Snapshot A 31-year-old G0 woman presents with difficulty becoming pregnant. She reports trying to conceive a child for over a year; however, she has not been successful. Past medical history is significant for type 2 diabetes mellitus and obesity. On physical exam, there is acne and hair on the upper lip and chin. There is also acanthosis nigricans in the posterior neck. Blood tests reveal an elevated free testosterone level and LH:FSH of 3. Introduction Endocrinopathy that can result in ovarian dysfunction can lead to primary or secondary amenorrhea and oligomenorrhea 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 Pathogenesis mechanism is unclear peripheral insulin resistance leads to hyperinsulinemia ovarian stimulation leading to excess androgen production Epidemiology a common cause of infertility in woman of reproductive age obesity is a risk factor Presentation Symptoms menstrual dysfunction e.g., dysfunctional uterine bleeding and amenorrhea infertility hirsutism acne Physical exam obesity hirsutism acne acanthosis nigricans bilateral enlarged ovaries on pelvic exam Evaluation Laboratory testing total and free testosterone level LH/FSH > 3 Pelvic ultrasound polycystic ovaries Differential Cushing syndrome Non-classical congenital adrenal hyperplasia Androgen-secreting tumor Pregnancy Premature ovarian failure Thyroid disease hyper- or hypothyroidism Prolactinoma Treatment Medical therapy obesity life-style modification diet and exercise anovulation hormonal contraceptives first-line also first-line for treating hirsutism metformin second-line agent infertility clomiphene citrate first-line glucose intolerance metformin Complications Complications infertility endometrial hyperplasia and cancer associated with increased insulin resistance
QUESTIONS 1 of 3 1 2 3 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 (M1.RP.12.1) A 32-year-old female complains to her gynecologist that she has had irregular periods for several years. She has severe facial acne and dense black hairs on her upper lip, beneath her hairline anterior to her ears, and the back of her neck. Ultrasound reveals bilateral enlarged ovaries with multiple cysts. Which of the following is the patient most likely increased risk of developing? Tested Concept QID: 101660 Type & Select Correct Answer 1 Hypothyroidism 12% (12/102) 2 Endometrial carcinoma 63% (64/102) 3 Addison disease 16% (16/102) 4 Wegener granulomatosus 2% (2/102) 5 Eclampsia 3% (3/102) M 4 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept
All Videos (1) Login to View Community Videos Login to View Community Videos PCOS Keshav Mudgal Reproductive - Polycystic Ovarian Syndrome E 3/11/2016 90 views (0)