that regulate insulin secretion/action, gonadotropin secretion/action, weight/energy regulation, and androgen biosynthesis/action. |
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Term
| What happens to the levels of LH, FSH, and the LH:FSH ratio in someone with PCOS? |
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Definition
| LH will be elevated, FSH will be low-normal, and the LH:FSH ratio will be increased. |
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Term
| Women with PCOS have more consistent levels of hormone throughout the cycle verses those without PCOS whose levels follow a cyclic pattern....T or F? |
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Definition
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Term
| Which androgens might be elevated in PCOS? |
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Definition
| Testosterone, Free Testosterone, androstenedione, DHEA, DHEA-S, 17-OHP |
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Term
| What happens to estradiol in PCOS? |
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Definition
| The levels fluctuate slightly but usually remain in levels seen in the early follicular phase that indicates continual low level production b/c of limited follicular development. |
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Term
| What happens to estrone in patients with PCOS? |
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Definition
| Estrone levels will be elevated due to peripheral conversion of androstenedione. |
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Term
| Name 8 risk factors for PCOS. |
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Definition
1) Obesity
2) oligovulatory infertility
3) Type I, II, GDM, or insulin resistance
4) 1st degree relative w/PCOS
5) Antiepileptic drugs like Valproic Acid
6) Hx of premature adrenarche
7) Overweight children or those born IUGR
8) Mexican-American population |
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Term
| How does insulin resistance/Hyperinsulinemia contribute to the hyperandrogenism we see with PCOS? |
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Definition
| Insulin leads to stimulation of the theca cells which biosynthesize androgens and suppresses sex hormone binding globulin that is produced by the liver. |
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Term
| What diseases are patients with PCOS at an increased risk for? |
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Definition
Diabetes
CAD
Dyslipidemia
Osteoporosis
Endometrial hyperplasia/neoplasia |
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Term
| Weight loss is easy for patients with PCOS....T or F? |
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Definition
False.
PCOS patient gain weight easily, especially visceral fat, have a wider waist to hip ratio, and have a difficult time loosing it due to the insulin resistance |
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Term
| Define the 2 types of menstrual dysfunctions you see in PCOS....oligo and anovulation. |
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Definition
Oligo- Less than 9 cycles in a year
Anovulation- More than 3 months without a cycle |
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Term
| What two organs are responsible for the excess androgen production? |
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Definition
| Ovaries and adrenal cortex. |
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Term
| Ovulation is dependent upon the proper functioning of what? |
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Definition
| The hypothalamic-pituitary-gonadal axis |
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Term
| Name some other causes of anovulation |
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Definition
1) Central defects (hypothalamic dysfunction) from things like weight loss, eating disorders, physical stress suppresses GnRH secretion that fails to promote progressive follicular development. Other central defects include pituitary tumors, which inhibit gonadotropin secretion, hyperprolactinemia causing a disruption or inhibition of normal GnRH pulse rhythm, and abnormal gonadotropin secretory dynamics most commonly due to an increase in serum LH from increased LH pulse amplitude and frequency.
2) Abnormal feedback signals from things like chronically elevated estrogen like seen in pregnancy and failure of the LH surge from the lack of functional ovarian follicles and estrogen production
3) Local Ovarian conditions including abnormally high local androgen concentrations, which end up being converted to 5a-reduced androgens that cant be converted to estrogen and inhibits aromatase activity and FSH induction of LH receptors on granulosa cells.
4) Obesity causing increased aromatization of androgens increasing estrogen levels, decreased levels of sex hormone binding globulin, and insulin resistance. |
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Term
| What happens to LH, FSH, and the LH:FSH ratio in PCOS? |
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Definition
| LH increases from abnormal LH secretory dynamics, FSH is usually low-normal from the increase in GnRH pulse frequency and negative feedback from chronically elevated estrone concentrations, and an increased FSH:LH ratio. |
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Term
| Insulin resistance and compensatory hyperinsulinemia are common features of PCOS....T or F? |
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Definition
| True-Up to 35% have impaired glucose tolerance and 10% end up with type II diabetes. |
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Term
| Obesity is a risk factor for the development of PCOS...T or F? |
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Definition
| True-Due to the insulin resistance and hyperinsulinemia obesity causes then starts the anovulation and cascade into PCOS. |
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Term
| What are the primary drivers of excess androgen production by the ovaries? |
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Definition
| Increased LH and insulin stimulation lead to excess androgen production by the ovary and to a lesser extent by the adrenals. Other drivers are thought to be the increased stroma of the ovary being more sensitive to LH & insulin and intrinsic dysregulation of key steroidogenic enzymes. |
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Term
| What is one of the most common metabolic abnormalities observed in women with PCOS? |
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Definition
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Term
| What other causes of androgen excess should be ruled out? |
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Definition
| Thyroid disorders, Hyperprolactinemia, Non-classical Congenital Adrenal Hyperplasia, Androgen-secreting Ovarian and Adrenal tumors, Severe insluin resistance syndromes, Cushing syndrome, Idiopathic Hirsutism. |
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Term
| What are the major clinical features of PCOS? |
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Definition
| Hyperandrogenism and menstrual dysfunction |
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Term
| What testing should be included in those suspected of having PCOS? |
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Definition
| Serum TSH, Prolactin, 2* GTT, Fasting lipid profile, Endometrial sampling (in those suspected of having long term unopposed estrogen stimulation), serum testosterone in those with moderate or severe hirsutism, morning follicular phase serum 17-hydroxyprogesterone in women w/pre or perimenarcheal onset of hirsutism, a family hx of congenital adrenal hyperplasia, or high-risk ethinicity, and an overnight dexamethasone suppression test in women w/signs of hypercortisolism. |
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Term
| What are some treatments for PCOS |
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Definition
COCs or progestins to combat sequela from anovulation
Weight reduction is important.
Treatment for heart disease, dyslipidemia, or diabetes
Metformin
Anti-androgens Spironalactone, cyproterone acetate, COCs, and flutamide
Clomiphene for infertility, also insulin sensitizing agents like thizolidinediones, D-chiro-inositol and metformin (Hirsutism) |
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