CASE STUDY PCOS EXAM QUESTIONS
AND ANSWERS
Clomifene - ANSWER-(not given to this patient). To initiate menses. Inhibits estrogen
receptors in hypothalamus to prevent feedback by estrogen on GnRH. Up-regulation of
HPG axis. FSH up, new follicle development. Follicles in turn, produce estrogen. Lack of
negative feedback means that increased FSH will make more ovarian follicles. Rupture
of follicles to ovulate.
Follow up (6 months) - ANSWER-6 months, weight reduction and BMI decrease.
Glucose tolerance improved and hyperinsulinemia better. Better lipid profile. Menses
occured only after dydrogesterone-induced withdrawal. Metformin increased.
Follow up (1 year) - ANSWER-Weight was 70kg and healthier. Still obese BMI. Fasting
glucose and insulin levels normal and lipid profile improved. Polycystic ovaries
remained but menses normal without progesterone medication.
Follow up (4.5 years) - ANSWER-Patient still on metformin therapy. Still obese and has
problems controlling weight. Glucose and insulin levels remained normal. Normal
ovulatory cycles and normal ovary morphology.
Discussion points (testosterone) - ANSWER-Testosterone is the principal circulating
androgen in woman produced from ovarian and adrenal precursors
Discussion points (glucose intolerance and genetics) - ANSWER-Study of obese PCOS
patients reported high prevalence of impaired glucose tolerance and type 2 diabetes in
relatives. Suggests a genetic component to impaired glucose metabolism.
Discussion points (hyperinsulinemia -> hyperandrogenemia) - ANSWER-
Hyperinsulinemia causes or exacerbates hyperandrogenemia. Increased insulin levels
at ovarian level lead to increased androgen production from thecal cells and amplifies
granulosa response to LH. Supresses hepatic production of sex hormone binding
globulin. More unbound and active testosterone. THUS -> premature follicular growth
and anovulation.
Case + Initial symptoms (why she was brought in) - ANSWER-15 year old girl.
Obesity and amenorrhea.
Metabolic Syndrome - ANSWER-Cluster of increased BP, sugar level, waist body fat,
cholesterol levels. Increases the risk of heart disease, stroke, and diabetes.
Family's health history - ANSWER-Parents normal weight but with metabolic syndrome.
Two female siblings healthy and normal weight. Mother had gestational diabetes
mellitus during pregnancy.
AND ANSWERS
Clomifene - ANSWER-(not given to this patient). To initiate menses. Inhibits estrogen
receptors in hypothalamus to prevent feedback by estrogen on GnRH. Up-regulation of
HPG axis. FSH up, new follicle development. Follicles in turn, produce estrogen. Lack of
negative feedback means that increased FSH will make more ovarian follicles. Rupture
of follicles to ovulate.
Follow up (6 months) - ANSWER-6 months, weight reduction and BMI decrease.
Glucose tolerance improved and hyperinsulinemia better. Better lipid profile. Menses
occured only after dydrogesterone-induced withdrawal. Metformin increased.
Follow up (1 year) - ANSWER-Weight was 70kg and healthier. Still obese BMI. Fasting
glucose and insulin levels normal and lipid profile improved. Polycystic ovaries
remained but menses normal without progesterone medication.
Follow up (4.5 years) - ANSWER-Patient still on metformin therapy. Still obese and has
problems controlling weight. Glucose and insulin levels remained normal. Normal
ovulatory cycles and normal ovary morphology.
Discussion points (testosterone) - ANSWER-Testosterone is the principal circulating
androgen in woman produced from ovarian and adrenal precursors
Discussion points (glucose intolerance and genetics) - ANSWER-Study of obese PCOS
patients reported high prevalence of impaired glucose tolerance and type 2 diabetes in
relatives. Suggests a genetic component to impaired glucose metabolism.
Discussion points (hyperinsulinemia -> hyperandrogenemia) - ANSWER-
Hyperinsulinemia causes or exacerbates hyperandrogenemia. Increased insulin levels
at ovarian level lead to increased androgen production from thecal cells and amplifies
granulosa response to LH. Supresses hepatic production of sex hormone binding
globulin. More unbound and active testosterone. THUS -> premature follicular growth
and anovulation.
Case + Initial symptoms (why she was brought in) - ANSWER-15 year old girl.
Obesity and amenorrhea.
Metabolic Syndrome - ANSWER-Cluster of increased BP, sugar level, waist body fat,
cholesterol levels. Increases the risk of heart disease, stroke, and diabetes.
Family's health history - ANSWER-Parents normal weight but with metabolic syndrome.
Two female siblings healthy and normal weight. Mother had gestational diabetes
mellitus during pregnancy.
