Chapter 23 Hirsutism and Virilism Flashcards
which laboratory tests to consider in pt with hair over upper lip, beneath her chin, clitoromegaly, with 17cm large adnexal mass
testosterone, dheas both measure androgen levels.
if testosterone is elevated, this confirms androgen excess. a dheas level assists with determining if the source of androgens is ADRENAL in origin.
sertoli-leydig cell tumor secretes androgens, leading to hirsutism and virilization. this tumor can result in high levels of testosterone and androstenedione and virilization in 25% of patients. there will also be vilization in 65% of female fetuses. these findings resolve in postpartum
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criteria for PCOS
two out of the following 3 criteria:
oligo/anovulation, clinical or laboratory evidence of hyperandrogenism, and polycystic ovaries on ultrasound.
day3 fsh and ESTRADIOL may be helpful in determining the underlying quality of her remaining oocytes in terms of her fertility, but are not necessary in making the dx of PCOS
urinary ovulation kits may be started day ___ and ___ of menstrual cycle
11 or 12
ovulation predictor kits detect which hormone
LH surger, which occurs approx 24-36hours prior to ovulation
in patients with PCOS there might be false positive due to elevated baseline circulating levels of LH.
measurement of progesterone in the luteal phase may indicate that ovulation has occurred ( although it will not help with predicting ovulation in order to time intercourse). in a woman with normal 28 day cycles, it is typically measured on cycle day 21, when you would expect elevated levels secondary to progesterone production by the corpus luteum after ovulation. day 3/day28 progesterone would not be helpful. in pt with irregular menstruation, progesterone blood test not accurate. in past years, endometrial bx used to be performed to evaluate for evidence of decidualizatio of the endometrium as evidence of progesterone effect. (no longer standard procedure i nworkup of anovulation since there are other less, paiful methods to determine ovulation
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first step in attempting to achieve pregnancy:
1. weight loss through diet and exercise and consider clomiphene citrate (clomid)
clomid is an antiestrogen that increases the probability that ovulation occurs by removing negative feedback of circulating estrogen to the brain, thereby increasing circulating levels of FSH seen by the ovary. 50mg daily starting day 3 or 5, continuing for 5 days of therapy.
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___are first line therapy for helping to decrease circulating androgens, and may prevent progessive, hirsutism and acne. this is achieved by increasing levels of SHBG concentrations, in turn decreasing circulating free androgen levels and their stimulatory effect on hair follicles.
depo provera and levonorgestrel IUD work well to decrease heavy bleeding and for contraception, but will not help in reducing symptoms and hyperandrogenism
ocps
patient with PCOS, and irregular menses need to check
- test her for diabetes and hyperlipidemia (at risk for both these diseases as well as cardiovascular disease.
- because of heavy flow check HYPOTHYROIDISM and evaluate for anemia
- increased risk for endometrial hyperplasia and carcinoma from chronic anovulation and elevated levels of circulating estrogens, recommend a pelvic ultrasound and an endometrial biopsy
oral contraceptive pill will reduce circulating levels of androgens by stimulating production of SHBG and in turn decreasing circulating levels of androgens. tried at least 6 mths before trying another method. spironolactone (aldactone ) is antiandrogen. it acts as an androgen receptor antagonist. best used in conjunction with combined ocps after ocps has failed.
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