Hirsutism, Virilism, Gynaecomastia + Impotence Flashcards
What is Hirsutism?
Male pattern of hair growth in women (face, chest, back)
How common is Hirsutism?
10% of women
What are the causes of Hirsutism? (8 things)
- Familial
- Idiopathic
- Steroids
- Polycystic Ovarian Syndrome (PCOS) (increased androgen secretion by ovary)
- Ovarian Cancer (increased androgen secretion by ovary)
- Cushing’s Syndrome (adrenal)
- Late-onset Congenital Adrenal Hyperplasia (adrenal)
- Adrenal Cancer (adrenal)
What investigations should you do for Hirsutism? (6 things)
- US
Bloods:
- High testosterone levels
- Low Sex Hormone Binding Globulin (bc PCOS)
- High LH:FSH ratio
- TSH
- Lipids
What are you looking for in an US of Hirsutism?
Bilateral polycystic ovaries
What should you investigate for if a Hirsutism pt has High testosterone levels?
Androgen producing adrenal / ovarian tumour
What should you address mental health wise in a Hirsutism pt?
Feelings of lack of conformity to society’s perceived norms of feminine beauty
What is the management for Hirsutism? (6 things)
- Weight reduction
- Shaving
- Laser
- Wax
- Creams
- Bleach
If the Hirsutism is caused by PCOS, what big problems do you also have? (2 things)
- Infertility
- Insulin resistance
How does Weight Reduction help with Hirsutism? (4 things)
- Raises SHBG levels
- Reduces Testosterone levels
- Reduces Insulin resistance
- Restores ovulation –> fertility
How do you manage the Infertility + Insulin Resistance which present alongside Hirsutism in PCOS? (3 things)
- Infertility: Clomifene
- Insulin resistance: Metformin
- Both: Weight reduction
What are the CF of Virilism? (4 things)
- Hirsutism
- Deep voice
- Clitoromegaly
- Amenorrhoea
What should you investigate for in Virilism?
Androgen secreting adrenal / ovarian tumour
What is Gynaecomastia?
Abn amount of breast tissue in men
What are the causes of Gynaecomastia? (6 things)
- Hypogonadism
- Hyperthyroidism
- Cirrhosis (increases oestrogen)
- Oestrogen secreting Tumours (e.g testicular / adrenal)
- hCG secreting Tumour (e.g testicular / bronchial)
- Drugs: Oestrogens / Testosterone / Spironolactone / Digoxin / Marijuana)
What are the management options for Gynaecomastia? (4 things)
- Treat underlying condition / Stop medication
- Testosterone replacement (if hypogonadism)
- Tamoxifen (Selective Oestrogen Receptor Modulator / SERM): if severe + 3+ months
- Mastectomy Surgery: if over 1 year
What are the causes of Impotence? (14 things)
- Smoking
- Alcohol
- Diabetes
- Hypogonadism
- Hyperthyroidism
- High Prolactin
- Spinal cord lesions
- MS
- Autonomic Neuropathy
- Pelvic surgery
- Radiotherapy
- Renal / Hepatic failure
- Prostatic Hyperplasia
- Drugs: Digoxin / Beta blockers / Diuretics / Antipsychotics / Antidepressants / Oestrogen / Narcotics
What investigations should you do for Impotence? (11 things)
- Full sexual + psychological history
- UnE
- LFT
- Glucose (diabetes)
- TFT
- LH + FSH
- Lipids
- Testosterone
- Prolactin
- Doppler: check if penile arterial pressure enough for inflow
- Check penile sensation (CNS problem?)
What are the management options for Impotence? (4 things)
- Treat causes
- Phosphodiesterase Inhibitors (e.g Sildenafil aka Viagra)
- Vacuum erection device (mechanical pump)
- Penile implants (inflatable / malleable)
How do Phosphodiesterase Inhibitors (e.g Sildenafil aka Viagra) work?
Promote vasodilation in penis (helps maintain erection)
What are the Side Fx of Phosphodiesterase Inhibitors (e.g Sildenafil aka Viagra)? (5 things)
- Headache
- Visual changes (blue green tinge in vision)
- Stuffy nose
- Flushing
- Dyspepsia (heartburn)
Which patients should NOT take Phosphodiesterase Inhibitors (e.g Sildenafil aka Viagra)?
Pt on nitrates, can cause unsafe low BP
