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#Phase 2.1: GI > Hirsutism, Virilism, Gynaecomastia + Impotence > Flashcards

Hirsutism, Virilism, Gynaecomastia + Impotence Flashcards

1
Q

What is Hirsutism?

A

Male pattern of hair growth in women (face, chest, back)

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2
Q

How common is Hirsutism?

A

10% of women

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3
Q

What are the causes of Hirsutism? (8 things)

A
  1. Familial
  2. Idiopathic
  3. Steroids
  4. Polycystic Ovarian Syndrome (PCOS) (increased androgen secretion by ovary)
  5. Ovarian Cancer (increased androgen secretion by ovary)
  6. Cushing’s Syndrome (adrenal)
  7. Late-onset Congenital Adrenal Hyperplasia (adrenal)
  8. Adrenal Cancer (adrenal)
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4
Q

What investigations should you do for Hirsutism? (6 things)

A
  1. US

Bloods:

  1. High testosterone levels
  2. Low Sex Hormone Binding Globulin (bc PCOS)
  3. High LH:FSH ratio
  4. TSH
  5. Lipids
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5
Q

What are you looking for in an US of Hirsutism?

A

Bilateral polycystic ovaries

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6
Q

What should you investigate for if a Hirsutism pt has High testosterone levels?

A

Androgen producing adrenal / ovarian tumour

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7
Q

What should you address mental health wise in a Hirsutism pt?

A

Feelings of lack of conformity to society’s perceived norms of feminine beauty

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8
Q

What is the management for Hirsutism? (6 things)

A
  1. Weight reduction
  2. Shaving
  3. Laser
  4. Wax
  5. Creams
  6. Bleach
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9
Q

If the Hirsutism is caused by PCOS, what big problems do you also have? (2 things)

A
  1. Infertility
  2. Insulin resistance
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10
Q

How does Weight Reduction help with Hirsutism? (4 things)

A
  1. Raises SHBG levels
  2. Reduces Testosterone levels
  3. Reduces Insulin resistance
  4. Restores ovulation –> fertility
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11
Q

How do you manage the Infertility + Insulin Resistance which present alongside Hirsutism in PCOS? (3 things)

A
  • Infertility: Clomifene
  • Insulin resistance: Metformin
  • Both: Weight reduction
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12
Q

What are the CF of Virilism? (4 things)

A
  1. Hirsutism
  2. Deep voice
  3. Clitoromegaly
  4. Amenorrhoea
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13
Q

What should you investigate for in Virilism?

A

Androgen secreting adrenal / ovarian tumour

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14
Q

What is Gynaecomastia?

A

Abn amount of breast tissue in men

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15
Q

What are the causes of Gynaecomastia? (6 things)

A
  1. Hypogonadism
  2. Hyperthyroidism
  3. Cirrhosis (increases oestrogen)
  4. Oestrogen secreting Tumours (e.g testicular / adrenal)
  5. hCG secreting Tumour (e.g testicular / bronchial)
  6. Drugs: Oestrogens / Testosterone / Spironolactone / Digoxin / Marijuana)
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16
Q

What are the management options for Gynaecomastia? (4 things)

A
  1. Treat underlying condition / Stop medication
  2. Testosterone replacement (if hypogonadism)
  3. Tamoxifen (Selective Oestrogen Receptor Modulator / SERM): if severe + 3+ months
  4. Mastectomy Surgery: if over 1 year
17
Q

What are the causes of Impotence? (14 things)

A
  1. Smoking
  2. Alcohol
  3. Diabetes
  4. Hypogonadism
  5. Hyperthyroidism
  6. High Prolactin
  7. Spinal cord lesions
  8. MS
  9. Autonomic Neuropathy
  10. Pelvic surgery
  11. Radiotherapy
  12. Renal / Hepatic failure
  13. Prostatic Hyperplasia
  14. Drugs: Digoxin / Beta blockers / Diuretics / Antipsychotics / Antidepressants / Oestrogen / Narcotics
18
Q

What investigations should you do for Impotence? (11 things)

A
  1. Full sexual + psychological history
  2. UnE
  3. LFT
  4. Glucose (diabetes)
  5. TFT
  6. LH + FSH
  7. Lipids
  8. Testosterone
  9. Prolactin
  10. Doppler: check if penile arterial pressure enough for inflow
  11. Check penile sensation (CNS problem?)
19
Q

What are the management options for Impotence? (4 things)

A
  1. Treat causes
  2. Phosphodiesterase Inhibitors (e.g Sildenafil aka Viagra)
  3. Vacuum erection device (mechanical pump)
  4. Penile implants (inflatable / malleable)
20
Q

How do Phosphodiesterase Inhibitors (e.g Sildenafil aka Viagra) work?

A

Promote vasodilation in penis (helps maintain erection)

21
Q

What are the Side Fx of Phosphodiesterase Inhibitors (e.g Sildenafil aka Viagra)? (5 things)

A
  1. Headache
  2. Visual changes (blue green tinge in vision)
  3. Stuffy nose
  4. Flushing
  5. Dyspepsia (heartburn)
22
Q

Which patients should NOT take Phosphodiesterase Inhibitors (e.g Sildenafil aka Viagra)?

A

Pt on nitrates, can cause unsafe low BP

#Phase 2.1: GI (29 decks)

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