Hirsutism & Virilism Flashcards Preview

OB/GYN > Hirsutism & Virilism > Flashcards

Flashcards in Hirsutism & Virilism Deck (26)
Loading flashcards...
1
Q

what are the 2 types of hair that adults have?

A

vellus - non-pig’d, soft, covers entire body

terminal = pig’d, covers scalp, axilla, pubic area. Androgens stim th econversion of vellous to terminal hair.

2
Q

what is an abnormal increase in terminal hair due to?

A

androgen excess, or increased 5alpha-reductase activity

3
Q

what does 5alpha reductase do?

A

converts TS to DHT (more potent)

4
Q

what is hirsutism?

A

increase in terminal hair on face, chest, back, lower abdomen, inner thighs in a woman

5
Q

what is escutcheon?

A

shape of patch of pubic hair - diamond in a male, triangle in female

6
Q

what is virilization?

A

dvpt of male features - voice deepening, frontal balding, increased m. mass, clitoromegaly, breast atrophy, male body habitus

7
Q

what enzyme is present in z. glomerulosa but lacking in z. reticularis and z. fasciculata?

A

aldosterone synthase

8
Q

what enzyme does the z. glomerulosa lack?

A

17-alpha-hydroxylase (can’t make cort & androgen)

9
Q

elevations and def’ies of which hrms can cause excess androgens?

A

elevated ACTH

enzymatic blockade of either cort or aldo syn (stuff gets shunted towards DHEAS syn pathway)

10
Q

what are the 2 categories of adrenal disorders that can cause virilization?

A

neoplastic (more often cause virilization)

non-neoplastic (rarely causes virilization)

11
Q

what are the adrenal disorders that cause virilization?

A

cushing

CAH

12
Q

how to make dx of Cushings?

A

overnight DXM suppression test - give DXM at night, then measure cort levels in a.m. Should be low in a normal pt. But if > 10microg/dL, dx of Cushings is made.

Check 24-h urine free cortisol

13
Q

what is most common form of CAH?

A

21-alpha hydroxylase def’y

14
Q

CP of CAH?

A

salt wasting (due to lack of aldo)
adrenal insuff’y
ambiguous genitalia at birth (due to excess androgens)

15
Q

CP of “adult-onset” CAH?

A

mild virilization, menstrual irregularities

16
Q

what labs should be checked when you suspect CAH?

A

17-alpha-hydroxyprogesterone (if elevated, suggests 21-alpha hydroxylase def’y)

17
Q

what are the non-neoplastic ovarian disorders that can cause virilization?

A

PCOS
Theca Lutein cysts
stromal hyperplasia & hyperthecosis

18
Q

why does androgen excess occur in PCOS?

A

excess LH => many ovarian cysts, increased ovarian androgen production

19
Q

what is a theca lutein cyst?

A

theca cells that produce excess androgens that are sec’d into circl’n instead of shunting them to the granulosa cells for aromatization to estrone & estradiol

20
Q

what is stromal hyperthecosis?

A

hyperplasia of stroma with foci of androgen production

21
Q

what’s the diff b/w functional and non-functional ovarian tumors?

A

fct’l tumors produce androgens, nonfct’l ones do not.

22
Q

what are the functional ovarian tumors?

A
Sertoli-Leydig cell tumors
granulosa-theca cell tumors
hilar (Leydig) cell tumors
germ cell tumors (gonadoblastomas)
luteoma (during pg'y only)
23
Q

how do non-fct’l tumors cause virilization?

A

the stimulate the surrounding stroma => increased androgens

24
Q

what labs should be ordered in w/u of hirsutism/virilization?

A

free TS
17-OHP
DHEAS

25
Q

what does rapid-onset virilization & TS > 200 ng/dL suggest?

A

ovarian ca

26
Q

tx of ovarian causes of hirsutism?

A
prednisone (suppresses androgen production)
finasteride
spironolactone
surgery if tumor
OCPs, minipill