PCOS

Question 1

what is rotterdam criteria?

Answer 1

must have 2 of 3:

• clinical sings of hyperandrogenism (clinical or biochemical)
• oligomenorrhea (3-4 cycles per year) or anovulation
• polycystic ovaries (12 or more follicles in 1 ovary)

Question 2

what is the ddx for PCOS?

Answer 2

• androgen secreting tumor (ovary vs adrenal)
• exogenous androgens
• cushing syndrome
• non-classical CAH
• acromegaly
• genetic defects in insulin action
• primary hypothalamic amenorrhea
• POI
• thyroid disease
• prolactin disorders

Question 3

what are associated comorbidities?

Answer 3

• diabetes (2-5x higher risk with PCOS)

- metabolic syndrome

Question 4

what are treatment options for PCOS - if no pregnancy desired?

Answer 4

• weight loss (in obese pts with PCOS)
• OCPs: regulates menses, improves hirsuitism
• Metformin: improves ovulation, hirsutism, and decreases circulating androgen level

Question 5

treatments for PCOS- if desiring to get pregnant?

Answer 5

letrozole > clomid

• better ovulation rates
• better live birth rates (27 vs 10%)
• better clinical pregnancy rate
• comparable twinning risk

Question 6

what benefit does weight loss have for patient’s with PCOS?

Answer 6

• more normal cycles
• increased pregnancy rates
• decreased hirsutism
• improved blood glucose/lipid parameters

Question 7

what % of secondary amenorrhea does PCOS account for?

Answer 7

28%

Question 8

what’s the work-up to rule out other diagnoses on ddx?

Answer 8

• endocrinopathies: TSH, PRL
• CAH: 17 OHP
• adrenal tumors: DHEA-S
• androgen secreting ovarian tumor: DHEA
• cushings syndrome (only in setting of rapid virilization): 24 hr urine cortisol
• POI: FSH, LH estradiol
• testosterone, free testosterone, SHBG

Question 9

interpretation/follow-up of testing for late onset CAH?

Answer 9

• 17 OHP
  Abnormals:
  Random: 4 ng/dl or greater
  Fasting: > 2 ng/dl or greater
• ACTH stimulation test: 250 micrograms of IM cosyntropin; then measure pathway intermediates 60 minutes after

Question 10

interpretation/follow-up of testing for Cushing’s syndrome?

Answer 10

• 24 hr urine cortisol test or
• low dose dexamethasone suppression test (in ppl with cushing’s syndrome cortisol will stay high despite dexamethasone administration)

Question 11

any medication for decreasing CV or DM risk?

Answer 11

no

- recommend lifestyle/caloric restriction