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

2. 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

3. 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

4. Pathophysiology of PCOS Post Receptor Defect Insulin Resistance

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

6. 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

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

8. How PCOS May Present in Patients

9. Other: Ultrasonographic evidence of polycystic ovaries

10. 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

11. 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%

12. Metabolic Syndrome NCEP ATP III HypertensionCurrent antihypertensive therapy and/or BP>130/85mmHg DyslipidemiaPlasma Triglyceride level >150mg/dl and/or HDL level <50 mg/dl ObesityWaist Circumference >88cm GlucoseFasting Blood Glucose level >110mg/dl Requirements for DiagnosisAny 3 of the above disorders

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

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

15. 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

16. 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

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

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

19. 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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