Polycystic Ovary Syndrome (PCOS) ppt
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Questions and Answers

Which of the following are recognized as necessary for the diagnosis of Polycystic Ovary Syndrome (PCOS)?

  • Irregular menses (correct)
  • Elevation of sex hormone-binding globulin (SHBG)
  • Appearance of polycystic ovaries on ultrasound
  • Hyperandrogenism (correct)

    • What is a potential metabolic sequela associated with PCOS?

  • Decreased risk of cardiovascular disease
  • Decreased insulin sensitivity
  • Increased risk of obesity
  • Increased risk of Type 2 Diabetes Mellitus (T2DM) (correct)

    • Which statement about the incidence and prevalence of PCOS is true?

  • It occurs primarily in women over 40 years of age.
  • It affects approximately 10-13% of women overall. (correct)
  • It shows a marked increase in prevalence during pregnancy.
  • It significantly varies between races.

    • What role does hyperinsulinemia play in PCOS?

    <p>It may stimulate androgen production in glands.</p> Signup and view all the answers

    Which of the following conditions is NOT associated with PCOS?

    <p>Chronic pelvic inflammatory disease</p> Signup and view all the answers

    What clinical manifestation may occur due to peripheral androgen excess in PCOS?

    <p>Hirsutism</p> Signup and view all the answers

    Which of the following is recognized by the Androgen Excess Society as a criterion for PCOS diagnosis?

    <p>Hyperandrogenism</p> Signup and view all the answers

    Which factor should be excluded before diagnosing PCOS?

    <p>Hyperprolactinemia</p> Signup and view all the answers

    Which of the following treatments is recommended as primary treatment for menstrual irregularities in patients not attempting conception?

    <p>Combined Hormonal Contraceptives</p> Signup and view all the answers

    What is the primary mechanism by which Metformin improves ovulation rates in patients with PCOS?

    <p>Increases insulin sensitivity</p> Signup and view all the answers

    Which of the following is NOT part of the evaluation for a patient suspected of having PCOS?

    <p>PCO genotype sequencing</p> Signup and view all the answers

    What role does SHBG (Sex Hormone Binding Globulin) play in the treatment of PCOS using Combined Hormonal Contraceptives?

    <p>Decreases androgen effect</p> Signup and view all the answers

    What is the preferred first-line medication for ovulation induction in PCOS?

    <p>Letrozole</p> Signup and view all the answers

    Which of the following statements regarding hirsutism treatment in PCOS is correct?

    <p>Medical methods do improve hirsutism</p> Signup and view all the answers

    In patients with PCOS, what is the purpose of determining biochemical hyperandrogenemia?

    <p>To evaluate for hyperandrogenism</p> Signup and view all the answers

    What is one of the benefits of letrozole in treating ovulation issues in PCOS?

    <p>It promotes the conversion of androgens to estrogens</p> Signup and view all the answers

    What is the primary reason for the increased risk of cardiovascular disease in individuals with PCOS?

    <p>Insulin resistance and associated metabolic syndrome</p> Signup and view all the answers

    Which factor has NOT been implicated as a contributing cause to hyperandrogenism in PCOS?

    <p>High levels of estradiol</p> Signup and view all the answers

    Which symptom is part of the clinical manifestations of PCOS due to high androgen levels?

    <p>Acne and hirsutism</p> Signup and view all the answers

    How does PCOS affect menstrual cycles?

    <p>Results in amenorrhea or irregular menses</p> Signup and view all the answers

    Which of the following statements accurately describes the Rotterdam Criteria for diagnosing PCOS?

    <p>It requires the presence of polycystic ovaries on ultrasound</p> Signup and view all the answers

    Which metabolic condition is a significant risk factor for individuals with PCOS?

    <p>Nonalcoholic fatty liver disease</p> Signup and view all the answers

    What impact does hyperinsulinemia have on androgen levels in PCOS patients?

    <p>It may increase bioavailable circulating androgen</p> Signup and view all the answers

    Which of the following is a key characteristic that differentiates PCOS from other conditions?

    <p>Presence of polycystic ovaries with irregular menses</p> Signup and view all the answers

    What is the primary outcome of combined hormonal contraceptives in patients with menstrual irregularities not attempting conception?

    <p>Prevents unopposed estrogen exposure</p> Signup and view all the answers

    How does Metformin contribute to the management of PCOS?

    <p>Improves insulin sensitivity</p> Signup and view all the answers

    Which of the following is a biochemical test included in the evaluation of patients suspected of PCOS?

    <p>2-hour oral glucose tolerance test</p> Signup and view all the answers

    Which statement regarding the use of Letrozole in ovulation induction is accurate?

    <p>It acts as an aromatase inhibitor</p> Signup and view all the answers

    What role does the measurement of SHBG play in the treatment of PCOS with hormonal contraceptives?

    <p>It decreases levels of free testosterone</p> Signup and view all the answers

    What is the purpose of using clomiphene citrate in patients with PCOS?

    <p>Stimulates FSH and LH while blocking negative feedback on the hypothalamus</p> Signup and view all the answers

    In assessing health risks associated with PCOS, which measure contributes to understanding body fat distribution?

    <p>BMI and waist circumference</p> Signup and view all the answers

    Which statement accurately describes hirsutism treatment strategies in patients with PCOS?

    <p>Many patients seek medical treatment despite a lack of a clear primary treatment</p> Signup and view all the answers

    Study Notes

    PCOS: What is it?

    • Characterized by hyperandrogenism, ovulatory dysfunction (irregular menses), and polycystic ovaries
    • Etiology (cause) remains unknown
    • Potential for substantial metabolic sequelae, including increased risk of diabetes and cardiovascular disease

    PCOS Diagnosis

    • No universally accepted definition
    • Rotterdam Criteria replaced NIH criteria, incorporating appearance of the ovary on ultrasound
    • May include milder phenotypes, increasing prevalence and changing treatment success rates
    • Androgen Excess Society requires hyperandrogenism for diagnosis
    • Secondary causes (e.g. adult-onset CAH, hyperprolactinemia, and androgen-secreting neoplasms) should be excluded first
    • Incidence: approximately 10 – 13% overall
    • No significant difference in prevalence of hirsutism or elevated circulating androgen levels between white and black women

    PCOS Etiology

    • Hyperinsulinemia and high androgen levels may result in decreased levels of sex hormone-binding globulin (SHBG), leading to more bioavailable circulating androgen
    • Increased androgen may stimulate production in the adrenal gland and ovary
    • Insulin may have direct hypothalamic effects, such as abnormal appetite stimulation and gonadotropin secretion
    • Hyperandrogenism may have etiologies unrelated to insulin resistance

    Clinical Manifestations of PCOS

    • Menstrual disorders: Amenorrhea/oligomenorrhea (varies according to age) to menorrhagia
    • Infertility
    • Skin disorders (due to peripheral androgen excess):
      • Hirsutism: High androgens
      • Acne
      • Androgenic alopecia
      • Acanthosis nigricans: Partly due to high androgens
    • Increased risk of insulin resistance and associated conditions:
      • Metabolic syndrome
      • Nonalcoholic fatty liver disease
      • Obesity-related disorders such as sleep apnea
    • Long-term metabolic sequelae:
      • T2DM
      • Cardiovascular disease
      • Risk factors for endometrial cancer
    • Other manifestations:
      • Chronic anovulation
      • Centripetal obesity
      • Diabetes (debated strength of association)
      • Mood disturbances and depression/anxiety

    PCOS Evaluation

    • TSH, PRL, FSH, 17 OHP, testosterone, cholesterol, Vaginal US to look at endometrium and ovaries
    • TSH, FSH, and PRL are part of the workup for oligomenorrhea
    • BMI, waist circumference to determine body fat distribution
    • Presence of stigmata of hyperandrogenism and insulin resistance
    • Documentation of biochemical hyperandrogenemia
    • 2-hour oral glucose tolerance test (fasting glucose)
    • Fasting lipid and lipoprotein levels
    • Determination of polycystic ovaries on US
    • Identification of endometrial abnormalities

    PCOS Treatment: Menstrual Irregularities (Not Attempting Conception)

    • Combined Hormonal Contraceptives:
      • Prevents unopposed estrogen exposure
      • Increases levels of SHBG, decreasing androgen effect
      • Primary treatment recommendation
      • Offers benefit through various mechanisms:
        • Suppression of pituitary LH secretion → suppression of ovarian androgen secretion
        • Increased levels of SHBG → decrease in free testosterone levels
    • Progestins:
      • No studies show effects on hirsutism for DMPA or OMPA
      • Regimen for endometrial protection is uncertain

    PCOS Treatment: Insulin-Sensitizing Agents (Not Attempting Conception)

    • Metformin:
      • Increase sensitivity to insulin
      • Decrease in circulating androgen levels
      • Increase in SHBG
      • Improved ovulation rate
      • Improved glucose tolerance

    PCOS Treatment: Reduce Risk of CVD and Diabetes (Not Attempting Conception)

    • Lifestyle Modification
    • Insulin-Sensitizing Agents
    • Diabetes Prevention Program: Metformin can delay development of DM in high-risk populations (e.g. impaired glucose tolerance)

    PCOS Treatment: Hirsutism

    • Medical Methods: Do improve hirsutism, but no clear primary treatment
    • Ovulation Induction:
      • Letrozole (Preferred First Line):
        • Aromatase inhibitor
        • Converts androgens to estrogens
        • Decreased estrogen at hypothalamus and pituitary, leading to production of FSH, LSH
        • Increases LH/FSH, stimulating development of a single follicle in the ovary
        • Letrozole or clomiphene prescribed for 5 days of follicular phase
        • Elevated progesterone in the luteal phase indicates ovulation
      • Clomiphene Citrate:
        • SERM (selective estrogen receptor modulator)
        • Blocks estrogen receptors at hypothalamus and pituitary, preventing negative feedback
        • Stimulates ovary with FSH, LH, leading to more follicles and a dominant follicle
      • Metformin + CC: Various combinations possible
    • Refer to Reproductive Endocrinology and Infertility (REI) if beyond these treatments

    PCOS Motivation

    • Affects 10-13% of women
    • Associated with significant long-term metabolic sequelae, including increased risk of diabetes and cardiovascular disease.

    Definition and Incidence

    • There is no universally accepted definition
    • Rotterdam criteria replaced the NIH criteria and incorporates ovarian appearance in ultrasound
    • Androgen Excess Society recognizes hyperandrogenism as necessary for diagnosis
    • Secondary causes should be excluded first
    • No significant difference in prevalence of hirsutism or elevated circulating androgen levels between white and black women

    Etiology

    • Etiology remains unknown
    • Increased insulin and androgen levels can lead to decreased SHBG levels, resulting in more bioavailable circulating androgen.
    • Insulin may have direct hypothalamic effects, like abnormal appetite stimulation and gonadotropin secretion.
    • Hyperandrogenism can have other etiologies not related to insulin resistance.

    Clinical Manifestations

    • Menstrual disorders: Amenorrhea/oligomenorrhea to menorrhagia
    • Infertility
    • Skin disorders (due to peripheral androgen excess):
      • Hirsutism: High androgens
      • Acne
      • Androgenic alopecia (to a lesser extent)
      • Acanthosis nigricans: Partly due to high androgens
    • Increased risk of insulin resistance and associated conditions:
      • Metabolic syndrome
      • Nonalcoholic fatty liver disease
      • Obesity-related disorders such as sleep apnea
    • All of these conditions are risk factors for long-term metabolic sequelae:
      • T2DM
      • Cardiovascular disease
    • Risk factors for endometrial cancer.
    • Chronic anovulation
    • Centripetal obesity
    • Diabetes (debated strength of association)
    • Mood disturbances and depression/anxiety

    Suggested Evaluation

    • TSH, PRL, FSH, 17 OHP, testosterone, cholesterol, Vaginal US to look at endometrium and ovaries
    • BMI, and waist circumference to determine body fat distribution
    • Documentation of biochemical hyperandrogenemia
    • 2-hour oral glucose tolerance test (fasting glucose)
    • Fasting lipid and lipoprotein levels
    • Determination of polycystic ovaries on US
    • Identification of endometrial abnormalities

    Treatment: Menstrual Irregularities in a Patient Not Attempting Conception

    • Combined Hormonal Contraceptives:
      • Prevents unopposed estrogen exposure
      • Increases levels of SHBG so that androgen effect is decreased
      • Recommended as Primary Treatment
      • Offer benefit through a variety of mechanisms
        • Suppression of pituitary LH secretion → suppression of ovarian androgen secretion.
        • Increased levels of SHBG → decrease in free testosterone levels.
    • Progestins:
      • No studies to show effects on hirsutism for DMPA, or OMPA,
      • Regimen for endometrial protection is uncertain
    • Insulin-Sensitizing Agents: METFORMIN
      • Increasing sensitivity to insulin → lower insulin → decrease in circulating androgen levels and increase in SHBG → improved ovulation rate.
      • Improved glucose tolerance.

    Treatment: Reduce Risk of CVD and Diabetes Not Attempting Conception

    • Lifestyle Modification
    • Insulin-Sensitizing Agents
    • Diabetes Prevention Program: Metformin can delay development of DM in high-risk populations (e.g. impaired glucose tolerance)

    Treatment of Hirsutism

    • No clear primary treatment for hirsutism in PCOS, but many patients seek treatment
    • Medical methods DO improve hirsutism

    Ovulation Induction

    • Letrozole, preferred first line:

      • Aromatase inhibitor
      • Converts androgens to estrogens
      • Decreased estrogen noted at hypothalamus and pituitary.
      • Increase production of FSH, LSH
      • More FSH/LH increase stimulates development of a single follicle in the ovary.
      • Prescribed for 5 days of the follicular phase
      • Elevated progesterone in the luteal phase indicates ovulation.

    • Clomiphene Citrate:

      • SERM (selective estrogen receptor modulator)
      • Blocks estrogen receptors at the hypothalamus and pituitary
      • Blocks negative feedback, leading to increased FSH, LH stimulation of the ovary
      • Increased likelihood of developing a dominant follicle

    • Various combinations also possible: Metformin + CC

    • Refer to Reproductive Endocrinology and Infertility (REI) if needed.

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    Description

    Explore the complexities of Polycystic Ovary Syndrome (PCOS), including its characteristics, diagnosis criteria, and potential health risks. This quiz covers key aspects of PCOS etiology and highlights the importance of understanding hyperandrogenism and metabolic implications.

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