Shailaja Nair
Drexel University College of Medicine, USA
Posters-Accepted Abstracts: Endocrinol Metab Syndr
PCOS is the most common cause of anovulatory infertility in females. It is a syndrome complex comprising of ovarian hyperandrogenism and hyper-insulinemia. Most patients have biochemical and clinical signs and symptoms of hyper-androgenemia with acne, hirsutism and alopecia. Patients also have anovulatory and irregular cycles and some have polycystic ovaries. Hyperinsulinemia may manifest as obesity, difficulty losing weight, pre-diabetes or Type-2 diabetes mellitus. The pathophysiology is multi factorial but is related to insulin resistance in many cases. Hyper-insulinemia causes disordered release of gonadotropins from the pituitary glands with high levels of Luteinizing Hormone. There is also increased secretion of estrogen from the ovaries, which is converted to testosterone causing the hyper-androgenic symptoms. The complication of PCOS encompasses a wide range of metabolic disorders including pre-diabetes, metabolic syndrome and Type-2 diabetes mellitus, in addition to infertility and irregular cycles. Patients with PCOS are also at higher risk of developing endometrial hyperplasia and possibly endometrial cancer due to the unopposed action of estrogen on the endometrium. Studies have also shown a link between PCOS and Obstructive Sleep Apnea, NASH and cardiovascular disease. In the past, patients were treated with oral contraceptives to suppress the hypothalamic-pituitaryovarian axis. This usually helps with the temporary relief of hyper-androgenemic symptoms, but does not treat the underlying insulin resistance. We use insulin sensitizers to treat our PCOS patients. The first line is still metformin for our insulin resistant patients, as this is safe to use in pregnancy and is known to help prevent early trimester pregnancy loss. We have had success in using newer insulin sensitizers as well, especially Glucagon-Like Peptide-1 receptor agonists like exenatide, liraglutide and dulaglutide.
Email: Shailaja.Nair@DrexelMed.edu
