Hairy Women

Question 1

What is the gold standard for assessing hirsutism?

Answer 1

Ferryman-galloway score

Question 2

Name three androgen receptor antagonists used for treatment of hirsutism

Answer 2

Spironolactone, cyproterone and flutamide

Question 3

What is the MOA for combined OCPs in treatment for hisutism

Answer 3

Increases sex hormone binding globulin and decreases LH dependent androgen

Question 4

What are the side effects of cyproterone?

Answer 4

Fatigue, weight gain, mastalgia

Question 5

What are the side effects of flutamide?

Answer 5

Dry skin , hepatitis

Question 6

What is the MOA of finasteride?

Answer 6

5-alpha reductase inhibitor

Question 7

What is the MOA of eflornithine?

Answer 7

Inhibits ornithine decarboxylase

Question 8

What happens to LH and FSH in PCOS?

Answer 8

Increased LH:FSH ratio

Increased LH pulse frequency

Question 9

What is the most potent androgen?

Answer 9

Dihydrotestosterone

Question 10

How is dihydrotestosterone formed?

Answer 10

Peripheral conversion of testosterone via 5-alpha reductase

Question 11

What is the criteria to DX PCOS?

Answer 11

Rotterdam criteria (requires 2/3)

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

Question 12

What’s the best treatment for PCOS?

Answer 12

Weight loss aka decreased calories

Question 13

What is the side effect of metformin?

Answer 13

Lactic acidosis - careful with increased creatinine

Question 14

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

Answer 14

Clomiphene

Question 15

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

Answer 15

Letrozole

Question 16

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

Answer 16

Congenital adrenal hyperplasia

Question 17

What is the inheritance pattern in congenital adrenal hyperplasia?

Answer 17

Autosomal recessive

Question 18

What’s the pathophysiology in congenital adrenal hyperplasia?

Answer 18

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

Question 19

21 hydroxylase deficiency

Answer 19

Salt wasting, simple virilizing or nonclassical

Characterized by elevated 17-hydroxyprogesterone

Question 20

11-beta hydroxylase deficiency

Answer 20

Increased accumulation of mineralocorticoids leading to HTN

Question 21

17 alpha hydroxylase deficiency

Answer 21

Hypertension
Hypokalemia
Males are feminized

Question 22

How do you prevent virilization in congenital adrenal hyperplasia?

Answer 22

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

Question 23

What commonly causes nonclassical Congenital adrenal hyperplasia?

Answer 23

Usually due to 21-hydroxylase deficiency

Question 24

What are the most common signs of nonclassical CAH?

Answer 24

Hirsutism, acne, oligomenorrhea

Question 25

How do you screen for nonclassical CAH?

Answer 25

Follicular phase AM serum 17 hydroxyprogesterone

Question 26

When should you think about an androgen secreting tumor?

Answer 26

Moderate to severe hirsutism, rapidly progressing hirsutism, or virilization

Question 27

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

Answer 27

Serum total testosterone | If >150, a tumor is highly likely

Question 28

Describe a pregnancy luteoma

Answer 28

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

Question 29

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

Answer 29

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

Question 30

What is the classic presentation in Cushing syndrome

Answer 30

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

Question 31

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

Answer 31

Rule out exogenous steroid exposure

Question 32

How do you screen for Cushing’s syndrome

Answer 32

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

Question 33

What’s the most likely cause of idiopathic hirsutism?

Answer 33

Increased peripheral 5alpha reductase activity

Question 34

What is the pathophysiology of increased insulin in PCOS?

Answer 34

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