Hyperandrogenism

Question 1

Hyperandrogenism Source: ADRENALS

Answer 1

Adrenal Tumors (Androgen producing)
Cushing Syndrome
Congenital Adrenal Hyperplasia

Question 2

Adenomas cause glucocorticoid excess

Carcinomas are rapidly progressive –> marked elevations in glucocorticoid, mineralocorticoid and androgen steroids

Answer 2

Adrenal Tumors (Androgen producing)

Question 3

Excess production of CORTISOL

May be caused by pituitary adenoma, ectopic sources of ACTH, tumors of adrenal gland

Answer 3

Cushing Syndrome

Hirsutism
Menstrual Irregularity
Central Obesity
Dorsal Neck Fat Pads
Abdominal Striae
Muscle wasting and weakness

Question 4

Diagnosis of Cushing Syndrome

Answer 4

Overnight Dexamethasone suppression test: (+) if elevated cortisol

24 hr urinary free cortisol

Question 5

Defect in 21 hydroxylase or 11 B hydroxylase (less common)

Accumulation of 17 OH progesterone and androstenedione

Answer 5

Congenital Adrenal Hyperplasia

Question 6

Hyperandrogenism Source: PERIPHERAL

Answer 6

Idiopathic Hirsutism

regular menses with normal androgen levels (DHEAS and testosterone)

Question 7

Hyperandrogenism Source: OVARIES

Answer 7

PCOS
Stromal Hyperplasia and Hyperthecosis
Ovarian neoplasm

Question 8

Management of Hyperandrogenism

Answer 8

Testosterone (unbound)
Free androgen index
DHEAS
17-OH progesterone
Ultrasound, MRI, CT scan

Question 9

Rotterdam criteria for PCOS

Answer 9

Polycystic Ovarian Syndrome (PCOS)/ Stein Leventhal Syndrome

any 2 of the ff

1. menstrual irregularity (anovulation)
2. hyperandrogenism
3. PCOS on ultrasound

Question 10

Menstrual Irregularities in PCOS

Answer 10

Oligomenorrhea (cycles over 35 days)

Menstrual frequency of every few months

Frank amenorrhea (over 6 mos missed)

Question 11

Ultrasound findings of PCOS

Answer 11

(+) 12 or more follicles measuring 2-9 millimeters in diameter

increased ovarian volume greater > 10 cm3

Question 12

Consequences of PCOS

Answer 12

YOUNG AGE

menstrual disorders
hirsutism
contraception
sexual health
infertility

OLDER AGE

pregnancy complications
quality of life
type 2 DM
CVD
cancer risk

Question 13

Treatment of PCOS - INFERTILITY

Answer 13

Letrozole
Clomiphene (+)/(-) Metformin
Gonadotropins
Ovarian drilling

Question 14

Treatment of PCOS - SKIN MANIFESTATIONS

Answer 14

OCP + antiandrogen (Spironolactone, Finasteride)

GnRH agonists

Question 15

Treatment of PCOS - ABNORMAL BLEEDING

Answer 15

Cyclic progestogen

Oral contraceptives

Question 16

Treatment of PCOS - WEIGHT, METABOLIC CONCERNS

Answer 16

Diet/Lifestyle management

Metformin