PCOS Diagnosis and Treatment

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Questions and Answers

What is the primary cause of the vicious cycle in PCOS?

Primary CNS error leading to HP dysfunction (correct)
Insulin resistance and obesity
Hypothalamic-pituitary-adrenal axis dysfunction
Primary enzymatic error in the ovary or adrenal gland

What is the result of the ineffective suppression of LH pulse frequency by estrogen and progesterone?

Increased FSH secretion relative to LH
Enhanced hypothalamic inhibitory feedback of progesterone
Excessive LH secretion relative to FSH (correct)
Decreased androgen production by ovarian thecal cells

What is the role of insulin in PCOS?

It stimulates the production of estrogen in ovarian granulosa cells
It inhibits the production of androgen in ovarian thecal cells
It stimulates the production of ILGF, leading to androgen synthesis (correct)
It enhances the hypothalamic inhibitory feedback of progesterone

What is the long-term risk of PCOS associated with dyslipidemia?

Coronary heart disease (A) 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 or anovulation, clinical and/or biochemical hyperandrogenism, and ovarian size and morphology on ultrasound (D) Signup and view all the answers

What is the role of estrogen in the negative feedback loop of PCOS?

It is ineffective in suppressing the LH pulse frequency (C) Signup and view all the answers

What is the result of excessive LH secretion relative to FSH?

Stimulation of androgen production in ovarian thecal cells (C) Signup and view all the answers

What is the diagnostic criterion for PCOS according to Adam's criteria?

The presence of polycystic ovaries on ultrasound (D) Signup and view all the answers

What is the long-term risk of PCOS associated with insulin resistance?

Type II diabetes mellitus and hypertension (C) Signup and view all the answers

What is the mechanism by which androgen excess increases LH?

By blocking the hypothalamic inhibitory feedback of progesterone (B) Signup and view all the answers

What is the primary effect of weight reduction in treating PCOS?

Decrease hyperandrogenism and decrease LH secretion (B) Signup and view all the answers

According to Adam's criteria, what is the minimum number of follicles required to diagnose PCOS?

10 (B) Signup and view all the answers

What is the primary goal of medical treatment in PCOS patients who do not desire pregnancy?

Treatment according to the main complaint (B) Signup and view all the answers

What is the surgical treatment option for PCOS patients who have failed induction of ovulation?

Bilateral laparoscopic ovarian drilling (D) Signup and view all the answers

What is the cut-off value for body mass index associated with PCOS?

27 kg/m2 (A) Signup and view all the answers

What is the effect of smoking on adrenal androgen in PCOS patients?

Increases adrenal androgen (D) Signup and view all the answers

What is the primary treatment option for hirsutism in PCOS patients?

Combined Oral Contraception (A) Signup and view all the answers

What is the characteristic skin feature associated with PCOS?

Acanthosis nigricans (B) Signup and view all the answers

What is the primary result of an imbalance in the hypothalamic-pituitary-ovarian axis?

Anovulation (A) Signup and view all the answers

What is the most common cause of chronic anovulation?

Polycystic Ovarian Syndrome (PCOS) (B) Signup and view all the answers

What is the possible role of intrauterine environment in PCOS?

Intrauterine programming of insulin resistance (C) Signup and view all the answers

What is the relationship between hyperinsulinemia and insulin resistance in PCOS?

Hyperinsulinemia causes insulin resistance (D) Signup and view all the answers

What is the mode of inheritance of genetic factors in PCOS?

Autosomal dominant and X-linked (C) Signup and view all the answers

What is the definition of anovulation?

Lack or absence of ovulation (A) Signup and view all the answers

What is the primary characteristic of PCOS?

Chronic anovulation and hyperandrogenism (D) Signup and view all the answers

What is the possible contribution of fetal programming to PCOS?

Intrauterine environment (B) Signup and view all the answers

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Study Notes

Polycystic Ovary Syndrome (PCOS)

PCOS is the commonest cause of chronic anovulation.
Definition: Chronic anovulation and hyperandrogenism in reproductive age females.
Cause: Unknown, but possible causes include genetic, familial tendency, obesity, and fetal programming.

Pathophysiology

PCOS originates possibly at the time of puberty due to interplay of:
- Obesity and excess of ovarian androgen production due to hyperinsulinemia and insulin resistance.
- Intrauterine environment.
- Genetic factors: both X-linked, autosomal dominant inheritance.
- Disturbance to hypothalamic-pituitary-ovarian axis.

Adam's Criteria

Ovarian volume > 10 cm3.
Multiple follicles (≥ 10-12).
Microcysts.
Bilateral enlarged ovaries.
Symmetrically enlarged uterus.

Diagnostic Criteria (Rotterdam criteria)

Presence of 2 or more of:
- Oligo or anovulation and menstrual dysfunction.
- Clinical and/or biochemical hyperandrogenism.
- Ovarian size and morphology on ultrasound.

Complications and Risks

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

Treatment

General measures:
- Stop smoking.
- Weight reduction to decrease insulin resistance and hyperandrogenism.
- Oral hypoglycemic agents.
Fertility treatment:
- Induction of ovulation.
- Bilateral laparoscopic ovarian drilling (cauterization).
- Assisted reproductive technology (ART) if failed.
Non-fertility treatment:
- Combined oral contraception for irregular cycles, uterine bleeding, and hirsutism.
- Medical treatment for hirsutism.
- Surgical treatment for irregular uterine bleeding (D&C or hysterectomy).