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Metabolic syndrome in PCOS patients
 

Metabolic syndrome in PCOS patients

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    Metabolic syndrome in PCOS patients Metabolic syndrome in PCOS patients Presentation Transcript

    • 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 Any 3 of the above disorders Requirements for Diagnosis Fasting Blood Glucose level >110mg/dl Glucose Waist Circumference >88cm Obesity Plasma Triglyceride level >150mg/dl and/or HDL level <50 mg/dl Dyslipidemia Current antihypertensive therapy and/or BP>130/85mmHg Hypertension NCEP ATP III
    • 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
    • References
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      • metabolic syndrome in women with polycystic ovary syndrome. The Journal of Clinical Endrocrinology and Metabolism. 2005; 90(4):1929-1935.
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      • endocrinopathy is associated with significant morbidity in women. The Journal of
      • Clinical Endocrinology and Metabolism 1999; 84(6):1897-1899.
      • Dunaif A., Scott D., Finegood D., Quintana B., Whitcomb R. The insulin-sensitizing
      • agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism. 1996; 81(9):3299-3306.
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      • Flegal et. al. CDC, National Center for Health Statistics, National Health and Nutrition
      • survery. JAMA. 2002;288: 1723-1727
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      • treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism. 2003; 52(7);908-915.
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    • References
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      • Marx T. Mehta E. Polycystic ovary syndrome: Pathogenesis and treatment over the
      • short and long term. Cleveland Clinic Journal of Medicine. 2003;70(1).
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      • Moghetti P., Castello R., Negri C., Tosi F., Perrone F., Caputo M., et al. Metformin
      • effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation. The Journal of Clinical Endocrinolgy and Metabolism. 2000; 85(1): 139-146.
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      •   Morin-Papunen L., Vauhdonen I., Koivunen R., Ruokonen A., Martikainen H.,
      • Tapanainen R., et al. Endocrine and metabolic effects of metformin versus ethinyl estradiol-cyproterone acetate in obese women with polycystic ovary syndrome: a randomized study. The Journal of Clinical Endrocrinology and Metabolism. 2000; 85(9): 3161-3168.
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      • Sheehan M. Polycystic ovarian syndrome: diagnosis and management. Clinical
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      • Sharpless JL., Polycystic ovary syndrome and the metabolic syndrome. Clinical
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      • Volek J., Feinman R., Carbohydrate restriction improves the features of metabolic
      • syndrome. Metabolic syndrome may be defined by the response to carbohydrate restriction. Nutrition and Metabolism. 2005; 2(31).
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      •   Vural B., Caliskan E., Turkoz E., Kilic T., Demirci A. Evaluation of metabolic
      • syndrome frequency and premature carotid atherosclerosis in young women with polycystic ovary syndrome. Human Reproduction. 2005; 20(9): 2409-2413.
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      • Zoe E. C. Hopkinson, Naveed Sattar, Richard Fleming, Ian A. Greer, Polycystic
      • ovarian syndrome: the metabolic syndrome comes to gynaecology. BMJ. 1998; 317: 329-332)