Hyperandrogenism and PCOS

Question 1

glandular source of androgen

Answer 1

ovaries

adreanal glands

Question 2

non glandular source of androgen

Answer 2

not necessarily produce but convert:
Skin
Fat celss

Question 3

Main form of androgen and their site of production:

Ovaries

Answer 3

testosterone

Question 4

Main form of androgen and their site of production:

adrenals

Answer 4

DHEAS

Question 5

Main form of androgen and their site of production:

peripheral tissues

Answer 5

3a diol G

Question 6

differentiate Bilogically inactive form vs biologically active form of testosterone

Answer 6

Bio inactive - bound to SHBG

Bio active - free/ bound to albumin

Question 7

among the types of testosterone w/c one is used to assess hyperandrogenism

Answer 7

Bio active form

Question 8

potent form of testosterone that causes effects to the target tissues

Answer 8

3 a diol G

Question 9

occurs in women where there is increase in androgen lvls or excess

Answer 9

hyperandrogenism

Question 10

manifestations of hyperandrogenism

Answer 10

hirsutism
alopecia
acne
voice deepening
amenorrhea

Question 11

abnormalities in the sebaceous component would lead to

Answer 11

acne

Question 12

abnormalities in the piliary component would lead to

Answer 12

hirsutism (excessive growth)

alopecia (excessive shedding)

Question 13

3 phases of hair growth

Answer 13

anagen
catagen
telogen

Question 14

treatment for hirsutism

Answer 14

oral contraceptives
progestins
GnRH agonist
Ketoconazole
spironolactone (anti-estrogen)

Question 15

increased amt of body hair in its normal location

Answer 15

hypertrichosis

Question 16

differentiate virilization from hirsutism in terms of testosterone lvls

Answer 16

hirustism - testosterone is mildly increased (<1.5)

viriliztion >2ng/ml

Question 17

most common cause of hyperandrogenism

Answer 17

androgenic medications

Question 18

examples of androgenic medications

Answer 18

testosterone
anabolic steroids
danazol
19-norprogestogens

Question 19

abnormal gonadal development can be attributed to a defect in the

Answer 19

Y chromosome (whole or part)

Question 20

solid ovarian tumor, usually unilateral that causes hyperandrogenism

Answer 20

luteoma

Question 21

cystic tumor usually bilateral that causes hyperandrogenism

Answer 21

hyperreactio luteinalis

Question 22

px 37 wk AOG undergo CS. solid ovarian luteoma was seen intraop. what will you do?

Answer 22

If unruptured, do not remove, it will usually regress to normal

Question 23

the main problem in idiopathic hirsutism

Answer 23

increased 5 a reductase thereby increasing androgen production

Question 24

histollogy of the ovary shows nest of luteinized theca cells scattered throughout the stroma

Answer 24

stromal hyperthecosis

Question 25

mgt for stromal hyperthecosis

Answer 25

TAHBSO

Question 26

ovarian tumor of reproductive age

Answer 26

sertoli-leydig cell tumors

Question 27

ovarian neoplasm commonly on postmenopauseal

Answer 27

hilus cell tumors

Question 28

most common adrenal neoplasm

Answer 28

adrenal carcinoma

Question 29

forms of late onset 21 hydroxylase deficiency

Answer 29

CAH | LOHD

Question 30

most common cause of sexual ambiguity

Answer 30

CAH

Question 31

symptoms of LOHD

Answer 31

post pubertal oligomenorrhea/amenorrhea prepubertal accelerated growth familial tendency

Question 32

diagnosis of LOHD

Answer 32

17-hydroxyprogesterone lvl >8ng/L | ACTH stimulation test above normal but <8ng/L

Question 33

treatment for LOHD

Answer 33

corticosteroids | OCP

Question 34

CAH is deficient with these enzymes

Answer 34

21-hydroxylase | 11B hydroxylase

Question 35

excessive cortisol production from adrenal neoplasm or excessive ACTH production from a pituitary tumor

Answer 35

Cushing's disease

Question 36

diagnosis for cushing's

Answer 36

``` dexamethasone suppresion test Liddle's test plasma ACTH 24 hr urinary cortisol late night salivary cortisol ```

Question 37

treatment for cushing's

Answer 37

OCP ( cyproterone acetate) | anti-androgens (spironolactone, flutamide and finasteride)

Question 38

most common endocinopathy in women

Answer 38

PCOS

Question 39

triad of PCOS

Answer 39

oligo and/or anovulation/menstrual irregularty clinical and/or biochem signs of hyperandrogenism PCOS on UTZ

Question 40

UTZ findings in PCOS

Answer 40

10 or more peripherally oriented cystic structures showing as black pearl necklace

Question 41

increase in LH will increase androstenedione, more peripheral conversion into estrogen form (estrone) by

Answer 41

aromatase

Question 42

type of CA that will put px with elevated LH at risk

Answer 42

endometrial cancer

Question 43

how can decreased SHBG lead to anovulation and hirsutism

Answer 43

dec SHB means increase in free testosterone leading to atresia of follicles leading to anovulation and hirsutism

Question 44

consequences of PCOS

Answer 44

``` infertility endomet CA ovarian CA DM HPN and CVD metabolic syndrome (high chol and trigly lvl) ```

Question 45

best approach to improve peripheral insulin sensitivity

Answer 45

metformin (insulin sensitizing agent)

Question 46

drugs for induction of ovulation

Answer 46

``` clomiphene citrate aromatase inhibitors (letrozole and anastrazole) injectable gonadotropin ```

Question 47

px with pcos given Clomiphene citrate but ineffective. what is the 2nd line treatment?

Answer 47

aromatase inhibitors (letrozole and anastrazole)

Question 48

what would u give to px with pcos who do not want to get pregnant but want to menstruate

Answer 48

medroxyprogesterone acetate | norethindorne

Question 49

these drugs suppresses ovarian steroidogenesis and is usesd to improve signs of hirsutism and lipid profile

Answer 49

Estrogen-progestin OCP

Question 50

last option for the treatment of metabolic and weight concerns in px with pcos

Answer 50

bariatric surgery