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29 Cards in this Set

  • Front
  • Back
hirsuitism vs virilization (Obj 1)
hirsuitism=terminal hair growth in a male pattern
*occurs gradually
*mild elevations in serum androgen

other signs of masculinization:
-clitoris enlargement
-temporal balding
-deepened voice
-incr musc mass

*more rapid progression
*high androgen levels
hair growth begins with what
proliferation of epi cells that are in contact with dermal papilla
what is resp for hair color
what is req for continued hair growth
intact dermal papilla
what causes permannet hair loss from the follicle
damage to the papilla
will injury to epi component of hair follicle produce hair loss?
will injury to dermal papilla cause hair loss?
yes, causes permanent hair loss from follicle
=fetal hair
short, fragile, lightly pigmented hair that easily falls out
vellus hair
thin, non-pigmented hair seen in pre-pubescent years
terminal hair
coarse, curly, pigmented hair that grows on various body parts after puberty (arms, legs)
what kind of hair is increased in hiruitism?
terminal hair
increased growth of LANUGO (hair) d/t malignancies and drugs (vs hirsuitism: terminal hair)
hair growth cycle
Hair Growth Cycle: 3
phases: "ACT!" (in chronological order)

1. "A"nagen ("A"ctive growth)
2. "C"atagen
3. "T"elogen (resting)
hair might appear to be shedding or falling out if...
large groups of follicles are in telogen (resting) phase
effects of androgen and est on hair growth
-androgens initiate harir growth adn incr diametere & pigmentation of hair
-est decr intiation and rate of growth
what is the most potent circulating androgen

(test=5-10x more potent than androstenedione & 20x more potent than DHEA)
what is the most abundant androgen produced
abudance: DHEA>androstenedione>tesst
1.test=most potent
test=5-10x more potent than androstenedione
test=20x more potent than DHEA

*women: 50% of circulating test derived from gladnular secretion equally produced by ovary and adrenal gland
*other 50% derived from extraglandular conversion of androstenedione-->test

==>women: 80% bound to SHBG (Sex Hormone Binding Globulin; INACTIVE), 19% bound to abumin; 1% free (ACTIVE)

==>thus, [SHBG] impacts action of circulating test; est incr [SHBG] & androgens decr [SHBG]. Thus, men have more free test than women.
androstenedione-produced by what?
produced in = amts by adrenal and ovary
DHEA: produced by what?
mostly (90%) adrenal
only 10% from ovary
serum level of what has strong correlation with hirsuitism
3a-AG (3-alpha-AG: metabolite of DHT)
MC presentation of hirsutism
irregular menstrual periods
idiopathic hirsuitism
increased hair growth (d/t high 3a-AG= DHT metabolite), but normal androgen levels and regular menstrual periods;
evaluation of Hirsute Pt (Obj 5)
1. First do H&P, including thorough pelvic exam
2. Then do TWO LABS:
1. If ↑test (>200 ng/ml)→ovarian or adrenal production
2. DHEA-S (derived mostly from adrenal gland), so...
-if DHEA-S greatly elevated (>700 ng/dl)==>suspect adrenal tumor, do CT or MRI
-if DHEA-S mildly elevated==>polycystic ovarian symdrome (chronic anovulation & elevated estrogen)

*if pelvic exam nl (Step 1)
and DHEA-S or test elevated to "tumor range" (Step 2)
==>do MRI or CT of adrenal

*do NOT get free test, LH, FSH, 3αAG, SHBG
if DHEA-S greatly elevated (>700 mg/dl)
==>suspect adrenal tumor,
do CT or MRI
if DHEA-S mildly elevated-
==>polycystic ovarian symdrome (chronic anovulation & elevated estrogen)
serum test>200 ng/dl
if DHEA-S or test elevated to "tumor range" and pelvic exam is nl
==>do MRI or CT of adrenal

("tumor range" for DHEA-S is >700 mg/dl;
for test is >200 ng/dl)
Tx Hirsutism
goal=decr activity of circulating androgens;
-must Tx for at least 6 months before clinical changes (hair growth) evident
-after 6 months==>medical Tx + electrolysis

1. birth control pills
*suppress LH==>ovary decr prod of testosteron
*estrogen in birth control==>incr SHBG
==>less free test
*decr DHEA-S

2. Spironolactone
*binds androgen receptor (antagonist)
*blocks test-->DHT