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8 Cards in this Set
- Front
- Back
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15 yr old with regular menstrual cycles, increasing hair growth on face & chest. An adrenal etiology is suspected. Elevation of what hormone would confirm the dx?
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DHEAS (Dihydroepiandosterone sulfate)
adrenal gland is the only source of DHEAS - the ovary does not produce it, therefore an elevation in this hormone indicates an adrenal etiology |
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15 yr old girl, amenorrhea, overweight, excess hair on chin and upper lip. Physician orders a hormone profile, recommends diet and exercise changes and begins her on oral contraceptives. 6 months later she has lost 12lbs and has decreased hair on her face. Compared to the first hormone profile, the second would show:
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elevated SHBG & decreased free testosterone
*androgens, obesity and hypOthyroidism all decrease the synthesis of SHBG *estrogen increased the synthesis of SHBG |
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21 yr old is seen for progressive increase in hair growth and acne Her periods are regular. There are no weight changes. Lab testing demonstrates a low normal cortisol, elevated DHEAS, high normal testosterone. She has a normal LH:FSH ratio. The most likely dx is?
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Congenital Adrenal Hyperplasia
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15 yr old female has increased acne, hirsuitism, and clitoromegaly that developed over the last 4 months. She has been using a special cream she found in her father's cabinet. She has increased DHEA levels and mildly increased DHEAS and testosterone levels. Cortisol level is normal and her LH:FSH ratio is normal. Imaging studies show no adrenal or ovarian masses. What is the most likely dx? (hint: her father is a professional baseball player)
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exogenous steroid use
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15 yr old female was seen for amenorrhea of 3 months duration, a 20lb weight gain and increasing facial hair over the past year. On exam she has acne and facial hair on her upper lip. Her T level is at the upper limits of normal. She has a normal FSH but an elevated LH. Her DHEAS and 17-OH progesterone are normal. Most likely dx?
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Polycystic ovary syndrome
the normal DHEAS and normal 17-OH progesterone, with an elevated LH:FSH ratio is characteristic also, slow onset is a clue |
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First line therapy for polycystic ovary syndrome?
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oral contraceptive pills
these will increase the sex hormone binding globulin (SHBG) that will bind the excess androgens. It will also help regulate the menstrual cycle. |
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Second line therapy for polycystic ovary syndome?
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spironolactone.
works to reduce the effects of androgen by inhibiting androgen binding sites, inhibiting the production of testosterone and by blocking the conversion of testosterone to DHT. |
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You notice a thickening of the skin on the back of a patient with polycystic ovary syndrome, and suspect acanthosis nigricans. You obtain a fasting insulin & glucose. What would you expect to find?
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normal glucose but an elevated insulin
- often PCOS pts are insulin resistant - have normal glucose levels but elevated insulin levels. - in some cases insulin resistance can be treated with metformin or rosiglitazone |
