Management of Lean PCOS and Hormones

Management Algorithm for Lean PCOS

• Lifestyle modifications are crucial, including weight maintenance, ample vegetable and some fruit intake, vitamin D, calcium, and herbs, along with regular exercise.

• Inadequate clinical response may necessitate additional management strategies for conditions like hirsutism, menstrual dysfunction, acne, and infertility.

• Additional management includes metformin +/- myoinositol.

Hypothalamic Hormones

• Corticotrophin releasing hormone (CRH): Stimulates the secretion of ACTH and β-endorphin from the anterior pituitary.

• Thyrotrophin releasing hormone (TRH): Stimulates the release of thyrotrophin from the anterior pituitary, which in turn stimulates the thyroid to produce thyroxin.

• Gonadotrophin releasing hormone (GnRH): Stimulates the release of luteinizing hormone and follicle stimulating hormones.

• Growth hormone releasing hormone (GHRH): Produces a rapid elevation in plasma growth hormone levels.

Growth Hormone Inhibiting Hormone (GHIH, Somatostatin)

• Inhibits the release of growth hormone, glucagon, gastrin, and thyrotrophin.

• Octreotide is a synthetic analog of somatostatin with a longer half-life used in acromegaly.

Prolactin Inhibiting Hormone (PIH)

• Dopamine acts as the physiological inhibitor of prolactin release.

Pituitary Hormones

• The pituitary gland is a small, rounded body attached to the base of the brain.

• It consists of anterior and posterior lobes. The anterior lobe hormone secretion is regulated by the hypothalamus. The posterior lobe does not produce hormones, but stores and secrets oxytocin and vasopressin.

Growth Hormone (GH, Somatotropin)

• Increased by hypoglycemia, fasting stress, and GHRH; decreased by glucose, corticosteroids, and GHIH administration
• Ghrelin, a peptide hormone secreted from the stomach, stimulates GH secretion.
• Blood level of IGF-1
• Physiological effects include stimulating secretions of insulin-like growth factor-1 (IGF-1), and stimulating lipolysis.

Growth Hormone Abnormalities

• GH deficiency (Pituitary dwarfism): Deficiency before puberty causing growth retardation, short stature, and delayed sexual development.

• GH excess (Gigantism & Acromegaly): Gigantism occurs before puberty, causing excessive upward and outward growth, and disproportionately long limbs. Acromegaly occurs in adults, causing enlargement of bones (hands, feet, jaw, nose), and visceral organs.

Drugs Acting on Growth Hormone

• Agonists: Treatment of dwarfism, stimulation of growth in children, Turner's syndrome, and counteracting wasting in AIDS. Somatrem (Protropin) or somatropin (Humatrope) are recombinant DNA technologies used for body building by athletes.

• Antagonists: Treatment of excess GH. Octreotide & Lanreotide (long-acting), Dopamine agonists (bromocriptine and cabergoline), and GH receptor antagonist (Pegvisomant) inhibit GH secretion.

Thyroid-Stimulating Hormone (TSH)

• Stimulates growth of the thyroid gland, increases blood flow to the thyroid gland, increases synthesis and release of T3&T4, and stimulates iodide uptake.
• Useful for diagnostic purposes to differentiate between pituitary and thyroid gland failures.

Adrenocorticotrophic Hormone (ACTH)

• Stimulates the synthesis of glucocorticoids, mineralocorticoids, and androgens.
• Stimulates cortisol secretion from adrenal glands.
• In the fetus, stimulates DHEA-S synthesis to prepare the mother for birth.
• Used to diagnose adrenal disorders or treat deficiencies (less commonly than glucocorticoids).

Prolactin

• Responsible for normal development and maturation of mammary glands (mammary effect).

• Responsible for milk production (lactogenic effect).

• Hyperprolactinemia: Elevated prolactin (>100 ng/mL) without stimulatory factors, often due to prolactinomas (tumors), certain medications (phenothiazines, cimetidine, fluoxetine, reserpine), hypothalamic dysfunction, tumors, tuberculosis, or sarcoidosis and other conditions.

• Common manifestations may including amenorrhea (absent menstruation), infertility, galactorrhea (lactation outside of pregnancy or breastfeeding), decreased sex drive, decreased sperm production, impotence, and breast enlargement (gynecomastia) in men.

Posterior Pituitary Hormones (Anti-diuretic Hormone, ADH)

• The posterior pituitary stores, but does not produce, oxytocin and ADH.

• ADH's physiological effects include renal effects (conserving water, increasing water retention), vasopressor effects (involving vasoconstriction), and increasing blood clotting factors VIII and von Willebrand's factor.

• Diabetes insipidus: Deficiency of ADH or abnormal ADH receptors can cause water imbalance and excessive urination.

Oxytocin

• Oxytocin's primary function is oxytocin effect, stimulating uterine contractions, likely aiding in fetal expulsion.
• It's also involved in milk ejection from lactating breasts in response to suckling.
• Although high doses of oxytocin can have a transient relaxant effect on vascular smooth muscle, it primarily affects the uterus and breasts.

This quiz explores the management of Lean PCOS, focusing on lifestyle changes, dietary modifications, and clinical responses to treatments. It also examines the role of hypothalamic hormones like CRH, TRH, GnRH, and GHRH in regulating body functions. Test your knowledge on these important health topics!