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NR 602 Week 6 Grand Rounds – PCOS. Complete Solution

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What is PCOS? Women with Polycystic Ovarian Syndrome (PCOS) have abnormalities with the metabolism of androgens and estrogen, which lead to an increase in androgen production (Beena & Thomas, 2016). PCOS can result from abnormal functioning within the hypothalamic-pituitary-ovarian axis (Beena & Thomas, 2016; Williams, Mortada, & Porter, 2016). PCOS can be diagnosed when a patient presents with two out of three of the following findings: polycystic ovaries (which is when there are 12 or more follicles in 1 ovary), hyperandrogenism, and ovulatory dysfunction (Williams, Mortada, & Porter, 2016). Pathophysiology The pathophysiology of PCOS is complex and no single reason can be confirmed one hundred percent, however, it is thought that insulin resistance plays a key role (Williams, Mortada, & Porter, 2016). Patient’s with PCOS are two times more likely to have metabolic syndrome when compared with the general population and they are four times more likely to have type 2 diabetes (Williams, Mortada, & Porter, 2016). The pathophysiology is also associated with altered luteinizing hormone (LH) action, a predisposition to hyperandrogenism, and insulin resistance (Williams, Mortada, & Porter, 2016). It is believed that the underlying insulin resistance these patients have exacerbate hyperandrogenism via suppression of the synthesis of the sex hormone-binding globulin and increase ovarian and adrenal synthesis of androgens, leading to an overall increase in androgen levels (Williams, Mortada, & Porter, 2016). The increase in androgens is what causes the menses to be irregular as well as the development of physical appearances of hyperandrogenism (Williams, Mortada, & Porter, 2016). Patients with PCOS have also been found to have an increased risk for developing nonalcoholic fatty liver disease, hyperlipidemia, and sleep apnea (Williams, Mortada, & Porter, 2016). Epidemiology PCOS is the most common cause of infertility due to anovulation (Williams, Mortada, & Porter, 2016). It is believed that between 6 to 25 percent of reproductive age women have PCOS (Williams, Mortada, & Porter, 2016). The symptoms typically begin around the time the woman begins her menses, therefore, the diagnosis is commonly made during adolescence or young adulthood (Williams, Mortada, & Porter, 2016). It has been found that these patients are at a higher risk for developing ovarian and endometrial cancers (Williams, Mortada, & Porter, 2016).

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