Polycystic ovarian syndrome (PCOS) Guide with complete
solution
PCOS
If a female patient presents with acne, hirsuitism, and alopecia, think:
DM2 and endometrial cancer
Women with PCOS have increased risk for what 2 things:
acne
hirsuitism
androgenic alopecia
infertility
menstrual irregularity
virilization
obesity
polycystic ovaries
insulin resistance
dyslipidemia
metabolic syndrome
psychologic impact
*cancer risks
Clinical presentation for PCOS:
PCOS
Female patient comes in with c/o of dark hair that has appeared on her upper lip,
areolae, inner thighs and chin. She has also noticed random spots of acne. Think what?
extent of hirsuitism
Ferriman-Gallwey scale measures:
ovaries and adrenal glands
DHEA-S, DHEA, androstenedione, testosterone, DHT
(1st 3 must be converted to testosterone to have androgenic effect)
Androgen production occurs where?
The major circulating androgens in women are:
0.2 to 0.3mg/day
Women typically produce how much testosterone per day?
hirsuitism
face, chin, upper lip, thighs, perineum, areolae
Excessive terminal hair growth in women, occurring in anatomic areas where hair
follicles are most androgen sensitive is called _____.
Most common sites are:
false
T/F Hirsuitism is always present in PCOS:
frontal region and crown
Androgen related hair loss generally occurs where?
virilization
, Characterized by clitoral hypertrophy, severe hirsuitism, deepening of the voice,
increased muscle mass, breast atrophy and male pattern baldness:
presence of adrenal or ovarian tumors, congenital hyperplasia or hyperthecosis
Virilization, if associated with oligomenorrhea or amenorrhea may indicate:
menstrual irregularity - oligomenorrhea, amenorrhea, polymenorrhea
Hallmark feature of PCOS:
who take COC because it modifies ovarian morphology
The definition of polycystic ovaries does not apply to what women:
yes
50% of patients with PCOS are obese
-increased peripheral aromatization of androgens --> elevated estrogen concentrations
-decreased levels of hepatic sex hormone binding globulin --> increased circulating
concentrations of free estradiol and testosterone
-insulin resistance --> compensatory increased in insulin levels that stimulate androgen
production in ovarian stroma, resulting in high local androgen ceoncentraiton that impair
follicular development
Obesity is associated with PCOS?
by stimulating ovarian androgen production and decreasing SHBG concentrations
How does hyperinsulemina play a pathologic role in the cause of PCOS?
obesity
insulin resistance
dyslipidemia
What makes up metabolic syndrome?
the expression of hyperandrogenism (acne, alopecia, hirsuitism)
the annoyance of irregular bleeding
the pain of infertility
obesity can have an impact on self image and self esteem
this can result to anxiety and depression and binge eating
How is there a psychological impact on PCOS?
endometrial cancer due to chronic unopposed estrogen stimulation
Women with PCOS are at 3-fold increase in developing what cancer?
d/t peripheral conversion of androgens to estrogen in adipose tissue
Why are obese women thought to be of greatest risk of developing endometrial cancer
who have PCOS?
-waist circumference > 88cm/35in
-triglycerides > 150 or treatment
-HDL < 50
-BP > 130/85
-fasting glucose > 100 or treatment
What are the criteria for metabolic syndrome in women?
solution
PCOS
If a female patient presents with acne, hirsuitism, and alopecia, think:
DM2 and endometrial cancer
Women with PCOS have increased risk for what 2 things:
acne
hirsuitism
androgenic alopecia
infertility
menstrual irregularity
virilization
obesity
polycystic ovaries
insulin resistance
dyslipidemia
metabolic syndrome
psychologic impact
*cancer risks
Clinical presentation for PCOS:
PCOS
Female patient comes in with c/o of dark hair that has appeared on her upper lip,
areolae, inner thighs and chin. She has also noticed random spots of acne. Think what?
extent of hirsuitism
Ferriman-Gallwey scale measures:
ovaries and adrenal glands
DHEA-S, DHEA, androstenedione, testosterone, DHT
(1st 3 must be converted to testosterone to have androgenic effect)
Androgen production occurs where?
The major circulating androgens in women are:
0.2 to 0.3mg/day
Women typically produce how much testosterone per day?
hirsuitism
face, chin, upper lip, thighs, perineum, areolae
Excessive terminal hair growth in women, occurring in anatomic areas where hair
follicles are most androgen sensitive is called _____.
Most common sites are:
false
T/F Hirsuitism is always present in PCOS:
frontal region and crown
Androgen related hair loss generally occurs where?
virilization
, Characterized by clitoral hypertrophy, severe hirsuitism, deepening of the voice,
increased muscle mass, breast atrophy and male pattern baldness:
presence of adrenal or ovarian tumors, congenital hyperplasia or hyperthecosis
Virilization, if associated with oligomenorrhea or amenorrhea may indicate:
menstrual irregularity - oligomenorrhea, amenorrhea, polymenorrhea
Hallmark feature of PCOS:
who take COC because it modifies ovarian morphology
The definition of polycystic ovaries does not apply to what women:
yes
50% of patients with PCOS are obese
-increased peripheral aromatization of androgens --> elevated estrogen concentrations
-decreased levels of hepatic sex hormone binding globulin --> increased circulating
concentrations of free estradiol and testosterone
-insulin resistance --> compensatory increased in insulin levels that stimulate androgen
production in ovarian stroma, resulting in high local androgen ceoncentraiton that impair
follicular development
Obesity is associated with PCOS?
by stimulating ovarian androgen production and decreasing SHBG concentrations
How does hyperinsulemina play a pathologic role in the cause of PCOS?
obesity
insulin resistance
dyslipidemia
What makes up metabolic syndrome?
the expression of hyperandrogenism (acne, alopecia, hirsuitism)
the annoyance of irregular bleeding
the pain of infertility
obesity can have an impact on self image and self esteem
this can result to anxiety and depression and binge eating
How is there a psychological impact on PCOS?
endometrial cancer due to chronic unopposed estrogen stimulation
Women with PCOS are at 3-fold increase in developing what cancer?
d/t peripheral conversion of androgens to estrogen in adipose tissue
Why are obese women thought to be of greatest risk of developing endometrial cancer
who have PCOS?
-waist circumference > 88cm/35in
-triglycerides > 150 or treatment
-HDL < 50
-BP > 130/85
-fasting glucose > 100 or treatment
What are the criteria for metabolic syndrome in women?
