PCOS and Androgen Excess

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Questions and Answers

What is the primary cause of chronic anovulation in reproductive age females?

Obesity

Fetal programming

Unknown (correct)

Genetic factors

What is the main outcome of the imbalance of the hormones of the HPO axis?

Insulin resistance

Anovulation (correct)

Polycystic ovaries

Hyperandrogenism

What is the term for the lack or absence of ovulation?

Hyperandrogenism

Chronic anovulation

Anovulation (correct)

Polycystic ovary syndrome

What is the key player in the development of PCOS according to the pathophysiology?

Disturbance to HPO axis Signup and view all the answers

What is the possible genetic inheritance pattern of PCOS?

Both X-linked and autosomal dominant Signup and view all the answers

What is the result of the maturation process in the HPO axis?

Ovulation Signup and view all the answers

What triggers the excessive secretion of LH by the pituitary gland?

Increased GnRH from the hypothalamus Signup and view all the answers

How does androgen excess affect the hypothalamic inhibitory feedback?

It blocks the inhibitory feedback of progesterone Signup and view all the answers

What is the primary site of androgen synthesis in PCOS?

Ovarian thecal cells Signup and view all the answers

What is the long-term risk of unmanaged PCOS?

Endometrial hyperplasia, insulin resistance, and dyslipidemia Signup and view all the answers

What is the diagnostic criterion for PCOS, according to the Rotterdam criteria?

The presence of 2 or more of oligo/anovulation, androgen excess, and polycystic ovaries on ultrasound Signup and view all the answers

What is the role of insulin in PCOS?

Insulin stimulates the production of androgen Signup and view all the answers

What is the primary mechanism by which estrogen and progesterone regulate LH secretion?

Estrogen and progesterone inhibit LH secretion Signup and view all the answers

What is the diagnostic role of ultrasound in PCOS diagnosis?

Ultrasound is used to evaluate ovarian morphology Signup and view all the answers

What is the minimum number of follicles required to diagnose Polycystic Ovary Syndrome (PCOS) according to Adam's criteria?

12 Signup and view all the answers

What is the primary mechanism by which weight reduction helps in treating PCOS?

Decrease in insulin resistance Signup and view all the answers

What is the next step in treatment if medical induction of ovulation fails in a woman with PCOS who desires pregnancy?

Bilateral laparoscopic ovarian drilling Signup and view all the answers

What is the primary treatment for hirsutism in women with PCOS who do not desire pregnancy?

Combined Oral Contraception Signup and view all the answers

What is the cut-off value for body mass index (BMI) in which more than 50% of females with PCOS are found?

27 kg/m2 Signup and view all the answers

What is the characteristic skin change seen in women with PCOS?

Acanthosis nigricans Signup and view all the answers

Study Notes

Polycystic Ovary Syndrome (PCOS)

Definition: Chronic anovulation and hyperandrogenism in reproductive age females.

Causes of PCOS

Unknown
Possible causes:
- Genetic
- Familial tendency
- Obesity
- Fetal programming

Pathophysiology of PCOS

Condition originating at puberty due to interplay of:
- Obesity and excess of ovarian androgen production
- Hyperinsulinemia and insulin resistance
- Intrauterine environment
- Genetic factors
- Disturbance to hypothalamic-pituitary-ovarian axis
Abnormal pituitary function: Altered negative feedback loop
- Increased GnRH from hypothalamus
- Excessive LH secretion relative to FSH by pituitary gland
- LH stimulates ovarian thecal cells androgen production
- Ineffective suppression of LH pulse frequency by estrogen and progesterone
- Androgen excess increases LH by blocking hypothalamic inhibitory feedback of progesterone

IR and Obesity in PCOS

Insulin resistance leads to:
- Increased insulin and ovarian ILGF
- Stimulation of androgen synthesis
- Increased LH and androgen production
- A vicious cycle that may start anywhere

Long-term Risks of PCOS

Endometrial hyperplasia and carcinoma
Insulin resistance: Type II diabetes mellitus and hypertension
Dyslipidemia: increased LDL, triglycerides, and decreased HDL, leading to coronary heart disease

Diagnosis of PCOS

Rotterdam criteria (ESHRE/ASRM):
- Presence of 2 or more of:
  - Oligo or anovulation and menstrual dysfunction
  - Clinical and/or biochemical hyperandrogenism
  - Ovarian size and morphology on ultrasound
Adam's criteria: Polycystic ovaries (by US)
PCOS is a diagnosis of exclusion after eliminating other causes of anovulation

Treatment of PCOS

General measures:
- Stop smoking
- Weight reduction: decrease insulin resistance, hyperandrogenism, and LH secretion
- Oral hypoglycemic agents (may be of benefit)
If pregnancy is desired:
- Medical: Induction of ovulation
- Surgical: Bilateral laparoscopic ovarian drilling (cauterization)
- If failed: ART
If pregnancy is not desired:
- Treatment according to main complaint:
  - Irregular cycles: Combined Oral Contraception
  - Irregular uterine bleeding: Medical (Combined Oral Contraception) or Surgical (D&C or hysterectomy)
  - Hirsutism: Combined Oral Contraception or Diane

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Description

This quiz covers the diagnosis and treatment of polycystic ovary syndrome (PCOS) and androgen excess, including Adam's criteria and general treatment measures.