Polycystic Ovarian Syndrome Flashcards
1
Q
Percent of women who are infertile due to PCOS
A
- 10%
2
Q
Stein-Leventhal PCOS characteristics
A
- Amenorrhea
- Hirsutism
- Obesity
- B/L enlarged ovaries
3
Q
PCOS genetic disease characteristics
A
- Heterogenous/ Variable phenotypic/ polygenic; women will have varying displays of the disease
- Manifests in reproductive problems; anovulation
- Cardiovascular features with a risk and propensity for DM II
4
Q
Physiologic GnRH Release
A
- GnRH neurons release GnRH in coordinate pulses
- too fast = desensitization/downregulation of FSH/LH
- too slow = insufficient FSH/LH to drive ovaries
- Frequency of pulses varies during the menstrual cycle
- 1st half of cycle = ~1 per min
- 2nd half of cycle = ~3 per min
- Possible surge of GnRH release at midcycle- contributes to triggering of LH/FSH surge
5
Q
Two cell-Two Gonadotropin Theory
A
- In thecal cells, LH under cAMP drives the conversion of LDL cholesterol using side-chain cleavage enzyme into androgens (androstenedione and testosterone)
- Androgens are then shifted over to the granulosa cells where cAMP under the influence of FSH drives their conversion into estrogen
6
Q
PCOS Definition
A
Endocrine Society Clinical Guidelines
2/3 of these = diagnosis of PCOS
- Ovulatory disturbance
- Androgen excess (clinical OR biochemical)
- Adolescent: androgen excess (clinical AND biochemical)
- Sonographic evidence
- Absence of other endocrine disorders
*nonclassical adrenal hyperplasia
*androgen-secreting tumors
*hyperprolactemia
*thyroid dysfunction
7
Q
PCOS Health Effects
A
Prevalence of
- Impaired glucose metabolism
- Dyslipidemia
- Obesity
- Sleep apnea
- Fatty liver (non-alcoholic hepatic steatosis)
8
Q
Overweight women w/ PCOS have increased incidence of?
A
- Obstructive sleep apnea
9
Q
PCOS Overall Health Implications
A
- Normal reproductive organs (just not getting the right signaling from the pituitary)
- May not regularly ovulate a mature egg on their own
- Ovulatory disturbance: means threshold levels of estradiol not sustained for pre-ovulatory LH surge
10
Q
PCOS Ovary
A
- Surface area is doubled
- Ovaries usually contain 10 or more small cysts
- cysts are generally <8mm
- cysts remain small and generally do not grow
- surgical removal is not necessary
- Same # of primoridal follicles present, however, the # of growing and atretic follicles is doubled
- so-called high antral follicle count
- Increased stroma is due to hyperplasia of thecal cells and increased formation subsequent to excess follicle maturation and atresia
11
Q
PCOS Hormonal Changes
A
- Increased LH
- too much LH = too much androgen or testosterone production; reason birth control works so well in polycystic pts, b/c it inhibits LH synthesis and release
- Constant estradiol exposure
- Minimal progesterone secretion
- Increased testosterone
- Decreased SHBG
- sex hormone binding globulin; made by liver, binds free testosterone, estrogen, etc.
- Increased free testosterone
- Increased insulin
12
Q
PCOS Symptoms
A
- Menstrual irregularities
*oligomenorrhea or amenorrhea
+eustrogenic exposure w/ little progesterone stimulation
+bleeding can be spotty and sometimes very heavy - Hair and skin
*hirsutism and acne (androgen excess) - Obesity
*estimates are 50% of women w/ PCOS obese
*enhances abnormal estrogen and androgen productions
13
Q
PCOS Patient History
A
- Abnormal menses
- amenorrhea or oligomenorrhea
- Reproductive abnormalities
- Endocrine disturbances
- Mothers or sister w/ PCOS
- Family history: premature cardiac disease
- cardiac disease based on diabetes
14
Q
PCOS Clinical Signs
A
Clinical
- Acne
- Androgenic alopecia
- Virilization
- “hirsutism on steroids”- more likely due to androgen secreting tumor
- rapid, high lvls of androgen production
- suspicious for androgen secreting tumor if serum testosterone >200
- Hirsutism
15
Q
PCOS Biochemical Signs
A
- Serum elevation of androgen(s)
- Not all PCOS pts demonstrate biochem hyperandrogenism
- inaccurate assays, inter-assay variations
- inconsistent timing of blood draw (ideal is fasting and early follicular portion of the menstrual cycle)
- wide variability in normal pop.
- age/BMI not factored into normative data
