PCOS Diagnosis and Treatment

20 Questions

What is the minimum ovarian volume required to diagnose PCOS according to Adam's criteria?

10 cm3

What is the effect of weight reduction on insulin resistance in PCOS patients?

Decreases insulin resistance

What is the treatment of choice for irregular uterine bleeding in PCOS patients?

D&C or hysterectomy

What is the purpose of bilateral laparoscopic ovarian drilling in PCOS patients?

To induce ovulation

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

Increases adrenal androgen

What is the treatment of choice for hirsutism in PCOS patients?

Combined Oral Contraception

What is the primary effect of excessive LH secretion on ovarian function?

Stimulation of androgen production

Which of the following is NOT a long-term risk of PCOS?

Type I diabetes mellitus

What is the primary role of insulin-like growth factor (ILGF) in PCOS?

Stimulation of androgen synthesis

According to the Rotterdam criteria, how many of the following characteristics must be present for a diagnosis of PCOS?

At least two

What is the effect of androgen excess on the hypothalamic-pituitary-ovarian axis?

Inhibition of hypothalamic inhibitory feedback by progesterone

What is the primary mechanism of insulin resistance in PCOS?

Decreased insulin receptor sensitivity

What is the role of aromatase enzyme in ovarian function?

Conversion of androgens to estrogens

What is the primary criterion for diagnosing PCOS, according to Adam's criteria?

Polycystic ovaries on ultrasound

What is the underlying cause of anovulation in the hypothalamic-pituitary-ovarian axis?

Imbalance of hormones

What is the definition of polycystic ovarian syndrome (PCOS)?

A hormonal disorder causing chronic anovulation and hyperandrogenism

What is the primary cause of polycystic ovarian syndrome (PCOS)?

Unknown, with multiple possible causes

What is the role of the hypothalamic-pituitary-ovarian (HPO) axis in ovulation?

It terminates in the ovaries, controlling ovulation

What is the relationship between anovulation and polycystic ovaries?

Polycystic ovaries are a manifestation of a larger disease process, including anovulation

What is the likely time of origin of polycystic ovarian syndrome (PCOS)?

During puberty

Study Notes

PCOS Diagnosis

Adam's criteria for PCOS diagnosis:
- Ovarian volume > 10 cm3
- Multiple follicles (≥ 10-12)
- Microcysts
Rotterdam criteria for PCOS diagnosis:
- Presence of 2 or more of:
  - Oligo or anovulation and menstrual dysfunction
  - Clinical and/or biochemical hyperandrogenism
  - Ovarian size and morphology on ultrasound

Pathophysiology of PCOS

PCOS originates possibly at the time of puberty due to interplay of:
- Obesity and excess of ovarian androgen production
- Hyperinsulinemia and insulin resistance
- Intrauterine environment
- Genetic factors
Abnormalities in the hypothalamic-pituitary-ovarian axis:
- Increased GnRH from hypothalamus
- Excessive LH secretion relative to FSH by pituitary gland
- LH stimulates ovarian thecal cells-- androgen production

Symptoms and Characteristics of PCOS

Acanthosis nigricans: a velvety, darkening of the skin
Bilateral enlarged ovaries
Symmetrically enlarged uterus
Obesity (in 50% of females with PCOS)

Treatment of PCOS

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

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

This quiz covers the diagnosis and treatment of Polycystic Ovary Syndrome (PCOS), including Adam's criteria, symptoms, and general measures for management.

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