PCOS hirsutism

Question 1

2 ways to Dx Cushing’s

Answer 1

Dexamethasone suppression test; 24 hour urine for free cortisol

Question 1

What is used as a marker for androgen excess from the adrenal gland?

Answer 1

DHEAS

Question 1

4 causes of hirsutism

Answer 1

Ovarian and Adrenal tumors, PCOS, Cushing’s (because SHBG is lowered) and CAH

Question 2

How do you diagnose 21 hydroxylase deficiency?

Answer 2

17-OH-Progesterone (17-OHP) test

Question 3

How do you treat ovarian non-neoplastic causes of hirsutism?

Answer 3

Oral contraceptives, Anti-estrogens, and GnRH agonists

Question 3

How do you treat adrenal non-neoplastic causes of hirsutism?

Answer 3

Glucocorticoids and spironolactone

Question 4

How do you diagnose 11-B hydroxylase deficiency?

Answer 4

elevated 11-deoxycortisol

Question 4

Though the spectrum for PCOS is broad, what is a common Sx that most women have?

Answer 4

anovulation

Question 6

Under the control of _________ the adrenal gland can do these 3 things with cholesterol

Answer 6

ACTH; convert to aldosterone, cortisol, or weak androgens

Question 7

What is significant about the treatment of acanthosis nigricans vs. many other hyperpigmentation disorders?

Answer 7

it will regress with treatment, most other disorders of pigmentation will not

Question 8

In which direction would a LH:FSH ratio have to shift for virilization to occur?

Answer 8

increase in LH with respect to FSH (normally it is 1:2), this is because there will be more testosterone than can be aromatized to estrogen

Question 8

What does a RAPID onset virilization and elevated test (greater than 200) suggest?

Answer 8

ovarian neoplasm

Question 9

How do you treat PCOS if fertility is not desired?

Answer 9

oral contraceptives and progestins

Question 11

How are the effects of an adrenal carcinoma different than an adenoma?

Answer 11

Adenomas really only tend to cause glucocorticoid excess; carcinomas tend to increase all 3 pathways of the adrenal gland

Question 13

What kind of adrenal gland tumor is most likely to cause virilization?

Answer 13

carcinoma more so than adenoma

Question 14

How do you treat neoplastic causes of hirsutism?

Answer 14

surgery

Question 16

What type of hair is increased in hirsuitism?

Answer 16

terminal hair on face, chest, back, lower abdomen (escutcheon), and inner thighs of a woman

Question 16

What do elevated androgens usually lead to?

Answer 16

hirsuitism or virilism

Question 17

Why would excess corticosteroids cause excess serum free testosterone?

Answer 17

because they decrease SHBG

Question 18

What are the 2 major clinical markers used for congenital adrenal hyperplasia?

Answer 18

17 hydroxyprogesterone and 11 deoxycortisol

Question 19

Triad of Stein-Leventhal syndrome

Answer 19

Anovulation, amenorrhea, hirsutism? This is the worst possible situation for PCOS

Question 20

Name 2 non-functional ovarian tumors that do not secrete androgens but cause the adjacent ovarian tissue to secrete androgens

Answer 20

Krukenburg tumor and cystadenoma

Question 21

What is the marker for excess ovarian androgen production? Excess adrenal?

Answer 21

Ovarian = testosterone; adrenal = DHEAS

Question 22

What effect will excess ACTH have on the adrenals?

Answer 22

it will increase the production of all adrenal gland products including aldo, cortisol, and androgens (DHEA, DHEAS)

Question 23

What are 4 androgens that may cause the issues of virilism etc. in a woman?

Answer 23

DHEA, DHEAS, testosterone, androstenedione

Question 25

What is responsible for conversion of vellus hair to terminal hair?

Answer 25

Androgens; specifically DHT (which requires 5 alpha reductase)

Question 25

Marker for excess ovarian androgen

Answer 25

testosterone

Question 27

Which functional tumors of the ovary secrete androgens?

Answer 27

Sex cord tumors, Sertoli-Leydig cell tumors, Granulosa-Theca cell tumors, Leydig cell tumors, and Germ cell tumors

Question 28

What does a theca-lutein cyst produce?

Answer 28

androgens

Question 29

What is the most common outcome of an adrenal adenoma?

Answer 29

These usually cause glucocorticoid excess and rarely cause virilizing symptoms

Question 31

What are the 3 possible enzymes that may be deficient to result in excess androgen precursors

Answer 31

21 hydroxylase, 11 B hydroxylase, and 3 B hydroxylase

Question 32

If a woman has hirsuitism and elevated DHEAS what is probably going on?

Answer 32

excess adrenal androgen production since DHEAS is pretty much only produced in the adrenal glands

Question 33

What are some Sx of virilism in a woman? (5)

Answer 33

Deepening of voice, clitoromegaly, frontal balding, breast atrophy, and increase in muscle mass

Question 34

marker for excess adrenal androgen production

Answer 34

DHEAS

Question 35

How do you treat PCOS if fertility is desired?

Answer 35

give clomiphene citrate; also in patients with DM you can give metformin but careful causes spontaneous abortions

Question 36

What are the 2 main locations that elevated androgens can come from?

Answer 36

adrenal glands or ovaries

Question 37

Markers for CAH

Answer 37

17 OHP, and 11 deoxycortisol

Question 38

How do you diagnose 3 B HSD deficiency?

Answer 38

elevated 17 OH progesterone and DHEA

Question 39

Differentiate when congenital adrenal hyperplasia is identified in its severe forms vs. mild

Answer 39

severe form is in early childhood or infancy because of the ambiguous genitalia; mild form is found after menarche and will lead to hirsuitism

Question 40

What effect does the chronic anovulation of PCOS have on LH, estrogen, androgens, and SHBG?

Answer 40

elevates LH and estrogen as well as androgens but decreases SHBG which leads to increased free estrogen