5.1 Flashcards
what score is used to diagnose hirsutism
ferriman-gallwey (>8)
btwn LH and FSH, which is higher in PCOS
LH (3:1)
what will you see on PE for PCOS
bilateral enlarged smooth and mobile ovaries
what criteria is used to diagnose PCOS
Rotterdam criteria (2 out of 3)
what are the Rotterdam criteria
Hyperandrogenism
Oligomenorrhea/Amenorrhea
Cysts on US
are prolactinomas usually benign or malignant
benign
MC pituitary adenoma
prolactinoma
prolactinomas are associated with what inherited disease
MEN1
what inhibits prolactin release
dopamine
effects of prolactinoma on growth
acromegaly in adults
gigantism in kids
common prolactinoma sx in women
galactorrhea
amenorrhea/oligorrhea
decreased vaginal lubrication
local compression from prolactinoma can cause
visual changes (bitemporal hemianopsia)
headache
FSH and LH in prolactinoma
decreased
what imaging for prolactinoma
MRI
tx for prolactinoma
dopamine agonists (Bromocriptine, Cabergoline)
Transsphenoidal surgery
what is a good marker for progress in ovarian CA
CA125
what type of ovarian cyst is low risk for CA
fluid filled, anechoic
what type of ovarian cyst is high risk for CA
nodular, solid
closed comedomes
whiteheads
open comedomes
blackheads
what gland is NOT affected in Sheehan’s syndrome
posterior pituitary
only one that is affected in anterior pituitary
common sx of Sheehan’s
agalactorrhea
amenorrhea
hypoTN
tachycardia
hyponatremia
what will you see on MRI for sheehan
pituitary ring sign
primary adrenocortical insufficiency (Addison’s dz)
decreased cortisol
decreased aldosterone
elevated ACTH
tx for primary adrenocortical insufficiency
glucocorticoids
mineralocorticoids can be added ONLY for primary (bc we have decreased aldosterone only in primary)
secondary adrenocortical insufficinecy (issue w pituitary)
decreased cortisol
intact aldosterone
decreased ACTH
deficiency in aldosterone (most prominent in primary adrenocortical insufficiency) most commonly leads to
orthostatic hypoTN
MC cause of addisonian crisis
rapid withdrawal of glucocorticoids
Cushing syndrome
excess cortisol (main)
high dose Dexamethasone suprpession test (Cushings) for Cushing’s disease (pituitary adenoma –> ACTH)
increased ACTH + suppression of cortisol with high-dose dexamethasone
high dose Dexamethasone suprpession test (Cushings) for ectopic tumor (like small cell lung CA producing ACTH)
increased ACTH + no suppression of cortisol with high dose
high dose Dexamethasone suppression test (Cushing’s) for adrenal tumor
decreased ACTH + increased cortisol/no suppression of cortisol
tx for cushings
corticoid steroid TAPER
if we have hypotension with adrenocortical insufficiency, what will we have with Cushing’s syndrome
HTN
ATP 3 criteria (3 of the following) for metabolic syndrome
HDL < 40 in men; < 50 in women
Increased BP >/= 135 S or >/=85 D or drug tx
Increased TG >/=150 or tx
Increased fasting blood sugar >/= 100 or tx
Increased waist circumference 40 in men and 35 in women (inches)
what rash is associated w celiac disease
dermatitis herpetiformis
everyone w PCOS should be tested for
NCAH
17-hydroxyprogesterone measurements for NCAH
> 1000 – likely
< 200 – unlikely (rule out)
what type of amenorrhea do people with anorexia have
hypogonadotropic hypogonadism
Turner’s syndrome - primary labs
low estrogen
high FSH, high LH
Klinefelter’s syndrome - primary labs
low testosterone
high FSH, high LH
first line for ovulation induction in PCOS
Letrozole
can also do Clomiphene
testosterone levels for when to suspect adrenal secreting tumor
> 150
A1C levels for normal, pre diabetes, diabetes
normal < 5.7
pre diabetes 5.7-6.4
diabetes > 6.5
A PCOS phenotype
full; amenorrhea/oligorrhea, hyperandrogens, cysts
B PCOS phenotype
classic
amenorrhea/oligorrhea, hyperandrogens
C PCOS phenotype
hyperandrogens and cysts
D PCOS phenotype
cysts and oligo/amenorrhea
BMI index
< 18.5 underweight
18.5-24.9 normal
25-29.9 overweight
30-34.9 obese
> 35 morbidly obese
