NURS 6501 Knowledge Check: Neurological and Musculoskeletal Disorders

NURS 6501 Knowledge Check: Neurological and Musculoskeletal Disorders

 

A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 12 years of age. She began to develop dark, coarse facial hair when she was 14 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted.  Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management.

 

Question 2 of 2:

 

How does PCOS affect a woman’s fertility or infertility? 
Selected Answer: The main cause of infertility in women with PCOS are problems in ovulation. Ovulation may be hindered by increased production of testosterone or failure of ovarian follicles to mature. When hormones fail to balance, an individual may experience irregular ovulation and menstruation. Since the main characteristic feature in the pathology of PCOS is a hyperandrogenic state, in excess, androgens   affect the growth of follicles while insulin suppresses apoptosis which declines follicular growth. There are also dysfunctions that occur in the development of ovarian follicles. In other instances, inappropriate secretion of gonadotropin triggers the start of a vicious cycle which perpetuates anovulation.
Correct Answer: Ovulation problems are usually the primary cause of infertility in women with PCOS. Ovulation may not occur due to an increase in testosterone production or because follicles on the ovaries do not mature. Due to unbalanced hormones, ovulation and menstruation can be irregular. A hyperandrogenic state is a cardinal feature in the pathogenesis of PCOS. Excessive androgens affect follicular growth, and insulin affects follicular decline by suppressing apoptosis and enabling follicle to persist. There is dysfunction in ovarian follicle development. Inappropriate gonadotropin secretion triggers the beginning of a vicious cycle that perpetuates anovulation.
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