Management of the Commonest Endocrine disorder in females Miss Bini Ajay.
Post on 19-Dec-2015
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CasesCases
25 year old with BMI 35, with history ofinfrequent periods, facial hair
30year old, normal BMI with irregular periods and unable to conceive for 3 years
• 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
Facts
PathophysiologyPathophysiology
Insulin Resistance
Hyperinsulinemia Stimulates Hypothalamus Stimulates adrenal gland Stimulates ovaries Suppresses Liver – less SHBG- Increased Androgen
DiagnosisDiagnosis
Rotterdam Criteria - 12 or more follicle <10mm
- Oligoovulation /anovulation
- hyperandrogenism
BiochemicalBiochemical teststests
-TFT/ Prolactin
- Free androgen & SHBG
- Androgen secreting tumours/ CAH(17OHprogesterone)
- LH:FSH > 2:1
- AMH
- GTT(fasting insulin)
- Lipid profile
TreatmentTreatment
• Exercise ,weight loss(5%)• Oral contraceptive pill- Dianette, Yasmin• Spironolactone ,Finasteride• Isotretinoin• Laser, electrolysis
VaniqaVaniqa
• Eflornithine Monohydrate chloride
• Blocks the action of ornithine decarboxylase in skin
• Twice daily • 4 months
MetforminMetformin
• Decreases androgens• Use insulin• Reduces cholesterol• Improves metabolism• Increases ovulation• If pregnant can continue Metformin
InositolInositol• Myo-inositol- carbohydrate essential for insulin
modulation• Increases action of insulin –improves insulin
sensitivity• Reduces cholesterol and BP• Reduces androgen • Increases ovulation-69.5%
LaparoscopicLaparoscopic drillingdrilling
• Drills into the outer capsule• Decreases testosterone• Increase FSH
Long termLong term EffectsEffects
• Diabetes, cardio and cerebrovascular disease-lipid profile, BP, HbA1c
• Endometrial cancer –hyperplasia
• Obstructive Sleep Apnoea- obese, insulin resistance –CPAP
• Psychological –Depression , sexual difficulties, eating disorder
PCOS and TrigyceridesPCOS and Trigycerides• Obesity and high insulin – promotes high triglycerides-
increases 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 hypertensionPCOS and hypertension• 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
EndometrialEndometrial hyperplasiahyperplasia
• Endometrial cancer• Withdrawl bleed -3-4months• TVS- ET-7mm
PCOS and PregnancyPCOS and Pregnancy
• Gestational diabetes- GTT at 16 and 28weeks• Preeclampsia• Preterm birth• Perinatal mortality• Multiple pregnancy
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