Hirsutism Flashcards
MC androgen formed by ovary
Androstenedione
Androgen exclusively formed by adrenals
DHEA - S
Sources of Testosterone in females
Androstenedione > Adrenals > Ovary
2nd most potent androgen
Testosterone
Most potent Androgen
DHT
End product of testosterone
Oxysteroid
Testosterone binds to
SHBG and albumin
SHBG is inc by
Estrogen
SHBG is dec by
A I P G C
Androgens, Insulin, Progestin, GH, Cortisol
HIrsutism
Excessive growth of male pattern sexual hair.
Scoring criteria for Hirsutism
Ferriman Gallwey or Modified Ferriman gallwey
Ferriman Gallwey scoring
Hirsutism
11 sites
0-4 at each site
Modified Ferriman Gallwey
Hirsutism 9 sites 0-4 @ each site Total score - > or = 8 Mild hirsutism > or = 15 severe hirsutism
Modified Ferriman Gallwey score greater than 8
MIld Hirsutism
Modified Ferriman Gallwey score greater than 15
Severe Hirsutism
Virilisation.
Entire spectrum of changes in a female exposed to Androgens. Hirsutism. Breast atrophy. Deep voice Inc Muscle mass. Clitoromegaly. Prader score
Scoring system for Virilisation.
Prader scoring.
0 = female
5 = Virilization present .
Hypertrichosis
Excessive growth of non sexual hair
Work up in a patient of Hirsutism
Step 1 - Androgen levels.
If normal - Idiopathic hirsutism
IF elevated - Check Testosterone levels -
Step 2 - testosterone levels - Normal level = 20 - 80
IF raised + Inc 17 OH progesterone levels - Late onset CAH
IF >200 - PCOS - Rotterdam criteria
IF >200 - sign of virilization and Ovarian mass
indicates Androgen producing tumor of ovary
Step 3 - IF DHEA and DHEA- S are elevated
Androgen secreting adrenal tumors
Mx of Hirsutism
DOC - OCP for 6 months
Dec free testosterone level and also androgen levels
3 or 4th gen Progesterone to be used - Diane 35 or Yasmin
If no improvement for 6 months
shift to Anti androgenic drugs
failure of that Continuous GnRH
Drug not to be given in Hirsutism
Danazol
Why is Danazol not given in hirsutism
S/E is Hirsutism
DOC in Menopausal women with hirsutism
Eflornithine cream