Metabolic Syndrome In Polycystic Ovarian Syndrome Patients Presented By: Brittany Atkins

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<ul><li> Slide 1 </li> <li> Metabolic Syndrome In Polycystic Ovarian Syndrome Patients Presented By: Brittany Atkins </li> <li> Slide 2 </li> <li> 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 </li> <li> Slide 3 </li> <li> 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 </li> <li> Slide 4 </li> <li> Pathophysiology of PCOS Post Receptor Defect Insulin Resistance </li> <li> Slide 5 </li> <li> Pathophysiology of PCOS Suggestion of the presence of a hypothalamic defect Elevated LH levels Hyperandrogenism Anovulation </li> <li> Slide 6 </li> <li> 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 </li> <li> Slide 7 </li> <li> How PCOS May Present in Patients Clinical Features: Acanthosis Nigricans Acne Alopecia Amenorrhea, oligomenorrhea, or dysfunctional uterine bleeding Anovulatory infertility Central Obesity Hirsutism </li> <li> Slide 8 </li> <li> How PCOS May Present in Patients </li> <li> Slide 9 </li> <li> Other: Ultrasonographic evidence of polycystic ovaries </li> <li> Slide 10 </li> <li> 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 </li> <li> Metabolic Syndrome NCEP ATP III HypertensionCurrent antihypertensive therapy and/or BP&gt;130/85mmHg DyslipidemiaPlasma Triglyceride level &gt;150mg/dl and/or HDL level 88cm GlucoseFasting Blood Glucose level &gt;110mg/dl Requirements for DiagnosisAny 3 of the above disorders </li> <li> Slide 13 </li> <li> Important! Recognize that PCOS patients are at a high risk for developing metabolic syndrome Take measures to delay or arrest metabolic sequelae </li> <li> Slide 14 </li> <li> Cardiovascular Disease PCOS patients have a 7-fold increased risk for a myocardial infarction PCOS patients have lowered HDL levels and increased LDL levels </li> <li> Slide 15 </li> <li> 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 </li> <li> Slide 16 </li> <li> 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 </li> <li> Slide 17 </li> <li> Current Treatments Lifestyle Modification Physical exercise Altered dietary composition Weight Loss Low fat Low Carbohydrate </li> <li> Slide 18 </li> <li> Current Treatments Insulin Sensitizing Agent Biguanide (metformin) Thiazolidinediones (Troglitazone, pioglitazone, rosiglitazone) Weight Loss Medications Phentermine Sibutramine and Orlistat </li> <li> Slide 19 </li> <li> 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 </li> <li> Slide 20 </li> <li> 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. </li> <li> Slide 21 </li> <li> 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) </li> </ul>