Ans. is d i.e. All are correct options                 

Symptoms and signs of PCOD :

• Menstrual dysfunction 
• In women with PCOS – Menstrual dysfunction ranges from amenorrhea to oligomenorrhea to episodic menometrorrhagia. Endometrium in PCOD patients can be both thickened/thinned and atrophied depending on the predominance of the hormone.
• Under the influence of unopposed action → Under the influence of Androgens of estrogen (due to anovulation)
• Thickened unstable endometrium →Thin, atrophied endometrium
• Unpredict able bleeding pattern → Amenorrhea/oligomenorrhea (menometrorrhagia)

Hyperandrogenism: It is manifested clinically by

• Hirsutism (i.e. presence of coarse, dark terminal hair distributed in the male pattern).
• Acne (Acne that is persistent or is late in onset) and/or Androgenic alopecia.
• In contrast signs of virilization such as increased muscle mass, deepening of the voice and clitoromegaly are not typical of PCOS. Virilisation reflects much higher androgen levels and should prompt investigation for an androgen producing tumor of ovary or the adrenal gland.

Other endocrine dysfunction :

• Insulin resistance.
• Acanthosis Nigricans – Skin is characterized by thick, gray-brown velvety plaques seen in areas of flexure like the back of the neck, axilla, crease beneath breast, waist, and groin. It occurs due to insulin resistance.
• Impaired glucose tolerance and type 2 diabetes mellitus.
• Dyslipidemia.
• Obesity.
• Obstructive sleep apnea.
• Increased incidence of metabolic syndrome and cardiovascular disease. A metabolic syndrome characterized by insulin resistance, obesity atherogenic dyslipidemia, and hypertension.
• Increased incidence of endometrial hyperplasia and cancer.
• Infertility.
• Increased rate (30 – 50%) of early miscarriage.
• Complications in Pregnancy – Increased risk of – Gestational diabetes

Consequences of PCOS

Short term consequences                                         Long term consequences

• Irregular menses                                          •  Diabetes
• Hirsutism / Acne / Androgenic alopecia           •  Cardiovascular disease
• Infertility                                                     • Endometrial cancer
• Obesity
• Metabolic disturbances
• Abnormal lipid levels / Glucose metabolism

Ans. is D. i.e. A and B both

• It is one of the most common endocrine system disorders that affect women in their reproductive age.
• PCOS occasionally is seen in prepubertal females.
• It is a syndrome manifested by amenorrhea, hirsutism, obesity and enlarged ovaries.
• Affecting  4-12%  of females.
• Familial inheritance is seen in PCOS.

Note: 
Streak ovaries are seen when genetic material is missing either from the long or short arm of the X chromosome or complete X chromosome is missing as in Turner’s syndrome. Streak ovaries are not seen in PCOS patients.

Ans.D.  PCOD          

• If a patient is having positive progesterone challenge test it means:-
• The uterus is sufficiently primed with estrogen i.e. estrogen production is normal so, hypopituitarism (option “C”) is ruled out.
• Uterus with its endometrial lining is normal i.e. Ashermann syndrome (option “A”) and Endometrial TB (option “B”) ruled out.
• The outflow tract is normal.
• The defect lies in the production of progesterone (as when progesterone is supplemented from outside it results in withdrawal bleeding) and since progesterone is produced mainly by corpus luteum so, the defect is anovulation. The main cause of Anovulation in a case of 2° amenorrhea is a polycystic ovarian disease (option “D”).

Ans. is C. i.e Low Prolactin

Ans. B. PCOD
USG feature: String of pearls/ Necklace appearance
DIAGNOSTIC CRITERIA – ROTTERDAM CRITERIA (2003)
Any two of the following three criteria should be present to diagnose a patient having PCOD after excluding other etiologies.

1. Ovulatory dysfunction such as oligomenorrhea or amenorrhea.
2. Clinical (hirsutism/acne/alopecia) or biochemical evidence of hyperandrogenism i.e. S. testosterone between 70-150 ng/ dl.
3. Polycystic ovarian morphology on USG scan defined as the presence of 12 or more cysts size: (2-9 mm) ] in any one ovary or both ovaries, with enlarged ovaries I (>10 ml) and other criteria being excluded.

Ans. is B i.e. PCOD

• It is one of the most common endocrine system disorders that affect women in their reproductive age.
• PCOS occasionally is seen in prepubertal females.
• It is a syndrome manifested by amenorrhea, hirsutism, obesity and enlarged ovaries.
• Affecting  4-12%  of females.
• Familial inheritance is seen in PCOS.
• The autosomal dominant mode of inheritance of Gene CYP21 mutation has been found associated.
  CLINICAL FEATURES :
  • Obesity: (BMI >30kg/m2) but PCOD can also occur in thin females.
  • Insulin resistance-hyperinsulinemia
  • Acanthosis nigricans
  • Hyperandrogenemia
  • Hirsutism
  • Anovulation
  • Menstrual Dysfunction
  • Acne and alopecia.
  • Sleep  apnea
  • High-stress levels
  • Skin  tags
  • Infertility
  • High  cholesterol and triglycerides
  • Type II diabetes
  • Pelvic pain
  • Depression and anxiety
    

    HORMONES INCREASED	HORMONES DECREASED
    Androgens (Testosterone, Androstenedione, DHEA, DHEAS)	Follicle-stimulating hormone (FSH)
    Luteinizing hormone (LH > 10 IU/L)	Progesterone (due to anovulation)
    Estrone	Sex hormone-binding globulin
    Total free estrone	HDL & Apoprotein A-l
    Insulin (> 10 m IU/L due to insulin resistance)
    Prolactin (in some patients)
    LDL cholesterol and triglycerides .
    AMH

Ans. is D ‘i.e., Both a and b

• Beside DM, metformin is also useful in polycystic ovarian disease.
• Suppress hepatic gluconeogenesis and glucose output from liver major action.
• Enhance insulin-mediated glucose disposal in muscle and fat (Increased peripheral utilization of glucose) by enhancing GLUT-1 transport from intracellular site to plasma membrane.
• Retard intestinal absorption of glucose.
• Promote peripheral glucose utilization by enhancing anaerobic glycolysis.
• Metformin is the only oral hypoglycemic that reduces macrovascular events in type 2 DM.
• Metformin is one of only two oral antidiabetics in the WHO model list of essential medicines (the other being glibenclamide).

Ans. is ‘B’ i.e., PCOD

GnRH agonists

• Long-acting GnRH (LHRH) agonists cause reversible pharmacological orchiectomy (medical castration) and are used for precocious puberty, prostatic carcinoma, endometriosis, premenopausal breast cancer, uterine leiomyoma, polycystic ovarian disease and to assist induced ovulation.
• GnRH agonists have an action similar to Gonadotropin-releasing hormone, i.e., they increase the secretion of gonadotropins (FSH, LH).
• GnRH agonists increase Gn secretion.
• But after 1-2 weeks they cause desensitization and down-regulation of FSH/LH receptors. (continuous exposure to agonist may cause downregulation of receptors)→ suppression of gonadal function.
• Spermatogenesis/ovulation ceases and testosterone/estrogen levels fall to castration level because the action of Gonadotropins (FSH & LH) is not there (these hormones promote gametogenesis and secretion of gonadal hormones).
• Preparation of superactive GnRH analogs is Buserelin, Goserelin, Leuprolide, Nafarelin, Triptorelin.
• Superactive/Long-acting GnRH is used as a nasal spray or SC injection.
• Cetraria, ganirelix and abarelix are GnRH antagonists. These are used subcutaneously for the treatment of uterine fibroid & endometriosis and controlled ovarian stimulation in in-vitro fertilization.
• GnRH agonists, as well as GnRH antagonists, can cause hot flushes, loss of libido and osteoporosis as adverse effects.

Ans: B. Tamoxifen

• The drug not given in a 30-year-old PCOD lady with infertility – Tamoxifen.

Treatment of PCOD:

• Dexamethasone 0.5 mg at bedtime – Reduces androgen production.
• In Clomiphene failed group – Ovulation induced with FSH or GnRH analogues.
• DOC – Metformin – Treats the root cause of PCOS, rectifies endocrine & metabolic functions and improves fertility.
• Surgery (laparoscopic multiple punctures of cyst) – Reserved for failed medical therapy, hyperstimulation cases & GnRH analogue usage.

Ans. is C. High FSH/LH ratio;   & E. ↑ estradiol (E2)/ estrone (E1) ratio
Hormone levels in PCOD
Raised:

• E2 (estradiol), LH, androgens, testosterone, Dehydroepiandrosterone (DHEA), fasting insulin, prolactin.

Decreased:

• FSH, FSH/ LH ratio, sex hormone binding globulin, estradiol(E2)/ estrone (E1) ratio

Ans. is C. i.e. Occur in postmenopausal women only
PCOD: Infertility is due to the anovulatory cycle
Clinical feature:

• Young woman
• Acanthosis nigra due to insulin resistance.
• Thick pigmented skin over the nape of the neck, inner thigh, and axilla.
• Hirsutism
• Infertility
• Oligomenorrhoea, amenorrhoea
• Central obesity:BMI > 30 kg/cm2;Waistline >88 cm 

Treatment:

• Metformin treats the root cause of PCOD, rectifies endocrine & metabolic functions & improves fertility rate. It is used as an insulin sensitizer

Ans. is A. i.e PCOD
The clinical and laboratory features of the patient described in the question match with those of PCOS.
CLINICAL FEATURES :

• Obesity: (BMI >30kg/m2) but PCOD can also occur in thin females.
• Insulin resistance-hyperinsulinemia
• Acanthosis nigricans
• Hyperandrogenemia
• Hirsutism
• Anovulation
• Menstrual Dysfunction
• Acne and alopecia.
• Sleep  apnea
• High-stress levels
• Skin  tags
• Infertility
• High  cholesterol and triglycerides
• Type II diabetes
• Pelvic pain
• Depression and anxiety

Ans.A.  PCOD

• PCOD is associated with HAIR-AN syndrome & Metabolic X syndrome.
• In HAIR-AN syndrome there is:-

1. HA-Hyperandrogenism
2. IR-Insulin resistance
3. AN-Acanthosis Nigricans

Ans. A. High FSH/LH
Because in PCOD there is increased LH: FSH

Ans is A, i.e LH
Stein Leventhal syndrome is also called ‘Polycystic Ovarian Syndrome’

Ans. is A, B, D, E i.e PCOD, Central obesity, Hyperinsulinemia, Stress

• Many patients with PCOS have features of metabolic syndrome such as visceral obesity, hyperinsulinemia, and insulin resistance.
• High blood pressure and low HDL levels are the features of metabolic syndrome.
• Chronic stress can contribute to metabolic syndrome.
• The key sign of metabolic syndrome is central obesity, also known as visceral, male-pattern or apple-shaped adiposity.