Hirsutism/Virilization Flashcards
Androgens + Hair physiology
Androgen exposure increases:
- hair shaft diameter
- # follicles in Anagen
- Transition of Vellus hair to terminal hair
- Most potent Androgen?
- How to measure activity?
- DHT
- MEasure via 5-a-reductase indirectly by assay of 3-a-DIOL-G
What is the marker for excess androgen of ovarian origin?
Testosterone
Marker for Adrenal origin of androgens
DHEA-S
Hirsutism
Longer time period
Terminal hair in midline not normally found in female
Virilization
Temporal balding, voice changes, clitoral enlargement, acne, increased muscle mass, decreased breast size
Shorter time period
Virilization/Hirsutism D/D
- Idiopathic
- PCOS
- Hyperthecosis
- Androgen tumors/excess
- Adrenal enzyme deficiencies
- adrenal adenoma/CA
What is a common Diagnostic feature of Idiopathic hirsutism?
Elevated 5-a-reductase
Diagnostic Criteria PCOS
- Oligo or An-ovulation
- Biochemical/clinical evidence of hyperandrogenism
- Polycystic appearing ovaries on US
Clinical feature Hyperthecosis
- similar to PCOS
- Higher androgens
- proncounced insulin resistance
- Unresponsive to Clomiphene
HAIR-AN Syndrome
- HyperAndrogenism
- Insulin Resistance
- Acanthosis Nigricans
- T Levels 100X normal
Pathophysiology of PCOS
Hyperinsulinemia at puberty augments LH stimulation of theca cell growth + androgen prod, + inhibits SHBG
Oligomenorrhea Tx
- OCPs
2. Metformin
Hirsutism Tx
- OCP + spironolactone
2. Metformin + spironolactone
Anovulatory infertility Tx
- Clomiphene or Metformin alone
2. Clomiphene + metformin
