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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