Metabolic Syndrome In Polycystic Ovarian Syndrome Patients Presented

Metabolic Syndrome In Polycystic Ovarian Syndrome Patients Presented By: Brittany Atkins

What is Polycystic Ovarian Syndrome? • Common disorder of women of reproductive age • Uniform definition does not exist! • Belief that PCOS should be defined by 1)ovulatory dysfunction 2) hyperandrongenism 3) exclusion of other disorders

Pathophysiology of PCOS • Etiology Unknown • Evidence supports the hypothesis that decreased peripheral insulin sensitivity and consequent hyperinsulinemia are pivotal in the pathogenesis of PCOS • Evidence of autosomal transmission related to strong familial clustering • Possible hypothalamic Defect • A post-receptor defect in adipose tissue has been identified

Pathophysiology of PCOS • Post Receptor Defect • Insulin Resistance

Pathophysiology of PCOS • Suggestion of the presence of a hypothalamic defect • Elevated LH levels • Hyperandrogenism • Anovulation

How PCOS May Present in Patients Endocrine Abnormalities • Elevated luteinizing hormone concentration with normal follicle stimulating hormone concentration • Increased testosterone activity (often expressed as raised free androgen index) • Insulin Resistance with compensatory hyperinsulinemia

How PCOS May Present in Patients Clinical Features: • Acanthosis Nigricans • Acne • Alopecia • Amenorrhea, oligomenorrhea, or dysfunctional uterine bleeding • Anovulatory infertility • Central Obesity • Hirsutism

How PCOS May Present in Patients

How PCOS May Present in Patients Other: Ultrasonographic evidence of polycystic ovaries

Diagnosing PCOS 1. Symptoms 2. Ultrasound Examination Positive = diagnosis Confirmed 3. Biochemical Examinations Negative elevated serum testosterone elevated free androgen index elevated LH concentrations Fasting glucose: insulin <4. 5

INSULIN RESISTANCE!!! • Insulin Resistance being the key pathogenic factor in PCOS, it also appears to play a pathogenic role in the metabolic syndrome!!! • Metabolic syndrome is more prevalent in women with PCOS then in the general U. S. population • One study found that the prevalence of Metabolic syndrome in women with PCOS was 43%

Metabolic Syndrome NCEP ATP III Hypertension Current antihypertensive therapy and/or BP>130/85 mm. Hg Dyslipidemia Plasma Triglyceride level >150 mg/dl and/or HDL level <50 mg/dl Obesity Waist Circumference >88 cm Glucose Fasting Blood Glucose level >110 mg/dl Requirements for Diagnosis Any 3 of the above disorders

Important! • Recognize that PCOS patients are at a high risk for developing metabolic syndrome • Take measures to delay or arrest metabolic sequelae

Cardiovascular Disease • PCOS patients have a 7 -fold increased risk for a myocardial infarction • PCOS patients have lowered HDL levels and increased LDL levels

Cardiovascular Disease • PCOS patients have an increased activity of hepatic lipase • Altered lipolytic response to insulin • Impaired fibrinolytic activity due to increased circulatory levels of PAI -1

Type 2 Diabetes • Metabolic syndrome population have an increased prevalence of glucose intolerance • Increased risk for type 2 diabetes • In presence of insulin resistance pancreatic b cell insulin secretion increases in a compensatory fashion • Type 2 diabetes develops when the compensatory increase is no longer sufficient to maintain euglycemia

Current Treatments • Lifestyle Modification – Physical exercise – Altered dietary composition • Weight Loss – Low fat – Low Carbohydrate

Current Treatments Insulin Sensitizing Agent – Biguanide (metformin) – Thiazolidinediones (Troglitazone, pioglitazone, rosiglitazone) Weight Loss Medications – Phentermine – Sibutramine and Orlistat

Conclusion • PCOS is a commonly encountered endocrinopathy in women of reproductive age • Providers need to appreciate that the syndrome is associated with significant morbidity in terms of reproductive as well as nonreproductive events • Recognize these patients • Use precautionary measures to prevent cardiovascular disease and type 2 diabetes

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