Hyperandrogenism Flashcards
what is defined as the presence of hair in locations where it is not normally found in women?
hirsutism
what is the definition of virilization?
presence of signs of masculinization in a woman
this is the general increase in the amount of body hair in its normal places for a woman
hypertrichosis
what is the name of the fine hairs found on most parts of the body?
vellus hairs
what is the name of the coarse, darker hairs found in the body?
terminal hairs
what facilitates the conversion of vellus hairs to coarse hair?
androgens
t or f: ovary is responsible for production of DHEA-S while the adrenal glands are responsible for production of testosterone
FALSE!! the ovaries testosterone and adrenals DHEA-S (and DHEA)
t or f: DHEA is converted to testosterone in the peripheral tissues
true
which layer of the adrenal cortex is responsible for production of androgens? cortisol? aldosterone?
ZONA reticularis; fasiculata; glomerulosa
what regulates the production of cortisol? aldosterone? androgens?
aldosterone is regulated by the RAAS; cortisol and androgen production is regulated by ACTH
cortisol, androgens and aldosterone are all derived from what substance?
cholesterol
in the ovaries, LH stimulates theca cells to produce what?
androgens (testosterone)
in the ovaries, FSH stimulates the granulosa cells to do what with the androgens produced by the theca cells?
convert them to estrone and estradiol
what happens to androgen levels when LH levels become disproportionately greater than FSH levels?
androgens become elevated
a pt with signs of hirsutism, regular menses, and normal levels of testosterone most likely has what diagnoses?
idiopathic hirsutism
what is the cause of most idiopathic hirsutism?
increased activity of 5 alpha reductase in the periphery - so treat with anti androgens that blocker peripheral activity of testosterone or inhibit the enzyme 5alpha reductase
a rapid onset of hirsutism and virilization should make you think of what etiology of dz?
tumor (ovarian or adrenal)
this is defined as an adrenal tumor which produces increased levels of cortisol with clinical findings of hirsutism, menstrual irregularity, central obesity, moon face, buffalo hump, abdominal striae, muscle wasting and weakness
cushing syndrome
this is defined as a benign pituitary adenoma which causes an increase in the secretion of ACTH leading to increased cortisol levels
cushing dz
t or f: paraneoplastic syndromes which produce ectopic ACTH account for a percentage of cushing syndromes
TRUE - especially from small cell lung carcinoma
what is the main difference in terms of presentation for adrenal tumors that are adenomas vs. carcinomas?
adenomas tend to only produce an increase in cortisol vs. carcinomas which tend to produce an increase in cortisol AND androgens
a baby with ambiguous genitalia, HYPOtension and elevated 17-hydroxprogesterone most likely has what diagnosis?
21-hydroxylase deficiency
what is the most common cause form of congenital adrenal hyperplasia?
21-hydroxylase deficiency (these pole lack an enzyme that is crucial to both cortisol and mineralcorticoid production)
how does 21-hydroxylase deficiency lead to increased androgen production?
these pole lack an enzyme that is crucial to both cortisol and mineral corticoid production which leads to increased precursors of cortisol that are shunted to androgen production
which congenital adrenal hyperplasia condition is associated with HYPERtension, low cortisol (duh), but increased mineralcorticoids?
11-beta hydroxylase deficiency
what is the most common cause of hirsutism and irregular menses?
PCOS
PCOS is diagnosed by the presence of 2 out of 3 clinical findings - what are they?
multiple cysts on ultrasound; hyperandrogenism; oligo/amenorrhea
what is the relation between GnRH and LH?
increased levels of GnRH increases LH
what is the LH:FSH ratio in PCOS pts?
greater than 3:1
why is there often an increased level of estrone in pts with PCOS?
adipose conversion of androgens
how is the diagnosis of theca lutein cyst made?
ovarian biopsy
a baby with ambiguous genitalia is born to a mother who complains of increased facial hair growth over the last few months of pregnancy - what is the most likely diagnosis?
luteoma of pregnancy - benign tumor that grows in response to hcg; disappears postpartum
what is the treatment of choice for idiopathic hirsutism?
spironolactone (blocks androgen receptors, decreases overal testosterone production and inhibits 5 alpha reductase)
