Androgen disorders

Question 1

What are the three types of androgens produced by the Ovaries?

Answer 1

DHEA, Androstenedione, Testosterone

Question 2

What is the main androgen produced by the adrenal glands?

Answer 2

DHEAS

Question 3

The ovary produces what androgen in the highest amount?

Answer 3

Androstenedione

Question 4

What percent of circulating testosterone is bound to SHBG?

Answer 4

80%

Question 5

PCOS affects what percent of women in the US?

Answer 5

5-10%

Question 6

What is the cardinal feature of PCOS?

Answer 6

Hyperandrogenism

Question 7

What are the 2 outcomes of hyperandrogenism in PCOS?

Answer 7

interference with follicular development, Decreases SHBG

Question 8

T/F: Insulin resistance is common in PCOS and leads to hyperinsulinemia

Answer 8

True

Question 9

What is the most current definition of PCOS?

Answer 9

Hyperandrogenism AND oilgo ovulation or polycystic ovaries

Question 10

What percent of women with PCOS have hirsutism?

Answer 10

65 - 75%

Question 11

Hair follicular growth are stimulated by what hormone?

Answer 11

DHT

Question 12

Testosterone is converted to DHT by what enzyme?

Answer 12

5 alpha reductase

Question 13

What is the term for rapid hair loss following delivery?

Answer 13

Telogen effluvium

Question 14

Why do women loose their hair following delivery?

Answer 14

All hair is in the resting teolgen phase during pregnancy

Question 15

If a patient has signs of virulization what conditions should you be worried about?

Answer 15

Adrenal hyperplasia, androgen producing tumors

Question 16

What percentage of testosterone is bound?

Answer 16

99%

Question 17

What percent of testosterone is bound by SHBG and what percent is bound by albumin?

Answer 17

80% bound by SHBG, 19% bound by albumin

Question 18

What percentage of women with PCOS have irregular menstrual cycles?

Answer 18

60 - 85%

Question 19

How do you verify ovulation?

Answer 19

Serum progesterone on day 20 -24 of menstrual cycle

Question 20

What level of serum progesterone signifies ovulation?

Answer 20

Progesterone > 3 ng/ml

Question 21

What is the definition of polycystic ovaries?

Answer 21

12 or more follicles measuring 2-9mm and/or ovarian volume > 10 ml

Question 22

What percentage of women with PCOS have polycystic ovaries?

Answer 22

> 80%

Question 23

What percentage of women WITHOUT PCOS have polycystic ovaries?

Answer 23

20 - 30%

Question 24

What is a cause of hirsutism in pregnancy?

Answer 24

Pregnancy luteoma

Question 25

If a patient has a luteoma, what is the possible outcome in the neonate?

Answer 25

female infants will be virilized

Question 26

In a patient with PCOS the LH/FSH ratio is often ____as ___ is elevated and ____ is normal

Answer 26

elevated as LH is often elevated and FSH is normal

Question 27

What percentage of women with PCOS are insulin resistant?

Answer 27

50 - 70%

Question 28

What labs should be ordered when evaluating a patient with PCOS?

Answer 28

Total testosterone, free testosterone, SHBG, DHEAS, progesterone, TSH, Prolactin, 17-OHP

Question 29

What is the first choice for ovulation induction in a patient with PCOS?

Answer 29

Letrozole

Question 30

What is the mechanism of letrozole?

Answer 30

Aromatase inhibitor

Question 31

How do OCPs improve Hirsutism?

Answer 31

Increase SHBG (estrogen), Inhibit 5 alpha reductase (progesterone) supress LH and ovarian steroidogenesis

Question 32

What does the estrogen do in OCPs to improve hirsutism?

Answer 32

Increases SHBG

Question 33

What does the progesterone do in OCPs to improve Hirsutism?

Answer 33

inhibit 5 alpha reductase

Question 34

How does spiranolactone treat hirsutism?

Answer 34

Inhibits androgen synthesis, inhibits 5 alpha reductase, competes for androgen receptor

Question 35

What is the mechanism spiranolactone?

Answer 35

aldosterone antagonist

Question 36

What are the side effects of spiranolactone?

Answer 36

AUB, hyperkalemia

Question 37

What is the mechanism of flutamide?

Answer 37

nonsteroidal antiandrogen

Question 38

What is the mechanism o Finasteride?

Answer 38

5 alpha reductase inhibitor

Question 39

How does eflornithine cream slow hair growth?

Answer 39

blocks ornithine decarboxylase

Question 40

True or False: Weight loss alone can lead to resumption of ovulation in patients with PCOS?

Answer 40

True

Question 41

What type of genetic inheritance is congenital adrenal hyperplasia?

Answer 41

Autosomal Recessive

Question 42

In CAH, Decreased production of ______, leads to increased ______ and high levels of adrenal androgens

Answer 42

Cortisol, ACTH

Question 43

What is the most common enzyme deficiency of CAH?

Answer 43

21 hydroxylase deficiency

Question 44

What steroid is increased in patients with 21 hydroxlase deficiency?

Answer 44

17 OHP

Question 45

21 Hydroxylase deficiency accounts for what percentage of CAH cases?

Answer 45

95%

Question 46

What are the classical findings in the neonate of 21 hydroxylase deficiency?

Answer 46

sexual ambiguity, virilization, salt wasting

Question 47

What are the classical findings of 11B Hydroxylase deficiency?

Answer 47

Virilization, Hypertension, volume overload.

Question 48

How do you diagnose CAH?

Answer 48

Oder 17 OHP

Question 49

In 11 B hydroxylase deficiency what androgen will be elevated?

Answer 49

11 deoxycortisol

Question 50

How do you differentiate between 21 hydroxylase and 11 B hydroxylase deficiency?

Answer 50

Order 11 deoxycortisol

Question 51

What is the mainstay of treatment of CAH?

Answer 51

Give cortisol and aldosterone

Question 52

What medications and dosing do you use to treat CAH?

Answer 52

Hydrocortisone 10 mg/day, fluorohydrocortisone 100 mg/day

Question 53

How do you diagnose CAH prenatally?

Answer 53

CVS to detect mutations

Question 54

T/F: 17 OHP and androstendione are detectable in amniotic fluid

Answer 54

True

Question 55

When should you initiate treatment with dexamethasone during pregnancy for fetuses at high risk?

Answer 55

4-5 weeks gestation

Question 56

What is the difference between classical and non classical CAH?

Answer 56

Presentation of nonclassical CAH is at puberty or later.

Question 57

What is the treatment for nonclassical CAH?

Answer 57

Dexamethasone 0.25 mg nightly

Question 58

What labs are included in the initial evaluation of a patient with hirsutism?

Answer 58

Total testosterone, SHBG, DHEAS, 17 OHP