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Raising The Barr > Hairy Women > Flashcards

Hairy Women Flashcards

1
Q

What is the gold standard for assessing hirsutism?

A

Ferryman-galloway score

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2
Q

Name three androgen receptor antagonists used for treatment of hirsutism

A

Spironolactone, cyproterone and flutamide

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3
Q

What is the MOA for combined OCPs in treatment for hisutism

A

Increases sex hormone binding globulin and decreases LH dependent androgen

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4
Q

What are the side effects of cyproterone?

A

Fatigue, weight gain, mastalgia

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5
Q

What are the side effects of flutamide?

A

Dry skin , hepatitis

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6
Q

What is the MOA of finasteride?

A

5-alpha reductase inhibitor

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7
Q

What is the MOA of eflornithine?

A

Inhibits ornithine decarboxylase

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8
Q

What happens to LH and FSH in PCOS?

A

Increased LH:FSH ratio

Increased LH pulse frequency

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9
Q

What is the most potent androgen?

A

Dihydrotestosterone

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10
Q

How is dihydrotestosterone formed?

A

Peripheral conversion of testosterone via 5-alpha reductase

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11
Q

What is the criteria to DX PCOS?

A

Rotterdam criteria (requires 2/3)

  • oligo or anovulation
  • hyperandrogenism
  • polycystic ovaries (12+ follicles 2-9 mm each)
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12
Q

What’s the best treatment for PCOS?

A

Weight loss aka decreased calories

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13
Q

What is the side effect of metformin?

A

Lactic acidosis - careful with increased creatinine

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14
Q

What medication is used for ovulation induction with BMI <30?

A

Clomiphene

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15
Q

What medication is used for ovulation induction with BMI >30?

A

Letrozole

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16
Q

What is the most common cause of ambiguous genitalia at birth?

A

Congenital adrenal hyperplasia

17
Q

What is the inheritance pattern in congenital adrenal hyperplasia?

A

Autosomal recessive

18
Q

What’s the pathophysiology in congenital adrenal hyperplasia?

A

Enzyme deficiency leads to decreased cortisol production leads to increased ACTH leading to adrenal hyperplasia

19
Q

21 hydroxylase deficiency

A

Salt wasting, simple virilizing or nonclassical

Characterized by elevated 17-hydroxyprogesterone

20
Q

11-beta hydroxylase deficiency

A

Increased accumulation of mineralocorticoids leading to HTN

21
Q

17 alpha hydroxylase deficiency

A

Hypertension
Hypokalemia
Males are feminized

22
Q

How do you prevent virilization in congenital adrenal hyperplasia?

A

Treat mom with dexamethasone starting at 4-5 weeks gestation then perform CVS and stop meds if karyotype is XY or if genotype not affected

23
Q

What commonly causes nonclassical Congenital adrenal hyperplasia?

A

Usually due to 21-hydroxylase deficiency

24
Q

What are the most common signs of nonclassical CAH?

A

Hirsutism, acne, oligomenorrhea

25
Q

How do you screen for nonclassical CAH?

A

Follicular phase AM serum 17 hydroxyprogesterone

26
Q

When should you think about an androgen secreting tumor?

A

Moderate to severe hirsutism, rapidly progressing hirsutism, or virilization

27
Q

What is the best initial lab test when you are concerned about an androgen secreting neoplasm?

A

Serum total testosterone

If >150, a tumor is highly likely

28
Q

Describe a pregnancy luteoma

A
  • solid ovarian mass
  • bilateral 30-50% of the time
  • high cholesterol content
  • can result in masculinization if female infant
29
Q

What is a hyperreactio luteinalis and when does it usually occur?

A

Usually occurs in pregnancy
Multicystic, spoke wheel appearance, Hcg stimulated theta cells increase androstenedione and testosterone

Resolved spontaneously PP

30
Q

What is the classic presentation in Cushing syndrome

A

Moon facies , buffalo hump, abdominal striae, centripetal fat distribution, hypertension

31
Q

What’s the first step in evaluation of someone with Cushing’s syndrome

A

Rule out exogenous steroid exposure

32
Q

How do you screen for Cushing’s syndrome

A

Overnight dexamethasone suppression test
If abnormal, perform second confirmatory test of either overnight dexamethasone suppression test, 24 hr urinary free cortisol excretion or late night salivary cortisol

33
Q

What’s the most likely cause of idiopathic hirsutism?

A

Increased peripheral 5alpha reductase activity

34
Q

What is the pathophysiology of increased insulin in PCOS?

A

Increased insulin levels stimulate ovarian androgen production, decreases liver SHBG production and potentiates action of LH on androgen production

Raising The Barr (5 decks)

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