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8. Polycystic ovarian syndrome

Terms in this set (12)

Synonym
-Chronic ovarian androgenism
Etiology
High insulin-> High LH/FSH ratio->increased LH->increased androgen->converted to estrone-> neg FSH feedback->follicular degeneration->anovulation->oligomenorrhea->infertility
Typical picture
obese young woman with infertility, oligomenorrhea, and hirsutism; some patients have insulin resistance and may develop type 2 diabetes mellitus 10-15 years later.
Dx
-Rotterdam diagnostic criteria: 2/3->
1)Oligomen for 6 months
2) Hyperandrogenism(hirsu or male pattern alopecia)or raised free testo
3)Polycystic ovaries on U/S
Clinical
1)15-35(wait 2 years to Dx adol)
2)abnormal uterine bleeding, hirsutism, infert, obesity, virilz
3)acanthosis nigricans: browning of skin folds in intertriginous zones(insulin res)
4)insulin resist in lean and obese
Investigations
1)identify hyperandrogenism or chronic anovulation
2)Rule out pituitary or adrenal disease as cause
Lab
1)Prolactin, 17OH prog, free test, DHEA, TSH, T4, SHBG
2)LH/FSH >2:1
3) Incr. DHEA-S, free test and low SHBG
Imaging
1)Transvaginal or abdominal US->polycystic appearing ovaries(string of pearls)12 or more small follicles, 2-9mm, or increased ovarian volume
Other
-Test for insulin resistance or glucose tolerance with 75g OGTT yearly
Tx
Cycle control:
-Lifestyle modification to decrease estrone formation
-OCP monthly or cyclic provera to prevent enometrial hyperplasia due to unopposed estrogen
-Metformin
Tx infertility
-Medical induction of ovulation-> Clomiphene citrate, FSH, HMG
-Ovarian drilling->many punctures to decrease LH pulsation
-Bromocript. if hyperprolact
Tx hirsutis
-Any OCP
-Mechanical removal of hair
-5a-reductase inhib
-Spironolactone
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