Metabolic syndrome in PCOS patients
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Transcript of Metabolic syndrome in PCOS patients
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Metabolic Syndrome InPolycystic Ovarian Syndrome
Patients
Presented By: Brittany Atkins
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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
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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
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Pathophysiology of PCOS
• Post Receptor Defect
• Insulin Resistance
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Pathophysiology of PCOS
• Suggestion of the presence of a hypothalamic defect
• Elevated LH levels
• Hyperandrogenism
• Anovulation
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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
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How PCOS May Present in Patients
Clinical Features:• Acanthosis Nigricans• Acne• Alopecia• Amenorrhea, oligomenorrhea, or dysfunctional
uterine bleeding• Anovulatory infertility• Central Obesity • Hirsutism
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How PCOS May Present in Patients
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How PCOS May Present in Patients
Other:
Ultrasonographic evidence of polycystic ovaries
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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
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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%
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Metabolic SyndromeNCEP ATP III
Hypertension Current antihypertensive therapy and/or BP>130/85mmHg
Dyslipidemia Plasma Triglyceride level >150mg/dl and/or HDL level <50 mg/dl
Obesity Waist Circumference >88cm
Glucose Fasting Blood Glucose level >110mg/dl
Requirements for Diagnosis Any 3 of the above disorders
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Important!
• Recognize that PCOS patients are at a high risk for developing metabolic syndrome
• Take measures to delay or arrest metabolic sequelae
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Cardiovascular Disease
• PCOS patients have a 7-fold increased risk for a myocardial infarction
• PCOS patients have lowered HDL levels and increased LDL levels
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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
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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
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Current Treatments
• Lifestyle Modification – Physical exercise
– Altered dietary composition
• Weight Loss– Low fat
– Low Carbohydrate
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Current Treatments
Insulin Sensitizing Agent– Biguanide (metformin)
– Thiazolidinediones (Troglitazone, pioglitazone, rosiglitazone)
Weight Loss Medications– Phentermine
– Sibutramine and Orlistat
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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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References
Apridonidze T., Essah P., Iuorno M., Nestler J. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. The Journal of Clinical Endrocrinology and Metabolism. 2005; 90(4):1929-1935.
Carmina E., Lobo R., Polycystic ovary syndrome (PCOS): Arguably the most common 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.
Ehrmann D., Liljenquist D., Kasza K., Azziz R., Legro R., Ghazzi M. Prevalence and
predictors of the metabolic syndrome in women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism. 2006; 91(1): 48-53.
Flegal et. al. CDC, National Center for Health Statistics, National Health and Nutrition survery. JAMA. 2002;288: 1723-1727 Glueck C.J., Papanna R., Wang P., Goldenberg N., Sieve-Smith L. Incidence and
treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism. 2003; 52(7);908-915.
Hopkinson Z., Sattar N., Fleming R., Greer I. Polycystic ovarian syndrome: the metabolic syndrome comes to gynaecology. BMJ. 1998; 317:329-332. Kendall D., Harmel A. The metabolic syndrome, type 2 diabetes, and cardiovascular
disease: understanding the role of insulin resistance. The Amecican Journal Of Managed Care. 2002; 8(20): 635-653.
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References Marx T. Mehta E. Polycystic ovary syndrome: Pathogenesis and treatment over the short and long term. Cleveland Clinic Journal of Medicine. 2003;70(1). 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.
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.
Sheehan M. Polycystic ovarian syndrome: diagnosis and management. Clinical Medicine and Research. 2004; 2(1); 13-27. Sharpless JL., Polycystic ovary syndrome and the metabolic syndrome. Clinical Diabetes. 2003; 21(4) 154-161. 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).
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.
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)