PCOS

Question 1

Outline the pathophysiology of PCOS

Answer 1

Cause unknown.

Polycystic ovaries produced when ovaries stimulated to produce ↑testosterone, caused by;

• ↑LH (and ↑FSH) [ant. pituitary] caused by excessive ↑GnRH pulsatility [hypothalamus]
• ↑insulin caused by insulin resistance/ diabetes, this also causes;
  
  • ↓sex hormone binding globulin [liver] causing ↑free androgens
  • Dyslipidaemia
  • Adrenal disturbance causing ↑androgens

Question 2

Outline the Epidemiology of PCO/S

Answer 2

20% of women have PCO’s, but majority dont have the syndrome

PCOS is throught to affect 5-15% of women of reproductive age

Question 3

Outline the clinical presentation of PCOS

Answer 3

• Oligomenorrhea
• Hirsutism /acne /alopecia
• Infertility/ subfertility
• Psychological
• Obesity

Question 4

Outline the investigations of PCOS

Answer 4

• ↑LH (LH:FSH 2:1, FSH may be ↑)
• ↑Free testosterone (if >5nmol/L exclude tumours/ congenital adrenal hyperplasia)
• GTT (↑insulin)
• Dyslipidaemia
• TFTs & FBC
• USS/ lap

Question 5

Outline the differentials for PCOS

Answer 5

• Cushings syndrome
• Androgen secreting tumours (adrenal/ ovarian)
• Thyroid disorder (particularly Hypothyroidism)
• Congenital adrenal hyperplasia

Question 6

Outline the diagnostic criteria for PCOS

Answer 6

Rotterdam criteria

• Polycystic ovaries (12+ or 10cm+)
• Oligo-menorhoea/ anovulation
• Clinical or biochemical signs for hyperandrogenism

Question 7

Outline the treatments for PCOS

Answer 7

• Lifestyle
• Medical - not planning pregnancy
  
  • Hirsutism & acne: Co-cyprindol [estradiol and anti-androgen] /Aflornithine
  • Insulin & weight: Metformin + Orlistat [inhibits lipase]
  • Oligomenohoea: COCP
• Medial - planning/ pregnant
  
  • Clomifene +/- Metformin
• Surgical
  
  • TAH + BSO

Question 8

Outline potential complications & so treatments of PCOS

Answer 8

• Oligomenorrhoea predisposes to Endometrial hyperplasia/ cancer
  
  • Protect with progestogens
• High Type 2 Diabetes risk
• High CV risk
• Sleep apnoea [ask & offer investigations]
• Pregnancy complications
  
  • Gestational diabetes [screen <20wks]
  • Pre-term birth
  • Pre-exlampsia