OTHER POLYCYSTIC OVARIAN
SYNDROME (PCOS) EXAM QUESTIONS
WITH CORRECT ANSWERS
What are the Rotterdam criteria for diagnosis of PCOS in adults? - ANSWER-*At least
two of the following must be present*:
> Oligomenorrhea or amenorrhea
> Biochemical or clinical hyperandrogenism
> Polycystic ovaries on US
Rule out other endocrine disorders than can mimic PCOS.
What are three other disorders that can mimic PCOS? - ANSWER-Congenital Adrenal
Hyperplasia
Cushing Syndrome
Hyperprolactinemia
Describe the four key lab findings for PCOS. - ANSWER-*Increased LH:FSH ratio 3:1*
(nml 1.5:1)
-The patient is not ovulating so LH increases out of proportion to FSH to attempt to get
the egg to release.
*Serum estrone > serum estradiol*
*Androstenedion levels at the ULN or increased*
*Testosterone levels at the ULN or increased*
Increased DHEA-S (intermediate of testosterone)
What is the Primary Mechanism of PCOS in obesity? - ANSWER-LH stimulates the
theca cells to increase androstenedione production
*Androstenedione undergoes aromatization to estrone within adipocytes*
Estrone exerts positive feedback (stimulation) of LH secretion.
(clin med notes say that estrone exerts negative feedback on LH secretion resulting in
anovulation?)
, Increasing obesity causes increased conversion of androstenedione to estrone.
What is the Secondary Mechanism of PCOS in obesity? - ANSWER-*Increased
testosterone* production causes acne and hirsutism.
*Compensatory hyper-insulinemia* may cause decreased levels of SHBG, resulting in
more circulating androgen.
The increased free androgen serves as trophic stimulus to androgen production in
adrenal gland and ovary.
Pathophysiology of PCOS Flow Chart - ANSWER-
What is the major risk associated with elevated estrone levels in PCOS? - ANSWER-
Unopposed long-term elevated estrone levels increase the risks of abnormal uterine
bleeding, endometrial hyperplasia and *endometrial carcinoma*.
What other disorders are women with PCOS at risk for? - ANSWER-Infertility
Metabolic syndrome
-Impaired glucose tolerance (acanthosis nigricans)
Diabetes (8%)
Elevated TG, LDL and low HDL -> Atherosclerosis
HTN
Sleep disordered breathing (e.g. OSA)
NASH (non-alcoholic steatic hepatitis)
What is Metabolic syndrome and what is the relationship between metabolic syndrome
and PCOS? - ANSWER-*Metabolic syndrome* is defined by the presence of at least 3
of the following:
> Waist circumference >=35
> TG >= 150 mg/dL
> HDL <50
> BP >=130/85
> FBG >=100
A typical PCOS patient may have many of these signs.
SYNDROME (PCOS) EXAM QUESTIONS
WITH CORRECT ANSWERS
What are the Rotterdam criteria for diagnosis of PCOS in adults? - ANSWER-*At least
two of the following must be present*:
> Oligomenorrhea or amenorrhea
> Biochemical or clinical hyperandrogenism
> Polycystic ovaries on US
Rule out other endocrine disorders than can mimic PCOS.
What are three other disorders that can mimic PCOS? - ANSWER-Congenital Adrenal
Hyperplasia
Cushing Syndrome
Hyperprolactinemia
Describe the four key lab findings for PCOS. - ANSWER-*Increased LH:FSH ratio 3:1*
(nml 1.5:1)
-The patient is not ovulating so LH increases out of proportion to FSH to attempt to get
the egg to release.
*Serum estrone > serum estradiol*
*Androstenedion levels at the ULN or increased*
*Testosterone levels at the ULN or increased*
Increased DHEA-S (intermediate of testosterone)
What is the Primary Mechanism of PCOS in obesity? - ANSWER-LH stimulates the
theca cells to increase androstenedione production
*Androstenedione undergoes aromatization to estrone within adipocytes*
Estrone exerts positive feedback (stimulation) of LH secretion.
(clin med notes say that estrone exerts negative feedback on LH secretion resulting in
anovulation?)
, Increasing obesity causes increased conversion of androstenedione to estrone.
What is the Secondary Mechanism of PCOS in obesity? - ANSWER-*Increased
testosterone* production causes acne and hirsutism.
*Compensatory hyper-insulinemia* may cause decreased levels of SHBG, resulting in
more circulating androgen.
The increased free androgen serves as trophic stimulus to androgen production in
adrenal gland and ovary.
Pathophysiology of PCOS Flow Chart - ANSWER-
What is the major risk associated with elevated estrone levels in PCOS? - ANSWER-
Unopposed long-term elevated estrone levels increase the risks of abnormal uterine
bleeding, endometrial hyperplasia and *endometrial carcinoma*.
What other disorders are women with PCOS at risk for? - ANSWER-Infertility
Metabolic syndrome
-Impaired glucose tolerance (acanthosis nigricans)
Diabetes (8%)
Elevated TG, LDL and low HDL -> Atherosclerosis
HTN
Sleep disordered breathing (e.g. OSA)
NASH (non-alcoholic steatic hepatitis)
What is Metabolic syndrome and what is the relationship between metabolic syndrome
and PCOS? - ANSWER-*Metabolic syndrome* is defined by the presence of at least 3
of the following:
> Waist circumference >=35
> TG >= 150 mg/dL
> HDL <50
> BP >=130/85
> FBG >=100
A typical PCOS patient may have many of these signs.
