Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCOG Gynaecology Part 2 Revision - Hay > Hyper-androgenism, hirsutism, PCOS > Flashcards

Hyper-androgenism, hirsutism, PCOS Flashcards

1
Q

Which androgens does the ovary produce?

A

Testosterone, androstenedione and dehydroepiandrostendione (DHEA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which androgens does the adrenal gland produce?

A

Dehydroepiamdrpsterone sulphate (DHEA-S) with androstendione and DHEA

(Very little testosterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Do androstenedione and DHEA have androgenic activity?

A

No, converted to testosterone in peripheral tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What % testosterone produced from ovaries?

A

2/3, normally overproduction caused by increased ovarian function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of testosterone is bound? To which molecules?

A

85% sex hormone binding globulin - inactive
10-15% albumin - active
1-2% free - active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which hormone converts testosterone to its active form dihydrotestosterone?

A

5 alpha reductase, increase in hormone → androgen excess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List causes of hyper androgenism

A

1) Exogenous - testosterone/anabolic steroids/danazol/androgenic steroids

2) Ovarian - PCOS/stromal hyperthecosis, ovarian tumours (sertoli, hilus cell, krenkenburg)

3) Adrenal - tumour, cushings, adult onset adrenal hyperplasia

4) Androgen excess in pregnancy

5) Idiopathic hirsutism - increased 5-a reductase

6) Abnormal gonadal/sexual development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If rapidly progressive hirsutism and virilisation, what should be the concern?

A

Androgen secreting tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What questions should be asked in history for high androgen?

A

Note timing of onset and rate of progression - puberty / pregnancy; rapid progression suggestive of adrenal / ovarian tumour

History of virilisation - reduction in breast size, deepening of voice, clitoral enlargement, change in physique, male pattern baldness, hair-loss
Hirsutism - onset, progression, psychological impact

Mood change - change in libido, aggression

Other symptoms - menstrual irregularity, acne, infertility
Exclude iatrogenic, exogenous androgens

Family history - late onset congenital adrenal hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should be assessed for in clinical examination for hyper-androgenism?

A

BP - hypertension

Hirsutism - grade using the Ferriman-Gallway system

Acanthosis nigricans

Identify signs of virilisation and exclude abnormalities of the external genitalia

Identify signs of Cushing’s syndrome - plethora, moon face, increased pigmentation, central obesity, hypertension, striae, proximal muscle wasting, glycosuria

Abdominal and pelvic examination for abdomino-pelvic mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

During Ix for hyper-androgenism, which androgens suggest which source?

A

Source of androgen
High testostone = ovarian
Very high testosterone= tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is suspecting Cushing syndrome, what test to order?

A

Overnight dexamethasone suppression test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

For Late onset CAH what test.

A

ACTH stimulation test, increase 17 hydroxyprogesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What imaging should be ordered to Ix hyper-androgenism?

A

Pelvic USS - ?PCO or tumour
Abdominal CT/MRI - adrenal tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Any other test for hyper-androgenism?

A

Consider SHBG, androstenedione, free adrogen index
If virilisation → karyotype
Consider lipids, OGTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the treatment for late onset CAH

A

Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is manamgnet for stromal hyperthecosis?

A

TAH + BSO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Who does ovarian hyperthecosis present in?

A

Postmenopasual women
Severe hyperandrogenism and insulin resistence (T2DM, CVD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which cancer do you need to consider in patients with ovarian hyperthecosis?

A

Endometrial cancer, testosterone is converted into oestrogen, risk endometrial hyperplasia, carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What would be seen in investigations for ovarian hyperthecosis?

A

High levels androstenedione
DHEA-S normal
USS: BL enlarged ovariaes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Definition of hirsutism

A

Terminal hair on body of women in same pattern/sequence seen in post pubertal male

22
Q

Causes of hirsutism?

A

1) Exogenous / iatrogenic androgens - testosterone, anabolic steroids, androgenic progestogens, danazol

2) Increased ovarian androgens - Polycystic ovary syndrome / stromal hyperthecosis / ovarian tumours (Sertoli-Leydig cell tumours, Hilus cell tumours

3) Adrenal - tumours, Cushing’s syndrome, adult onset congenital adrenal hyperplasia

4) Androgen excess in pregnancy - luteoma

5) Idiopathic hirsutism - due to increased 5-alpha reductase activity in pilosebaceous unit

6) Abnormal gonadal / sexual development

7) Drugs - phenytoin, cortisone, minoxidil, diazoxide, cyclosporin A - alter the texture and extent of hair growth the pattern is non-androgenic and is referred to as hypertrichosis.

23
Q

What grading system if used to score hirsutism?

A

Ferriman-Gallway grading system
0 (no terminal hair)
4 score at 11 sites

24
Q

How does weight loss help treat hirsutism?

A

Reduced peripheral conversion androstenedione to testosterone

25
Q

What physical methods can be used to treat hirsutism?

A

Bleaching
Shaving
Electolysis

26
Q

What pharmacological methods can be used to treat hirsutism?

A

COCP
Medroxyprogesterone
Spironolactone
Flutamide - non steroid anti-androgen, check LFT
Finasteride - 5 alpha reductase inhibitor - needs effective contraception
Ketoconazole

27
Q

Topical treatment for hirsutism?

A

Elfornithine hydrochloride (VANIQA) - improvement not seen until 4-8 weeks, can be used on face

28
Q

What is the Rotterdam Criteria for the Dx of PCOS?

A

Must 2 of the following + exclusion of other causes:

1) PCO - >12 peripheral follicles or >10 cubic cm ovarian volume

2) Oligo-anovulation

3) Clinical/biochemical hyperandrogegism

29
Q

What baseline bloods would you order for ?PCOS

A

TFT
Prolactin
Free androgen index

If clinical hyperandrogegism:

Total testosterone
17-hydroxyprogesterone

30
Q

What is the free androgen index?

A

(Total testosterone/SHBG) x 100

31
Q

How common is PCOS

A

Most common female endocrine abnormality
6-7% reproductive years

32
Q

How common is PCO?

A

16-33% asymptomatic women

33
Q

Biochemical changes PCOS
What would you see in androgens?

A

Raised, testosterone and androstenedione (ovarian hyper secretion)
50% also have raised DHEA-s (adrenal androgen)

34
Q

Biochemical changes PCOS
What would you see in oestrogens?

A

Increased free estradiol/oestrone (peripheral conversion from androstenedione)

35
Q

Biochemical changes PCOS
What would you see in SHBG?

A

Decreased SHBG, less production in the liver, increased biologically active androgens/oestrdiol

36
Q

Biochemical changes PCOS
What would you see in prolactin?

A

Mildly raised

37
Q

Risk of adult onset diabetes by age 40 with PCOS?

A

40%

38
Q

Management of PCOS

A

Weight loss

COCP (Low androgen progesterone or cryproterone) or Medroxyprogesterone

BP/GDM/Cholesterol controll

39
Q

If PCOS resistant to clomiphene indiction, what are the options?

A

GnRH therapy
Lap Ovarian drilling

40
Q

How common is normalisation of serum androgens and SHBG after Lap ovarian drilling?

A

60% for up to 20 years

41
Q

What skin condition can arise due to diabetes in PCOS?

A

Acanthosis nigricans

42
Q

How to treat mild acne?

A

treat with topical agents such as azaleic acid, benzoyl peroxide, retinoids (contraception required) or antibacterial agents such as clindamycin 1% or erythromycin 2%.

43
Q

How to treat severe acne?

A

Consider COCP (use one with non-androgenic progestogen / cyproterone acetate)

Isotrentinion

44
Q

How long before starting isotrentinion should contraception be started?

A

1 month before strarting and 1 week after

45
Q

At what level of free testosterone should you consider androgen secreting tumour?

A

> 5 or 2 x upper range

46
Q

What is the definition of metabolic syndrome?

A

3 of the 5 following criteria:

1) Abdominal obesity
2) Hypertriglyceridemia
3) Low HDL cholesterol
4) Hypertension
5) High fasting gluovse

47
Q

What os the most important risk actors for metabolic syndrome?

A

BMI
RR 1.89 per 4.7 kg

48
Q

treatment for metabolic syndrome?

A

Increased exercise
Weight loss
Healthy diet
Treating hypertension / hypercholesterolaemia
Treating type II diabetes

49
Q

What medical treatment for anovulatory infertility due to PCOS?

A

Clomifene citrate 50mg OD, 5 days from early menstrual cycle
USS monitoring
Max 6 months

or

Metformin
USS not required
GI upset

or

Letrozole

50
Q

What are second line treatments of anovulatory infertility due to PCOS?

A

Laproscopic ovarian drilling
or
Gonadotrophin ovulation induction, S/C injections 10-20 days per cycle

51
Q

What are third line treatments of anovulatory infertility due to PCOS?

A

IVF

52
Q
A

MRCOG Gynaecology Part 2 Revision - Hay (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions