Hirsutism, Virilism, PCOS

Question 1

Name and describe the two types of body hair.

Answer 1

Vellus hair: soft, fine, non-pigmented hair that covers the entire body.

Terminal Hair: coarse, pigmented hair that covers the scalp, axilla, and pubic areas

Question 2

What converts vellus hair to terminal hair?

Answer 2

Androgens

Question 3

What’s hirsutism?

Answer 3

Increased terminal hair on the face, chest, back, lower abdomen, and thighs of a woman.

Question 4

Two general causes of hirsutism.

Answer 4

Increased serum androgens or increased levels of 5-alpha-reductase activity

Question 5

What is virilism?

Answer 5

Masculinization in a woman:

• deepening of the voice
• frontal balding
• increased muscle mass
• clitoromegaly
• breast atrophy

Question 6

Source of excess androgens in the female.

Answer 6

Adrenal cortex and ovaries

Question 7

Marker that is used to assess the amount of androgens that are being produced by the adrenal cortex.

Answer 7

DHEAS

Question 8

What are 3 adrenal causes of virilization and hirsutism?

Answer 8

1. Tumors
2. Cushing Syndrome
3. Congenital Adrenal Hyperplasia (CAH)

Question 9

Which adrenal tumor type is most likely to cause virilization?

Answer 9

Adrenal carcinoma: causes increase in all 3 adrenal cortex pathways.

(benign adenomas usually only increase cortisol levels)

Question 10

Test to diagnose cushing syndrome.

Answer 10

Dexamethasone Suppression Test, or 24hr urine collection for free cortisol

Question 11

Most common enzyme deficiency in CAH.

Answer 11

21-hydroxylase deficiency

-leads to salt wasting and ambiguous genitalia

Question 12

How is a 21-hydroxylase deficiency diagnosed?

Answer 12

elevated 17-OH Progesterone serum levels

Question 13

What is the general mechanism of an ovarian cause of hirsutism or virilization?

Answer 13

Anything that increases the LH:FSH ratio

Question 14

What is Stein Leventhal Syndrome?

Answer 14

Anovulation, amenorrhea, hirsutism, enlarged and polycystic ovaries in an obese woman

Many of these women develop insulin resistance, hyperinsulinemia and type II diabetes

Question 15

How does anovulation lead to an increased LH:FSH ratio?

Answer 15

Chronic anovulation leads to high levels of estrogen and androgens. The reduction in SHBG leads to increased serum estrogen which causes negative feedback on the FSH release. Increased LH: FSH ratio occurs.

Question 16

What are Theca Lutein Cysts?

Answer 16

Benign cysts in the ovaries that release high levels of testosterone, often seen in molar pregnancies and leads to hirsutism.

Question 17

Marker used to assess excess androgen production in the ovaries.

Answer 17

Free Testosterone

Question 18

What is a Krukenberg Tumor?

Answer 18

A malignancy in the ovary that metastasized from a primary site like the gastrointestinal tract, although it can arise in other tissues such as the breast.

Question 19

When does acanthosis nigricans appear on patients with hirsutism?

Answer 19

In patients with PCOS

Question 20

Treatment for hirsutism caused by ovarian or adrenal tumors.

Answer 20

Surgical Management

Question 21

Treatment for hirsutism caused by ovarian non-neoplastic causes.

Answer 21

Oral contraceptives, anti-estrogens (Sprionolactone), GnRH agonists and estrogen

Question 22

Treatment for hirsutism caused by adrenal non-neoplastic causes.

Answer 22

Glucocorticoids

Sprinolactone

Question 23

What is the treatment for PCOS?

Answer 23

Similar to hirsutism, however, if fertility is desired use clomiphene citrate.

If patients are diabetic, metformin can be used.

Clomiphene is a selective estrogen receptor modulator (SERM) that increases production of gonadotropins by inhibiting negative feedback on the hypothalamus.