Williams Gyn Chapter 17: Pcos

Front 2

percentage of women with pcos

Back 2

4 to 12 percent

Front 3

how common is PCOS

Back 3

most common endocrine disorder of reproductive aged women

Front 4

what race gets PCOS

Back 4

PCOS appears to equally affect all races and nationalities.

Front 5

Rotterdam criteria for PCOS

Back 5

two out of the following three criteria: (1) oligo- and/or anovulation, (2) hyperandrogenism (clinical and/or biochemical), and (3) polycystic ovaries on sonographic examination

Front 6

NIH (1990) for PCOS

Back 6

To include both of the following:

1.
Oligo-ovulation

2.
Hyperandrogenism and/or hyperandrogenemia (with the exclusion of related disorders)

Front 7

a more severe form of PCOS

Back 7

ovarian hyperthecosis

Front 8

what is ovarian hyperthecosis

Back 8

is a rare condition characterized by nests of luteinized theca cells distributed throughout the ovarian stroma

Front 9

symps of ovarian hyperthecosis

Back 9

severe hyperandrogenism, and may occasionally display frank virilization signs such as clitoromegaly, temporal balding, and deepening of the voice
In addition, there is typically a much greater degree of insulin resistance and acanthosis nigricans

Front 10

(HAIRAN) syndrome

Back 10

marked hyperandrogenism, severe insulin resistance, and acanthosis nigricans

Front 11

The etiology of HAIRAN

Back 11

etiology of this disorder is unclear, may represent either a variant of PCOS or a distinct genetic syndrome.

Front 12

underlying cause of PCOS

Back 12

unknown. However, a genetic basis that is both multifactorial and polygenic is suspected

Front 13

candidate gene linked to PCOS and its function

Back 13

possibly dysregulation of the CYP11a gene in patients with PCOS. This gene encodes the cholesterol side-chain cleavage enzyme, the enzyme that performs the rate-limiting step in steroid biosynthesis

Front 14

possible chromosome involved in PCOS and function

Back 14

insulin receptor gene on chromosome 19p13.2 may be involved

Front 15

gonadotropin levels in pcos

Back 15

LH levels rise, and increased levels are observed clinically in approximately 50 percent of affected women

, luteinizing hormone:follicle-stimulating hormone (LH:FSH) ratios are elevated and rise above 2 in approximately 60 percent of patients

Front 16

1st step in the mechanism of PCOS

Back 16

Alterations in pulsatile gonadotropin-releasing hormone (GnRH) release may lead to a relative increase in luteinizing hormone (LH) versus follicle-stimulating hormone (FSH) biosynthesis and secretion. LH stimulates ovarian androgen production, while the relative paucity of FSH prevents adequate stimulation of aromatase activity within the granulosa cells, thereby decreasing androgen conversion to the potent estrogen estradiol.

Front 17

mechanism of endometrial hyperplasia in PCOS

Back 17

Elevated serum androgens (primarily androstenedione) are converted in the periphery to estrogens (primarily estrone). increased weak estrogens decrease feedback to hypothalmus leading to anovulation

Front 18

what are the types of androgens and estrogens that dominate PCOS

Back 18

Elevated serum androgens (primarily androstenedione) are converted in the periphery to estrogens (primarily estrone).

Front 19

Short-term consequences of PCOS

Back 19

1.
Irregular menses

2.
Hirsutism/acne/androgenic alopecia

3.
Infertility

4.
Obesity

5.
Metabolic disturbances

6.
Abnormal lipid levels/glucose intolerance

Front 20

Long-term consequences of PCOS

Back 20

1.
Diabetes mellitus

2.
Cardiovascular disease

3.
Endometrial cancer

Front 21

why do some women with PCOS will have total testosterone levels in the normal range

Back 21

decreased levels of sex hormone-binding globulin (SHBG).

Front 22

why do pcos women have decreased levels of sex hormone-binding globulin (SHBG).

Back 22

The synthesis of SHBG is suppressed by insulin as well as androgens, corticoids, progestins, and growth hormone

Front 23

ways to improve anovulation in PCOS

Back 23

weight losss
metformin
ovarian wedge resection in the past, and more recently laparoscopic ovarian drilling

Front 24

oligomenorrhea

Back 24

fewer than eight menstrual periods in 1 year

Front 25

amenorrhea

Back 25

absence of menses for 3 or more consecutive months

Front 26

However, approximately ??? percent of all postmenarchal girls have irregular periods for up to ??? years due to ?????

Back 26

50 percent

2 years
due to immaturity of the hypothalamic-pituitary-ovarian axis

Front 27

Hyperandrogenism is typically manifested clinically by

Back 27

hirsutism, acne, and/or androgenic alopecia

Front 28

signs of virilization what and WRT PCOS

Back 28

such as increased muscle mass, deepening of the voice, and clitoromegaly are not typical of PCOS.

Front 29

hypertrichosis, what and WRT PCOS

Back 29

increase in lanugo soft, lightly pigmented hair associated with some medications and malignancies
not related to PCOS

Front 30

medications related to hirsutism

Back 30

steroids
Danazol
Metoclopramid
Methyldopa
Phenothiazines
Progestins
Reserpine

Front 31

medications related to hypertrichosis

Back 31

cyclosporine
diazoxididil
penicillamine
phenytn
hydrocortisone
minoxidil

Front 32

Pathophysiology of Hirsutism

Back 32

Within a hair follicle, testosterone is converted by the enzyme 5-reductase to dihydrotestosterone (DHT)

Front 33

what type of testosterone converts soft hair to terminal coarse hair

Back 33

Although both testosterone and DHT convert short, soft vellus hair to coarse terminal hair, DHT is markedly more effective than testosterone

Front 34

concentration of hair follicles per unit area
WRT sex and race

Back 34

does not differ between men and women, however, racial and ethnic differences do exist.

Front 35

The pathogenesis of acne vulgaris involves four factors

Back 35

blockage of the follicular opening by hyperkeratosis, sebum overproduction, proliferation of commensal Propionibacterium acnes, and inflammation

Front 36

testosterone is converted within sebaceous glands to its more active metabolite, DHT, by

Back 36

5-reductase

Front 37

5-Reductase has two isoenzymes, type 1 and type 2.
what do they do

Back 37

type 1 isoenzyme predominates in sebaceous glands. In skin types prone to acne, such as the face, the activity of type 1 isoenzyme is greater and implies that more DHT is being produced in these sebaceous glands