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Fitzpatrick Tables > Chapter 90 - Hirsutism and Hypertrichosis > Flashcards

Chapter 90 - Hirsutism and Hypertrichosis Flashcards

1
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
- Regular ovulation and normal to slightly elevated androgen levels
- Often presents with mild to moderate hirsutism

A

Idiopathic hirsutism (IH)

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2
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
Hyperandrogenism; menstrual irregularities, including oligomenorrhea, amenorrhea, and infertility; and impaired glucose tolerance, hyperlipidemia, and obesity

A

Polycystic ovarian syndrome (PCOS)

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3
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
- Autosomal recessive inheritance of 21-hydroxylase deficiency
- Rarely secondary to 11β-hydroxylase deficiency
- Hirsutism, acne, alopecia, anovulation, and menstrual dysfunction

A

Nonclassic congenital adrenal hyperplasia

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4
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
- Hyperandrogenism, insulin resistance, and acanthosis nigricans
- Considered a subtype of PCOS

A

HAIR-AN
Hyperandrogenism (HA), insulin resistance (IR), and acanthosis nigricans (AN)

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5
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
Seborrhea, acne, hirsutism, and alopecia

A

SAHA

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6
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
Presents with amenorrhoea, galactorrhea, and infertility

A

Hyperprolactinemia

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7
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
Centripetal fat distribution, thinning of the skin with striae, glucose intolerance, osteoporosis, and proximal muscle weakness; signs and symptoms of hyperandrogenism and menstrual irregularities

A

Cushing syndrome

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8
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
Most common areas involved are the upper abdomen, lower abdomen, lower back, upper lip, and thighs

A

Pregnancy

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9
Q

TABLE 90-1
Causes of Hirsutism

FINDINGS
Elevated random serum GH and IGF-1

A

Acromegaly

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10
Q

TABLE 90-1
Causes of Hirsutism

COMMENT
Mean age, BMI, and hip and waist circumference higher in these patients vs patients with metabolic disturbance

A

Idiopathic hirsutism (IH)

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11
Q

TABLE 90-1
Causes of Hirsutism

COMMENT
- Cutaneous findings of acanthosis nigricans may also be observed in 5% of obese women with insulin resistance
- Warrants endocrinology evaluation for impaired glucose tolerance as increased risk for type 2 diabetes mellitus

A

Polycystic ovarian syndrome (PCOS)

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12
Q

TABLE 90-1
Causes of Hirsutism

COMMENT
Patients often present accelerated bone age maturation and increased basal or stimulated 17-OHP

A

Nonclassic congenital adrenal hyperplasia

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13
Q

TABLE 90-1
Causes of Hirsutism

COMMENT
Insulin elevated; elevated or high-normal levels of testosterone and androstenedione but normal levels of LH and prolactin

A

HAIR-AN
Hyperandrogenism (HA), insulin resistance (IR), and acanthosis nigricans (AN)

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14
Q

TABLE 90-1
Causes of Hirsutism

COMMENT
Associated with stress, pituitary adenoma, pregnancy, drug intake, and primary hypothyroidism with elevated TSH

A

Hyperprolactinemia

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15
Q

TABLE 90-1
Causes of Hirsutism

COMMENT
Multiple causes:
- Adrenal neoplasm
- Ectopic ACTH-secreting tumor
- Pituitary tumor (Cushing disease)

A

Cushing syndrome

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16
Q

TABLE 90-1
Causes of Hirsutism

COMMENT
- Serum total testosterone levels and mFG score increase with the progression of this condition
- Associated with physiological changes of this condition

A

Pregnancy

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17
Q

TABLE 90-1
Causes of Hirsutism

COMMENT
Patients can present with abnormal growth of the hands and feet, arthritis, sleep apnea, headache, and impaired vision

A

Acromegaly

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18
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
- Suppress ovarian androgen synthesis
- Increase SHBG

A

Oral contraceptive pills (OCPs)

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19
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
- Competitive inhibitor of AR and 5α-reductase
- Increases SHBG
- Decreases androgen synthesis

A

Spironolactone

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20
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
Competes with DHT for binding to the androgen receptor

A

Cyproterone acetate

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21
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
Nonsteroidal competitive inhibitor of androgen receptor binding

A

Flutamide and bicalutamide

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22
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
Suppress adrenal function

A

Glucocorticoids

23
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
Suppresses gonadotropin and ovarian androgen secretion

A

GnRH agonist
(Leuprolide acetate, depot suspension)

24
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
Cytochrome P450 enzyme inhibitor and decreases adrenal steroid production

A

Ketoconazole

25
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
Inhibits 5α-reductase

A

Finasteride

26
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

MECHANISM OF ACTION
Insulin-sensitizing agent

27
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Oral contraceptive pills (OCPs)

A

Single pill a day

28
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Spironolactone

A

Starting dosage is 50 mg twice daily and may be increased to a total daily dose of 200 mg

29
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Cyproterone acetate

A

Low dose (2 mg) in OCPs 12.5-100 mg as monotherapy or with estrogen

30
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Flutamide

A

62.5–250 mg, twice daily

31
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Bicalutamide

32
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Prednisone

A

5-7.5 mg by mouth at bedtime

33
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Dexamethasone

A

0.5 mg at bedtime

34
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
GnRH agonist (Leuprolide acetate, depot suspension)

A

7.5 mg monthly intramuscularly, with 25–50 ug of transdermal estradiol

35
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Ketoconazole

A

400–600 mg by mouth daily

36
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Finasteride

A

1–5 mg by mouth

37
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

DOSAGE
Metformin

A

850 mg twice a day or 500 mg three times a day

38
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
- Headaches
- Migraines
- Risk of venous thromboembolic event
- Melasma
- Alopecia (upon discontinuation)

A

Oral contraceptive pills (OCPs)

39
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
- Polyuria
- Hypotension
- Headaches
- Fatigue
- Syncope
- Hyperkalemia
- Irregular menses
- Teratogen
- Decreased libido

A

Spironolactone

40
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
- Fluid retention
- Depression
- Menstrual irregularities
- Teratogen
- Increased risk of liver dysfunction

A

Cyproterone acetate

41
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
- Teratogen
- Hepatotoxicity
- Diarrhea
- Nausea
- Vomiting

A

Flutamide and bicalutamide

42
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
- Hyperglycemia
- Hypertension
- Cushingoid changes
- Esophageal reflux and peptic ulcer disease
- Psychosis and agitation
- Increased risk of infections
- Adrenal suppression

A

Glucocorticoids

43
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
Osteoporosis if not combined with estrogen–progestin

A

GnRH agonist
(Leuprolide acetate, depot suspension)

44
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
- Headache
- Nausea
- Hair loss

A

Ketoconazole

45
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
- Headaches
- Decreased libido

A

Finasteride

46
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

ADVERSE EFFECTS
- Rare lactic acidosis
- GI distress

47
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

COMMENTS
- First-line therapy (in women not seeking to conceive)
- Contradictions:
– Uncontrolled HTN
– Thromboembolic disorder
– Breast cancer
– Active smoker (absolutely if older than 35 yr)
– Cardiovascular disease

A

Oral contraceptive pills (OCPs)

48
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

COMMENTS
- Avoid combination with other potassium-sparing diuretics and thiazides
- Contraindicated in patients with renal failure
- Recommend combination with OCPs
- Pregnancy Category C

A

Spironolactone

49
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

COMMENTS
- Not available in the United States
- Contraindicated during pregnancy and breastfeeding and with liver diseases

A

Cyproterone acetate

50
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

COMMENTS
- Recommend combination with OCPs
- Pregnancy Category D

A

Flutamide and bicalutamide

51
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

COMMENTS
- Indicated for hirsutism secondary to CAH
- Not recommended in patients with uncontrolled diabetes and hypertension
- When used as monotherapy, does not significantly improve hirsutism
- Pregnancy Category C

A

Glucocorticoids

52
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

COMMENTS (2)
Pregnancy Category X

A
  1. GnRH agonist
    (Leuprolide acetate, depot suspension)
  2. Finasteride
53
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

COMMENTS
Pregnancy Category C

A

Ketoconazole

54
Q

TABLE 90-2
Pharmacologic Treatment of Hirsutism

COMMENTS
- Must ensure normal renal function before starting
- Pregnancy Category B

Fitzpatrick Tables (77 decks)

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