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21 Cards in this Set

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What is the syndrome of Polycystic Ovarian Syndrome (PCOS)
Ovary creates too much androgen (too much testosterone)
What is the most COMMON CAUSE of hirsutism (hair growth) and anovulation in women?
PCOS!
Morphologically speaking, what is different in patients with PCOS in female repro. tract
Ovaries are MASSIVE relative to normal sized ovaries. q
What is the HALLMARK of PCOS on ultrasound
STRING OF BLACK PEARLS on ULTRASOUND due to the fact that PCOS patients have ovaries that contain numerous follicles and associated cysts.
What are current diagnostic criteria for PCOS?
MUST HAVE 2 of 3

1)Polycystic ovaries on ultrasound

2) Oligo (cycles greater than 40 days)/anovulation

3) Clinical or biochemical signs of hyperandrogenism
Is PCOS genetically linked?
Yes!

Autosomal dominant transmission.
How do PCOS patients produce too much androgen?
Androgen comes from theca cells. Theca cells respond to LH.

in PCOS, there is an increase in LH pulse amplitude and frequency. Higher baseline levels too.
How is insulin resistance important in PCOS?
Decreased post-receptor signaling will result in HYPERINSULINEMIA!

Insulin has been linked to increased androgen synthesis and LH synthesis.

Insulin also promotes lipid synthesis and fat storage. Obesity also means more insulin resistance.
What is a sign of hyperandrogenism in ABSENCE of hirsutism
ACNE!
What is acanthosis nigricans?
Darkening/"dirty" skin color around axilla, neck, intertrigenous.

MARKER OF INSULIN RESISTANCE. ASSOCIATED WITH PCOS
How many follicles are necessary to diagnose PCOS?
greater than 12 follicles. Only need to see it in ONE OVARY.
What is characteristic of PCOS in adolescent with respect to menstruation?
Earlier maturation of HPA axis. Persistent oligomenorrhea even after 2 years post-menarche.
What are the most relevant health consequences to PCOS?
Diabetes, obesity.

Cardiovascular important too.
What is the best method to prevent diabetes?

What is the most important factor to dietary recommendations?
Lifestyle changes.

REDUCE CALORIC INTAKE.
Are OCP's useful in treating PCOS?
Yes!

Prevent endometrial hyperplasia (progesterone)...decrease in androgens. Regulates menstruation. Controls PCOS symptoms.

Decrease in androgens because increase in Sex Hormone Binding Protein.
What are anti-androgens good for?
BLOCK hirsutism, acne
What are the metabolic manifestations of obesity and insulin resistance?
Glucose intolerance, dyslipidemia, vascular dysfunction ...

LONG-TERM SEQUELAE: Diabetes, Vascular disease
What are endocrine manifestations of obesity and insulin resistance?
Increase in insulin leads to increase in androgen production. Also results in decreased SHBG.

LONG-TERM SEQUELAE: Hirsutism, Infertility/menstrual disturbance
What would be a good therapeutic agent for PCOS given all this insulin resistance information?
Insulin sensitizing agent.

WEIGHT LOSS!

Treats insulin resistance

Induces ovulation

Prevents diabetes mellitus


CONS: Potential long-term toxicity? Induces ovulation.
Is treatment aimed at underlying cause or symptoms of PCOS?
SYMPTOMS! hirsutism, acne, diabetes, etc
What is the MOST COMMON CAUSE of Hyperandrogenemia?
PCOS!