Snapshot A 25-year-old woman presents with excessive hair growth and abnormal menses. She reports shaving mulitple times to remove hair from her chin and chest, states that her menses has been irregular, and is currently sexually active and only uses condoms as a form of contraception. She is not on any medications. The patient is 5' 1" (155 cm) and weighs 165 lbs (75 kg). On physical examination, there is hair in the periareolar and linea alba region. There is also acanthosis nigricans in the posterior neck. Introduction Clinical definition an acquired endocrinopathy characterized by ovarian dysfunction can lead to primary or secondary amenorrhea and oligomenorrhea which prevents formation of the corpus luteum, impairing progesterone synthesis which leads to unapposed estrogen proliferative effect on the endometrium that results in bleeding increased risk of endometrial hyperplasia and cancer hyperandrogenism may present as acne and hirsutism polycystic ovaries Epidemiology incidence ~7% of reproductive-aged women demographics females only risk factors family history obesity Pathophysiology mechanism is unclear peripheral insulin resistance leads to hyperinsulinemia ovarian stimulation leading to excess androgen production Associated conditions infertility the most common cause of infertility in woman menstrual dysfunction hyperandrogenism obesity insulin resistance Prognosis natural history of disease patients may present for hirsutism, irregularities in their menses, obesity, and acanthosis nigricans prognostic variable favorable weight loss Presentation Symptoms menstrual dysfunction e.g., dysfunctional uterine bleeding and amenorrhea infertility hirsutism acne Physical exam obesity hirsutism acne acanthosis nigricans a sign of insulin resistance bilateral enlarged ovaries on pelvic exam Imaging Ovarian ultrasonography indications can be performed when pelvic examination is inadequate findings may show polycystic ovaries affecting one or both ovaries Studies Labs total and free testosterone level LH/FSH > 3 Differential Cushing syndrome Non-classical congenital adrenal hyperplasia Androgen-secreting tumor Pregnancy Premature ovarian failure Thyroid disease hyper- or hypothyroidism Prolactinoma Treatment Lifestyle weight loss indications for obese patients, weight loss is the first-line of treatment for obese patients pursuing pregnancy Pharmcologic hormonal contraceptives indications first-line of treatment for anovulation first-line of treatment for hirsutism/acne metformin indications first-line of treatment for the insulin resistance associated with PCOS also known to improve ovulation and assist in reducing androgen levels to improve regular menstrual cycles clomiphene citrate indications first-line of treatment for infertility caused by PCOS can cause heterotopic pregnancy Operative bariatric surgery indications for treatment of obesity ovarian-drilling indications can be considered in patients who are refractory to clomiphene citrate Complications Complications infertility endometrial hyperplasia and cancer due to unopposed estrogen exposure associated with increased insulin resistance
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.GN.13.255) A 27-year-old woman presents to her primary care physician for difficulties getting pregnant. She and her husband have been having unprotected intercourse once per day without success for the past year. She reports irregular menses. She is otherwise healthy and is not taking any medications. Her temperature is 98.0°F (36.7°C), blood pressure is 144/88 mmHg, pulse is 83/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical examination is notable for acne and the finding in Figure A. The patient has a notable abdominal pannus without any rashes noted. The patient is subsequently worked up with a TSH, prolactin level, and hysterosalpingogram, all of which are normal. She is instructed to lose weight by her physician and prescribed a medication to help her achieve pregnancy. What potential side effect must the physician warn the patient about? QID: 106211 FIGURES: A Type & Select Correct Answer 1 Facial hair 5% (1/21) 2 Heterotopic pregnancy 33% (7/21) 3 Lactic acidosis 43% (9/21) 4 Increased insulin sensitivity 5% (1/21) 5 Loss of bone mineral density 10% (2/21) M 7 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (1) Login to View Community Videos Login to View Community Videos Polycystic Ovarian Syndrome Luigi Bonini Gynecology - Polycystic Ovarian Syndrome D 2/8/2016 229 views 5.0 (2)