Changes in PCOS
Excessive androgen production
Defect in folliculogenesis
Defect in gonadotropin secretion and action
Defect in insulin action
Obesity
USG findings of PCOS
Small unruptured follicles arranges in periphery of ovary giving NECKLACE appearance
Multiple follicles
Number->= 12
Size- 2-9mm
Volume ->= 10cc
Lab finding of PCOS
Increased
Testosterone
DHEA-S
LDL
AMH
E1 in obese females
LH
Decreased
Progesterone (as no corpus leutum)(also increases risk of abortion during pregnancy)
HDL
SHBG
No change
FSH
E2
Prolactin
TSH
Complications of insulin resistance
Acanthosis nigricans
HAIRAN syndrome
What is HAIRAN syndrome
Is obesity a defining feature of PCOS
No
Menometrorrgagia can occur in pcos due to
D/t Increase in E2
(Estrogen breakthrough bleeding)
What are FSH and LH levels in PCOS
FSH are normal
LH increase
Why does LH increase in PCOS
Pulse frequency of GnRH increase
What is best time to evaluate LH and FSH in PCOS
Day 2/day 3 of cycle
Cause of anovulation in PCOS
Folliculotoxic effect of androgens
Absence of LH surge
What is Rotterdam criteria?
Increase in androgens levels( hyperandrogenemia or hyperandrogenism)
Ovulatory dysfunction (2 ° amenorrhea/oligomenorrhea)
Polycystic appearance of ovaries on USG
>= 12 follicles
2-9mm in size in one or both ovaries or volume of ovary>=10cc
If any 2 + provisional diagnosis
What is next step after diagnosis of PCOS by Rotterdam criteria
17OH progesterone levels to rule out CAH
<200ng level CAH rules out
What happens to 17OH progesterone levels in PCOS
Normal
What are the two conditions in which there is
Increase LH
Normal FSH
If 2° amenorrhea
PCOS
If 1° amenorrhea
Androgen insensitivity syndrome
Ovaries may be normal in PCOS
What is progesterone challenge test?
What are its result in PCOS
Positive in PCOS
Withdrawal bleeding on adminstration of P for 5 days and then stopping
If there is complication of hirsutism, acne, irregular cycle what is next step
S. Testosterone levels
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