Hirsutism

Question 1

MC androgen formed by ovary

Answer 1

Androstenedione

Question 2

Androgen exclusively formed by adrenals

Answer 2

DHEA - S

Question 3

Sources of Testosterone in females

Answer 3

Androstenedione > Adrenals > Ovary

Question 4

2nd most potent androgen

Answer 4

Testosterone

Question 5

Most potent Androgen

Answer 5

DHT

Question 6

End product of testosterone

Answer 6

Oxysteroid

Question 7

Testosterone binds to

Answer 7

SHBG and albumin

Question 8

SHBG is inc by

Answer 8

Estrogen

Question 9

SHBG is dec by

Answer 9

A I P G C

Androgens, Insulin, Progestin, GH, Cortisol

Question 10

HIrsutism

Answer 10

Excessive growth of male pattern sexual hair.

Question 11

Scoring criteria for Hirsutism

Answer 11

Ferriman Gallwey or Modified Ferriman gallwey

Question 12

Ferriman Gallwey scoring

Answer 12

Hirsutism
11 sites
0-4 at each site

Question 13

Modified Ferriman Gallwey

Answer 13

Hirsutism 
9 sites 
0-4 @ each site
Total score - > or = 8 Mild hirsutism 
> or = 15 severe hirsutism

Question 14

Modified Ferriman Gallwey score greater than 8

Answer 14

MIld Hirsutism

Question 15

Modified Ferriman Gallwey score greater than 15

Answer 15

Severe Hirsutism

Question 16

Virilisation.

Answer 16

Entire spectrum of changes in a female exposed to Androgens.
Hirsutism.
Breast atrophy.
Deep voice
Inc Muscle mass.
Clitoromegaly.
Prader score

Question 17

Scoring system for Virilisation.

Answer 17

Prader scoring.
0 = female
5 = Virilization present .

Question 18

Hypertrichosis

Answer 18

Excessive growth of non sexual hair

Question 19

Work up in a patient of Hirsutism

Answer 19

Step 1 - Androgen levels.
If normal - Idiopathic hirsutism
IF elevated - Check Testosterone levels -
Step 2 - testosterone levels - Normal level = 20 - 80
IF raised + Inc 17 OH progesterone levels - Late onset CAH
IF >200 - PCOS - Rotterdam criteria
IF >200 - sign of virilization and Ovarian mass
indicates Androgen producing tumor of ovary
Step 3 - IF DHEA and DHEA- S are elevated
Androgen secreting adrenal tumors

Question 20

Mx of Hirsutism

Answer 20

DOC - OCP for 6 months
Dec free testosterone level and also androgen levels
3 or 4th gen Progesterone to be used - Diane 35 or Yasmin
If no improvement for 6 months
shift to Anti androgenic drugs
failure of that Continuous GnRH

Question 21

Drug not to be given in Hirsutism

Answer 21

Danazol

Question 22

Why is Danazol not given in hirsutism

Answer 22

S/E is Hirsutism

Question 23

DOC in Menopausal women with hirsutism

Answer 23

Eflornithine cream