Aligner Study Group
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Transcript Aligner Study Group
Management of the Commonest
Endocrine disorder in females
Miss Bini Ajay
Cases
25 year old with BMI 35, with history of
infrequent periods, facial hair
30year old, normal BMI with irregular
periods and unable to conceive for 3 years
PCOS
•Definition
•Pathophysiology
•Management
•Long term consequences
•Summary
Facts
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Stein & Levanthal in 1935
5-10% PCOS,20% PCO
Heritable disorder
30%of PCOS- normal periods, 85-90% of
oligomenorrhoea,30-40 % of amenorrhoea
70%- hyperandrogenism
50-70%- insulin resistance, 30-40% -IGTT, 7.5-10% type II
40% - subfertility
42-73%-miscarriages
35%- depression
Pathophysiology
Pathophysiology
Insulin Resistance
Hyperinsulinemia
Stimulates Hypothalamus
Stimulates adrenal gland
Stimulates ovaries
Suppresses Liver – less SHBG- Increased Androgen
Diagnosis
Rotterdam Criteria
- 12 or more follicle <10mm
- Oligoovulation /anovulation
- hyperandrogenism
PCOS
Biochemical tests
-TFT/ Prolactin
- Free androgen & SHBG
- Androgen secreting tumours/
CAH(17OHprogesterone)
- LH:FSH > 2:1
- AMH
- GTT(fasting insulin)
- Lipid profile
Treatment
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Exercise ,weight loss(5%)
Oral contraceptive pill- Dianette, Yasmin
Spironolactone ,Finasteride
Isotretinoin
Laser, electrolysis
Vaniqa
• Eflornithine Monohydrate
chloride
• Blocks the action of
ornithine decarboxylase
in skin
• Twice daily
• 4 months
Metformin
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Decreases androgens
Use insulin
Reduces cholesterol
Improves metabolism
Increases ovulation
If pregnant can continue Metformin
Inositol
• Myo-inositol- carbohydrate essential for insulin
modulation
• Increases action of insulin –improves insulin
sensitivity
• Reduces cholesterol and BP
• Reduces androgen
• Increases ovulation-69.5%
Laparoscopic drilling
• Drills into the outer capsule
• Decreases testosterone
• Increase FSH
Long term Effects
• Diabetes, cardio and cerebrovascular disease-lipid
profile, BP, HbA1c
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Endometrial cancer –hyperplasia
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Obstructive Sleep Apnoea- obese, insulin resistance –
CPAP
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Psychological –Depression , sexual difficulties, eating
disorder
PCOS and Trigycerides
• Obesity and high insulin – promotes high triglyceridesincreases VLDL
• Insulin resistance – reduced clearance of VLDL and
chylomicrons
• Hepatic content of triglycerides is high larger VLDL
particles are produced- metabolised to small, dense LDL
particles- poorly cleared and atherogenic
• Statins improve hyperandrogenemia
PCOS and hypertension
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Increased endothelin_1 levels
Increased aldosterone concentrations
Czech-22% Dutch-28%
Coronary artery calcium (CAC scores) and
carotid intima –media thickness (CIMT)subclinical atherosclerosis- stroke ,MI
Endometrial hyperplasia
• Endometrial cancer
• Withdrawl bleed -3-4months
• TVS- ET-7mm
PCOS and Pregnancy
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Gestational diabetes- GTT at 16 and 28weeks
Preeclampsia
Preterm birth
Perinatal mortality
Multiple pregnancy
Summary
• PCOS is a common endocrine and metabolic disorder
with long term consequences