Metabolic syndrome in PCOS patients


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Metabolic syndrome in PCOS patients

  1. 1. Metabolic Syndrome In Polycystic Ovarian Syndrome Patients Presented By: Brittany Atkins
  2. 2. What is Polycystic Ovarian Syndrome? <ul><li>Common disorder of women of reproductive age </li></ul><ul><li>Uniform definition does not exist! </li></ul><ul><li>Belief that PCOS should be defined by 1)ovulatory dysfunction 2) hyperandrongenism 3) exclusion of other disorders </li></ul>
  3. 3. Pathophysiology of PCOS <ul><li>Etiology Unknown </li></ul><ul><li>Evidence supports the hypothesis that decreased peripheral insulin sensitivity and consequent hyperinsulinemia are pivotal in the pathogenesis of PCOS </li></ul><ul><li>Evidence of autosomal transmission related to strong familial clustering </li></ul><ul><li>Possible hypothalamic Defect </li></ul><ul><li>A post-receptor defect in adipose tissue has been identified </li></ul>
  4. 4. Pathophysiology of PCOS <ul><li>Post Receptor Defect </li></ul><ul><li>Insulin Resistance </li></ul>
  5. 5. Pathophysiology of PCOS <ul><li>Suggestion of the presence of a hypothalamic defect </li></ul><ul><li>Elevated LH levels </li></ul><ul><li>Hyperandrogenism </li></ul><ul><li>Anovulation </li></ul>
  6. 6. How PCOS May Present in Patients <ul><li>Endocrine Abnormalities </li></ul><ul><li>Elevated luteinizing hormone concentration with normal follicle stimulating hormone concentration </li></ul><ul><li>Increased testosterone activity (often expressed as raised free androgen index) </li></ul><ul><li>Insulin Resistance with compensatory hyperinsulinemia </li></ul>
  7. 7. How PCOS May Present in Patients <ul><li>Clinical Features: </li></ul><ul><li>Acanthosis Nigricans </li></ul><ul><li>Acne </li></ul><ul><li>Alopecia </li></ul><ul><li>Amenorrhea, oligomenorrhea, or dysfunctional uterine bleeding </li></ul><ul><li>Anovulatory infertility </li></ul><ul><li>Central Obesity </li></ul><ul><li>Hirsutism </li></ul>
  8. 8. How PCOS May Present in Patients
  9. 9. How PCOS May Present in Patients <ul><li>Other: </li></ul><ul><li>Ultrasonographic evidence of polycystic ovaries </li></ul>
  10. 10. Diagnosing PCOS <ul><li>1. Symptoms 2. Ultrasound Examination </li></ul><ul><li>Positive = diagnosis </li></ul><ul><li>Confirmed </li></ul><ul><li>3 . Biochemical Examinations Negative </li></ul><ul><li>elevated serum testosterone </li></ul><ul><li>elevated free androgen index </li></ul><ul><li>elevated LH concentrations </li></ul><ul><li>Fasting glucose:insulin <4.5 </li></ul>
  11. 11. INSULIN RESISTANCE!!! <ul><li>Insulin Resistance being the key pathogenic factor in PCOS, it also appears to play a pathogenic role in the metabolic syndrome!!! </li></ul><ul><li>Metabolic syndrome is more prevalent in women with PCOS then in the general U.S. population </li></ul><ul><li>One study found that the prevalence of Metabolic syndrome in women with PCOS was 43% </li></ul>
  12. 12. 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
  13. 13. Important! <ul><li>Recognize that PCOS patients are at a high risk for developing metabolic syndrome </li></ul><ul><li>Take measures to delay or arrest metabolic sequelae </li></ul>
  14. 14. Cardiovascular Disease <ul><li>PCOS patients have a 7-fold increased risk for a myocardial infarction </li></ul><ul><li>PCOS patients have lowered HDL levels and increased LDL levels </li></ul>
  15. 15. Cardiovascular Disease <ul><li>PCOS patients have an increased activity of hepatic lipase </li></ul><ul><li>Altered lipolytic response to insulin </li></ul><ul><li>Impaired fibrinolytic activity due to increased circulatory levels of PAI-1 </li></ul>
  16. 16. Type 2 Diabetes <ul><li>Metabolic syndrome population have an increased prevalence of glucose intolerance </li></ul><ul><li>Increased risk for type 2 diabetes </li></ul><ul><li>In presence of insulin resistance pancreatic b cell insulin secretion increases in a compensatory fashion </li></ul><ul><li>Type 2 diabetes develops when the compensatory increase is no longer sufficient to maintain euglycemia </li></ul>
  17. 17. Current Treatments <ul><li>Lifestyle Modification </li></ul><ul><ul><li>Physical exercise </li></ul></ul><ul><ul><li>Altered dietary composition </li></ul></ul><ul><li>Weight Loss </li></ul><ul><ul><li>Low fat </li></ul></ul><ul><ul><li>Low Carbohydrate </li></ul></ul>
  18. 18. Current Treatments <ul><li>Insulin Sensitizing Agent </li></ul><ul><ul><li>Biguanide (metformin) </li></ul></ul><ul><ul><li>Thiazolidinediones (Troglitazone, pioglitazone, rosiglitazone) </li></ul></ul><ul><ul><li>Weight Loss Medications </li></ul></ul><ul><ul><li>Phentermine </li></ul></ul><ul><ul><li>Sibutramine and Orlistat </li></ul></ul>
  19. 19. Conclusion <ul><li>PCOS is a commonly encountered endocrinopathy in women of reproductive age </li></ul><ul><li>Providers need to appreciate that the syndrome is associated with significant morbidity in terms of reproductive as well as nonreproductive events </li></ul><ul><li>Recognize these patients </li></ul><ul><li>Use precautionary measures to prevent cardiovascular disease and type 2 diabetes </li></ul>
  20. 20. References <ul><li>Apridonidze T., Essah P., Iuorno M., Nestler J. Prevalence and characteristics of the </li></ul><ul><li>metabolic syndrome in women with polycystic ovary syndrome. The Journal of Clinical Endrocrinology and Metabolism. 2005; 90(4):1929-1935. </li></ul><ul><li>Carmina E., Lobo R., Polycystic ovary syndrome (PCOS): Arguably the most common </li></ul><ul><li>endocrinopathy is associated with significant morbidity in women. The Journal of </li></ul><ul><li>Clinical Endocrinology and Metabolism 1999; 84(6):1897-1899. </li></ul><ul><li>Dunaif A., Scott D., Finegood D., Quintana B., Whitcomb R. The insulin-sensitizing </li></ul><ul><li>agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism. 1996; 81(9):3299-3306. </li></ul><ul><li>  </li></ul><ul><li>Ehrmann D., Liljenquist D., Kasza K., Azziz R., Legro R., Ghazzi M. Prevalence and </li></ul><ul><li>predictors of the metabolic syndrome in women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism. 2006; 91(1): 48-53. </li></ul><ul><li>  </li></ul><ul><li>Flegal et. al. CDC, National Center for Health Statistics, National Health and Nutrition </li></ul><ul><li>survery. JAMA. 2002;288: 1723-1727 </li></ul><ul><li>  </li></ul><ul><li>Glueck C.J., Papanna R., Wang P., Goldenberg N., Sieve-Smith L. Incidence and </li></ul><ul><li>treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism. 2003; 52(7);908-915. </li></ul><ul><li>  </li></ul><ul><li>Hopkinson Z., Sattar N., Fleming R., Greer I. Polycystic ovarian syndrome: the </li></ul><ul><li>metabolic syndrome comes to gynaecology. BMJ. 1998; 317:329-332. </li></ul><ul><li>  </li></ul><ul><li>Kendall D., Harmel A. The metabolic syndrome, type 2 diabetes, and cardiovascular </li></ul><ul><li>disease: understanding the role of insulin resistance. The Amecican Journal Of Managed Care. 2002; 8(20): 635-653. </li></ul>
  21. 21. References <ul><li>  </li></ul><ul><li>Marx T. Mehta E. Polycystic ovary syndrome: Pathogenesis and treatment over the </li></ul><ul><li>short and long term. Cleveland Clinic Journal of Medicine. 2003;70(1). </li></ul><ul><li>  </li></ul><ul><li>Moghetti P., Castello R., Negri C., Tosi F., Perrone F., Caputo M., et al. Metformin </li></ul><ul><li>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. </li></ul><ul><li>  </li></ul><ul><li>  Morin-Papunen L., Vauhdonen I., Koivunen R., Ruokonen A., Martikainen H., </li></ul><ul><li>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. </li></ul><ul><li>  </li></ul><ul><li>Sheehan M. Polycystic ovarian syndrome: diagnosis and management. Clinical </li></ul><ul><li>Medicine and Research. 2004; 2(1); 13-27. </li></ul><ul><li>  </li></ul><ul><li>Sharpless JL., Polycystic ovary syndrome and the metabolic syndrome. Clinical </li></ul><ul><li>Diabetes. 2003; 21(4) 154-161. </li></ul><ul><li>  </li></ul><ul><li>Volek J., Feinman R., Carbohydrate restriction improves the features of metabolic </li></ul><ul><li>syndrome. Metabolic syndrome may be defined by the response to carbohydrate restriction. Nutrition and Metabolism. 2005; 2(31). </li></ul><ul><li>  </li></ul><ul><li>  Vural B., Caliskan E., Turkoz E., Kilic T., Demirci A. Evaluation of metabolic </li></ul><ul><li>syndrome frequency and premature carotid atherosclerosis in young women with polycystic ovary syndrome. Human Reproduction. 2005; 20(9): 2409-2413. </li></ul><ul><li>  </li></ul><ul><li>Zoe E. C. Hopkinson, Naveed Sattar, Richard Fleming, Ian A. Greer, Polycystic </li></ul><ul><li>ovarian syndrome: the metabolic syndrome comes to gynaecology. BMJ. 1998; 317: 329-332) </li></ul>