Androgen disorders Flashcards
What are the three types of androgens produced by the Ovaries?
DHEA, Androstenedione, Testosterone
What is the main androgen produced by the adrenal glands?
DHEAS
The ovary produces what androgen in the highest amount?
Androstenedione
What percent of circulating testosterone is bound to SHBG?
80%
PCOS affects what percent of women in the US?
5-10%
What is the cardinal feature of PCOS?
Hyperandrogenism
What are the 2 outcomes of hyperandrogenism in PCOS?
interference with follicular development, Decreases SHBG
T/F: Insulin resistance is common in PCOS and leads to hyperinsulinemia
True
What is the most current definition of PCOS?
Hyperandrogenism AND oilgo ovulation or polycystic ovaries
What percent of women with PCOS have hirsutism?
65 - 75%
Hair follicular growth are stimulated by what hormone?
DHT
Testosterone is converted to DHT by what enzyme?
5 alpha reductase
What is the term for rapid hair loss following delivery?
Telogen effluvium
Why do women loose their hair following delivery?
All hair is in the resting teolgen phase during pregnancy
If a patient has signs of virulization what conditions should you be worried about?
Adrenal hyperplasia, androgen producing tumors
What percentage of testosterone is bound?
99%
What percent of testosterone is bound by SHBG and what percent is bound by albumin?
80% bound by SHBG, 19% bound by albumin
What percentage of women with PCOS have irregular menstrual cycles?
60 - 85%
How do you verify ovulation?
Serum progesterone on day 20 -24 of menstrual cycle
What level of serum progesterone signifies ovulation?
Progesterone > 3 ng/ml
What is the definition of polycystic ovaries?
12 or more follicles measuring 2-9mm and/or ovarian volume > 10 ml
What percentage of women with PCOS have polycystic ovaries?
> 80%
What percentage of women WITHOUT PCOS have polycystic ovaries?
20 - 30%
What is a cause of hirsutism in pregnancy?
Pregnancy luteoma
If a patient has a luteoma, what is the possible outcome in the neonate?
female infants will be virilized
In a patient with PCOS the LH/FSH ratio is often ____as ___ is elevated and ____ is normal
elevated as LH is often elevated and FSH is normal
What percentage of women with PCOS are insulin resistant?
50 - 70%
What labs should be ordered when evaluating a patient with PCOS?
Total testosterone, free testosterone, SHBG, DHEAS, progesterone, TSH, Prolactin, 17-OHP
What is the first choice for ovulation induction in a patient with PCOS?
Letrozole
What is the mechanism of letrozole?
Aromatase inhibitor
How do OCPs improve Hirsutism?
Increase SHBG (estrogen), Inhibit 5 alpha reductase (progesterone) supress LH and ovarian steroidogenesis
What does the estrogen do in OCPs to improve hirsutism?
Increases SHBG
What does the progesterone do in OCPs to improve Hirsutism?
inhibit 5 alpha reductase
How does spiranolactone treat hirsutism?
Inhibits androgen synthesis, inhibits 5 alpha reductase, competes for androgen receptor
What is the mechanism spiranolactone?
aldosterone antagonist
What are the side effects of spiranolactone?
AUB, hyperkalemia
What is the mechanism of flutamide?
nonsteroidal antiandrogen
What is the mechanism o Finasteride?
5 alpha reductase inhibitor
How does eflornithine cream slow hair growth?
blocks ornithine decarboxylase
True or False: Weight loss alone can lead to resumption of ovulation in patients with PCOS?
True
What type of genetic inheritance is congenital adrenal hyperplasia?
Autosomal Recessive
In CAH, Decreased production of ______, leads to increased ______ and high levels of adrenal androgens
Cortisol, ACTH
What is the most common enzyme deficiency of CAH?
21 hydroxylase deficiency
What steroid is increased in patients with 21 hydroxlase deficiency?
17 OHP
21 Hydroxylase deficiency accounts for what percentage of CAH cases?
95%
What are the classical findings in the neonate of 21 hydroxylase deficiency?
sexual ambiguity, virilization, salt wasting
What are the classical findings of 11B Hydroxylase deficiency?
Virilization, Hypertension, volume overload.
How do you diagnose CAH?
Oder 17 OHP
In 11 B hydroxylase deficiency what androgen will be elevated?
11 deoxycortisol
How do you differentiate between 21 hydroxylase and 11 B hydroxylase deficiency?
Order 11 deoxycortisol
What is the mainstay of treatment of CAH?
Give cortisol and aldosterone
What medications and dosing do you use to treat CAH?
Hydrocortisone 10 mg/day, fluorohydrocortisone 100 mg/day
How do you diagnose CAH prenatally?
CVS to detect mutations
T/F: 17 OHP and androstendione are detectable in amniotic fluid
True
When should you initiate treatment with dexamethasone during pregnancy for fetuses at high risk?
4-5 weeks gestation
What is the difference between classical and non classical CAH?
Presentation of nonclassical CAH is at puberty or later.
What is the treatment for nonclassical CAH?
Dexamethasone 0.25 mg nightly
What labs are included in the initial evaluation of a patient with hirsutism?
Total testosterone, SHBG, DHEAS, 17 OHP
