Documente Academic
Documente Profesional
Documente Cultură
Fall 2009
WHAT IS PCOS?
Polycystic ovaries:
Defined by the presence of at least eight small (2 to
8 mm) follicles (cysts) in each ovary with ovarian
enlargement
WHAT IS PCOS?
Typical symptoms include any of the
following:
Polycystic ovaries Obesity
Oligo- or amenorrhea Dyslipidemia
Anovulatory infertility Metabolic syndrome
Hirsutism Insulin resistance
Male pattern baldness Type 2 diabetes
Acanthosis nigricans Sleep apnea
Acne Fatty liver
PHYSICAL SYMPTOMS
acanthosis
nigricans
hirsutism
polycystic ovaries
HOW IS PCOS DIAGNOSED?
Gracie Moore
Race/Sex: white female
Age: 34 years
Testosterone Level
Affected by:
5 alpha-reductase enzyme at vellus
Hair follicles and sebaceous gland
promotes acne and terminal hair
Clearance rate increase with production rate
Any elevation indicates excess androgen production
Free testosterone measured by available Sex Hormone
Binding Globulin (SHBG)
Normal/unit 6 yrs ago 4 yrs ago 2 yrs ago present
Testosterone 20-76 mg/dL 56 75 87 H 25
LAB VALUES
<200 149
<200 134
<200 116
MEDICATIONS
Yaz (Drospirenone and Ethinyl estradiol)
Oral contraceptive
Suppresses the pituitary's production of LH, FSH
Suppresses the ovarian production of androstenedione
Is an androgen
Estrogen in birth control increases testosterone binding
protein in the blood stream
Less available testosterone to be converted to dihydrotestosterone
by 5 alpha-reductase enzyme
Reduces hirsutism
Regulates menstrual cycle
Increase serum K
Should limit dietary intake
MEDICATIONS
Glucophage (Metformin)
Increases insulin sensitivity
Hyperinsulinemia increases free testosterone
Reduces ovarian androgen production
Decreases hepatic glucose production
Reduces insulin secretion
Decreases conversion of testosterone to
dihydrotestosterone
Reduces hirsutism and acne
Nutritional concerns
B12 absorption, adequate fluid intake, monitor lactic acidosis,
GI upset
MEDICATIONS
Aldactone
Diuretic used to treat hypertension
Excretion of sodium relaxes blood vessels
Most widely prescribed anti-androgen in the United States
At high doses Aldactone blocks cytochrome P-450 system
Reduces capacity of the ovary and adrenal glands to make
androgens
Alters the conversion of testosterone to dihydrotestosterone (DHT)
by 5 alpha-reductase
K sparing diuretic
Increases serum K
Limit dietary intake
MEDICATIONS
Vaniqa (Eflornithine)
Does not inhibit the production or action of androgens
Interferes with 5 alpha-reductase enzyme
Reduces terminal hair formation
Topical cream used twice daily
No nutritional implications
GRACIE’S ENERGY NEEDS
Diet Coke™ 12 oz 0 0 0 0
42% Fat
4,255 mg Na