1. A patient has just had a pelvic ultrasound which showed bilateral polycystic ovaries however has normal menstrual cycles and androgen levels. Your patient asks, “so does this mean I have PCOS?” How would you respond to your patient.
a. Since your ultrasound shows us cysts on your ovaries, we would diagnose you with polycystic ovarian syndrome (PCOS).
b. Women who are postmenopausal can only have PCOS.
c. In order to be diagnosed with PCOS, you would need to have irregular menstrual cycles and/or elevated androgen levels along with cysts on your ovaries.
d. You must have low androgen levels to be diagnosed with PCOS.
2. Polycystic Ovarian Syndrome is the prominent cause of _____ for women in the US.
a. Obesity
b. Dyslipidemia
c. Insulin Resistance
d. Infertility
3. When assessing a patient’s serum hormone levels, what would be consistent with PCOS?
a. Decreased testosterone and decreased estrogen
b. Increased testosterone and LH, decreased FSH
c. Decreased testosterone and decreased prolactin
d. Decreased LH and Increased FSH
4. Clinical Manifestations of PCOS include the following (select all that apply):
a. None of the above.
b. Facial Hair (Hirsutism)
c. Acne
d. Weight Loss
e. Amenorrhea or Irregular Menses
5. Your patient with polycystic ovarian syndrome has asked if her weight gain of 25 pounds will affect her PCOS symptoms. How do you respond?
a. Weight gain usually exacerbates symptoms of PCOS so we encourage our patients with this diagnosis to exercise and maintain a balanced diet.
b. Your weight will not affect your PCOS symptoms.
c. PCOS patients tend to have weight loss, not weight gain.
d. None of the above.
Quiz Answer Key
- c
- d
- b
- b, c, and e
- a
Rationale for answers:
1. According to Huether and McCance (2014), the diagnosis of polycystic ovarian syndrome (PCOS) requires a patient to have at least two of these components: inconsistent ovulation time, increased androgen levels, and cysts present on the ovaries which would be seen on an ultrasound image. If a patient is found to have cysts on her ovaries but does not have any other components, they would not be diagnosed with PCOS (p. 764). PCOS will affect women both prior to and after menopause. Women with PCOS will have an increased level of androgens, not decreased.
2. As stated by McCance and Huether (2014), “PCOS remains one of the most common endocrine disturbances affecting women, especially young women, and is the leading cause of infertility in the United States, where prevalence rates are estimated at between 5%-15% of women” (p. 764). PCOS is associated with altered lipid levels, resistance to insulin, and obesity, however the syndrome is not the leading cause of these diagnoses.
3. In patients with PCOS, an elevated testosterone level would be present since this hormone is categorized as an androgen and as mentioned, an increase in androgens is one of the key features of PCOS. Estrogen elevation is also present in these patients. The cause for this is due to high levels of androgens, which converts to estrogen in the peripheral tissue, and a decrease in the Sex Hormone Binding Globulin (SHGB) leading to free estradiol (McCance & Huether, 2014). Because of this information, you would not see a decreased testosterone or estrogen level. The increase in estrogen also will cause a decrease in FSH, not an increase. McCance and Huether (2014) states, “elevated estrogen levels trigger a positive-feedback response in LH and negative feedback response in FSH” (p. 765). Luteinizing hormone (LH), which is affected by the increase in Gonadotropin Releasing Hormone (GnRH), is also elevated (McCance & Huether, 2014). So a decrease in LH is not expected with PCOS. Finally, you would expect your patient to have a normal prolactin level. A patient with an increase or decrease in prolactin may be associated with a differential diagnosis, hyperprolactinemia or hypoprolactinemia.
4. A patient with PCOS would clinically exhibit amenorrhea or irregular periods, acne, and male pattern hair growth. Weight gain in women with PCOS is common and may make their symptoms worse (McCance & Huether, 2014, p. 765). Weight loss will help alleviate some of the symptoms associated with the syndrome.
5. As explained in the pathophysiology section, women with PCOS are known to have insulin resistance. The body’s cells are unable to use the hormone insulin to metabolize glucose and when there is an excess amount of glucose in the body, it is stored in the body as fat. If a patient begins to lose weight the symptoms can start to improve which is why exercise and a healthy diet is encouraged. Weight is shown to have a direct correlation with the symptoms in PCOS. (McCance & Huether, 2014, p. 765).