Hirsuitism

Question 1

Tumors that can secrete androgens

Answer 1

Androgen-secreting tumors can be of the following kinds:

• Adrenal
• Adenoma
• Adenocarcinoma
• Ectopic ACTH-secreting tumor
• Ovarian
• Gonadal stromal tumor
• Thecoma
• Lipoid tumor
• Pituitary
• Prolactinoma

Question 2

Polycystic ovarian syndrome diagnosis

Answer 2

Increased total and free testosterone level

Increased LH to FSH ratio: LH/FSH > 3

Pelvic ultrasound - polycystic ovaries

Question 3

Mechanism of development of PCOS

Answer 3

The excess of fat promotes transformation of peripheral testosterone to estradiol and excess estradiol causes decreased FSH secretion via feedback inhibition and this leads to LH predominance over FSH making anovulatory cycles and arrested follicles (seen as cysts under U/S).

Increased Insulin levels also are involved.

The set of hormonal changes that you must answer in USMLE with regard to PCOS is as follows:

Increased estrogen (causing FSH inhibition)

Increased testosterone (hirsuitism, acne, hair growth)

Increesed LH

Decreased FSH

Increased GnRH pulse frequency

Increased insulin resistance