Hyperandrogenism

Question 1

what is defined as the presence of hair in locations where it is not normally found in women?

Answer 1

hirsutism

Question 2

what is the definition of virilization?

Answer 2

presence of signs of masculinization in a woman

Question 3

this is the general increase in the amount of body hair in its normal places for a woman

Answer 3

hypertrichosis

Question 4

what is the name of the fine hairs found on most parts of the body?

Answer 4

vellus hairs

Question 5

what is the name of the coarse, darker hairs found in the body?

Answer 5

terminal hairs

Question 6

what facilitates the conversion of vellus hairs to coarse hair?

Answer 6

androgens

Question 7

t or f: ovary is responsible for production of DHEA-S while the adrenal glands are responsible for production of testosterone

Answer 7

FALSE!! the ovaries testosterone and adrenals DHEA-S (and DHEA)

Question 8

t or f: DHEA is converted to testosterone in the peripheral tissues

Answer 8

true

Question 9

which layer of the adrenal cortex is responsible for production of androgens? cortisol? aldosterone?

Answer 9

ZONA reticularis; fasiculata; glomerulosa

Question 10

what regulates the production of cortisol? aldosterone? androgens?

Answer 10

aldosterone is regulated by the RAAS; cortisol and androgen production is regulated by ACTH

Question 11

cortisol, androgens and aldosterone are all derived from what substance?

Answer 11

cholesterol

Question 12

in the ovaries, LH stimulates theca cells to produce what?

Answer 12

androgens (testosterone)

Question 13

in the ovaries, FSH stimulates the granulosa cells to do what with the androgens produced by the theca cells?

Answer 13

convert them to estrone and estradiol

Question 14

what happens to androgen levels when LH levels become disproportionately greater than FSH levels?

Answer 14

androgens become elevated

Question 15

a pt with signs of hirsutism, regular menses, and normal levels of testosterone most likely has what diagnoses?

Answer 15

idiopathic hirsutism

Question 16

what is the cause of most idiopathic hirsutism?

Answer 16

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

Question 17

a rapid onset of hirsutism and virilization should make you think of what etiology of dz?

Answer 17

tumor (ovarian or adrenal)

Question 18

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

Answer 18

cushing syndrome

Question 19

this is defined as a benign pituitary adenoma which causes an increase in the secretion of ACTH leading to increased cortisol levels

Answer 19

cushing dz

Question 20

t or f: paraneoplastic syndromes which produce ectopic ACTH account for a percentage of cushing syndromes

Answer 20

TRUE - especially from small cell lung carcinoma

Question 21

what is the main difference in terms of presentation for adrenal tumors that are adenomas vs. carcinomas?

Answer 21

adenomas tend to only produce an increase in cortisol vs. carcinomas which tend to produce an increase in cortisol AND androgens

Question 22

a baby with ambiguous genitalia, HYPOtension and elevated 17-hydroxprogesterone most likely has what diagnosis?

Answer 22

21-hydroxylase deficiency

Question 23

what is the most common cause form of congenital adrenal hyperplasia?

Answer 23

21-hydroxylase deficiency (these pole lack an enzyme that is crucial to both cortisol and mineralcorticoid production)

Question 24

how does 21-hydroxylase deficiency lead to increased androgen production?

Answer 24

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

Question 25

which congenital adrenal hyperplasia condition is associated with HYPERtension, low cortisol (duh), but increased mineralcorticoids?

Answer 25

11-beta hydroxylase deficiency

Question 26

what is the most common cause of hirsutism and irregular menses?

Answer 26

PCOS

Question 27

PCOS is diagnosed by the presence of 2 out of 3 clinical findings - what are they?

Answer 27

multiple cysts on ultrasound; hyperandrogenism; oligo/amenorrhea

Question 28

what is the relation between GnRH and LH?

Answer 28

increased levels of GnRH increases LH

Question 29

what is the LH:FSH ratio in PCOS pts?

Answer 29

greater than 3:1

Question 30

why is there often an increased level of estrone in pts with PCOS?

Answer 30

adipose conversion of androgens

Question 31

how is the diagnosis of theca lutein cyst made?

Answer 31

ovarian biopsy

Question 32

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?

Answer 32

luteoma of pregnancy - benign tumor that grows in response to hcg; disappears postpartum

Question 33

what is the treatment of choice for idiopathic hirsutism?

Answer 33

spironolactone (blocks androgen receptors, decreases overal testosterone production and inhibits 5 alpha reductase)