POLYCYSTIC OVARIAN SYNDROME MCQs

PCOS must know points:
🎯Definition
• PCOS: A common endocrine disorder in women of reproductive age, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology (Rotterdam criteria).
🎯Etiology
1. Multifactorial causes:
• Genetic predisposition.
• Environmental factors like lifestyle, obesity, and insulin resistance.
🎯Pathophysiology
1. Hyperandrogenism:
• Increased production of androgens (testosterone, DHEA-S) from the ovaries/adrenal glands.
2. Insulin resistance:
• Hyperinsulinemia worsens ovarian androgen production.
3. Anovulation:
• Follicles do not mature properly, leading to menstrual irregularities.
4. Chronic inflammation:
• May play a role in its pathogenesis.
🎯Clinical Features
1. Menstrual irregularities:
• Oligomenorrhea or amenorrhea.
2. Hyperandrogenic signs:
• Hirsutism, acne, androgenic alopecia.
3. Infertility:
• Due to anovulation.
4. Obesity/metabolic features:
• Central obesity, acanthosis nigricans (insulin resistance).
5. Psychological symptoms:
• Depression, anxiety, body image issues.
🎯Diagnostic Criteria (Rotterdam 2003, 2/3 required)
1. Oligo/anovulation.
2. Clinical or biochemical hyperandrogenism.
3. Polycystic ovarian morphology (12 or more follicles or ovarian volume more than 10 mL on ultrasound).
🎯Investigations
1. Hormonal assays:
• Increased LH/FSH ratio (more than 2:1).
• Increased Testosterone, DHEA-S.
• Normal or decreased progesterone (anovulation).
2. Imaging:
• Transvaginal ultrasound (polycystic ovaries).
3. Other labs:
• Fasting glucose, HbA1c, lipid profile (for metabolic syndrome).
4. Exclude other causes:
• Thyroid function tests (hypothyroidism).
• Prolactin levels (hyperprolactinemia).
• 17-OHP (CAH).
🎯Complications
1. Reproductive:
• Infertility, miscarriage, pregnancy complications.
2. Metabolic:
• Type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease (NAFLD).
3. Cardiovascular:
• Hypertension, increased risk of CVD.
4. Cancer:
• Endometrial hyperplasia/cancer (unopposed estrogen).
5. Psychological:
• Depression, anxiety, eating disorders.
🎯Management
1. Lifestyle modifications (first-line):
• Weight loss, diet (low GI), exercise.
2. Pharmacological treatment:
• Hormonal: Combined oral contraceptives (to regulate cycles, decrease androgens).
• Anti-androgens: Spironolactone, finasteride (for hirsutism/acne).
• Ovulation induction: Clomiphene citrate, letrozole (for infertility).
• Insulin sensitizers: Metformin (for insulin resistance).
3. Surgical:
• Ovarian drilling (second-line for infertility).
4. Psychological support:
• Counseling for mental health issues.
🌺 Key Exam Tips
• Always rule out differential diagnoses (e.g., hypothyroidism, Cushing syndrome, hyperprolactinemia).
• Emphasize multidisciplinary approach: gynecologist, endocrinologist, nutritionist.
• Highlight long-term management strategies (e.g., cardiovascular risk reduction).
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