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22 Cards in this Set
- Front
- Back
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What kind of onset and progression does hirsutism have?
What about virilization? |
gradual onset, slow progression
rapid onset, rapid progression |
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What is the first sign of true virilization?
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clitoromegaly
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The major androgens in the female are, in order of serum concentrations:
-... (more readily measurable) -... -... -... -... (most potent androgen) |
Dehydroepiandrosterone sulfate (DHEA-S)
Dehydroepiandrosterone (DHEA) Androstenedione (A) Testosterone (T) Dihydrotestosterone (DHT) |
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If you have elevated DHEAS, it will most likely come from the ...
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adrenal glands
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If you have elevated testosterone, it will most likely come from the ...
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ovaries
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The most common cause of hirsutism:
Idiopathic/constitutional/peripheral/ familial (esp. Mediterranean descent). -Circulating androgen levels are _______. -Abnormally high androgen metabolism at the level of the hair follicle. -Increased ... activity. -DHT ... testosterone in adrogenic potency. |
normal
5α-reductase >> |
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What is the most common pathologic cause of hirsutism?
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Polycystic ovarian syndrome (PCOS). It’s also the most common female endocrinopathy
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Insulin resistance results in elevated insulin levels that appear to cause:
-Increase ovarian production of ____________ . -Decreased hepatic synthesis of __________resulting in increased free testosterone. |
androgens
sex hormone binding globulin (SHBG) |
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Hyperandrogenism acting at the level of the hair follicle is responsible for the __________ seen in patients with PCOs.
Hyperandrogenism acting at the level of the ovary may play a role in arresting follicular development leading to ___________________. |
hirsutism
chronic anovulation |
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In pts w/ PCOS, estrogen levels are ..., LH levels are ..., and FSH levels are ... than women without PCOS, and the estrone:estradiol ratio is ... in pts w/ PCOS. (there is less of the metabolically active ..., but total is not lowered)
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higher
higher lower elevated estradiol |
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What are 3 risk factors for PCOS?
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obesity, hx of premature adrenarche, and family hx of PCOS
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Laboratory Studies:
-Experts argue for and against labs. -...: screening for non-classical congenital adrenal hyperplasia; probably the single most appropriate lab. -... : screening for androgen-secreting tumor (adrenal, ovary); probably not necessary unless virilization present. -... : may miss the classic elevated LH:FSH ratio due to pulsatile secretion; not terribly useful and probably unnecessary. -... : Screen for Cushing’s. |
17-hydroxyprogesterone
T and DHEA-S LH/FSH 24 hr urinary free cortisol |
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look at slide 25
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ok
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Treatment of Hirsutism:
What are 2 anti-androgen options? What is a 5-alpha reductase inhibitor option? Will this help halt the progression of hirsutism? Will it transform terminal hair follicles back into vellous follicles? |
spironolactone and flutamide
Finasteride yes no |
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Tx of infertility:
... ± ... is first line treatment. -In PCOS patients, the high estrogen levels prevent adequate ... secretion for mature follicle development. -... blocks the E receptors and removes the negative feedback and allows FSH secretion to increase which can then lead to follicular maturation and ovulation. |
Clomiphene citrate
metformin FSH Clomiphene |
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What is the preferred DM screening test in women w/ PCOS?
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2-hour OGTT
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risks of untreated PCOS:
Chronic anovulation > lack of ovarian progesterone production > unopposed endogenous estrogen > endometrial hyperplasia > ______________________. HTN, DM (insulin resistance), hypercholesterolemia, obesity > ______________________________. |
endometrial cancer
coronary artery disease |
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...:
-Severe form of PCOS with potential virilization. ...: -HyperAndrogenism, Insulin Resistance, & Acanthosis Nigrans. |
Hyperthecosis
HAIR-AN Syndrome |
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evaluation when virilization is present:
-Think ... until proven otherwise. -Check testosterone, DHEAS, and 17-OHP levels. -Elevated T or DHEAS levels – think ... or ... tumor > image the ... (US) and the ... (CT). |
androgen-secreting tumor
ovarian or adrenal ovaries adrenal glands |
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Androgen-Secreting Tumors:
Ovary: -... (MC. Leads to increased T) -Gynandroblastoma. -Lipid cell tumors. -Hilus cell tumors. Adrenal: -Adrenal .... Treatment for all is ... . |
Sertoli-Leydig Cell Tumors
adenomas surgical removal |
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Elevated 17-OHP levels are indicative of non-classic adrenal hyperplasia due to ... deficiency
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21-hydroxylase
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Congenital Adrenal Hyperplasia:
-Severe “classic” form causes virilization of female newborn > congenital ambiguous genitalia. -Mild “non-classic” form results in hirsutism and/or virilization in puberty or adulthood. -... deficiency is most common form; diagnosed by elevated ... levels. -... deficiency is rare form; diagnosed by elevated ... levels. Tx is ... supplementation (...) |
21-hydroxylase
17-OHP 11β-hydroxylase desoxycorticosterone corticosteroid prednisone |
