Hyperandrogenism and PCOS Flashcards
glandular source of androgen
ovaries
adreanal glands
non glandular source of androgen
not necessarily produce but convert:
Skin
Fat celss
Main form of androgen and their site of production:
Ovaries
testosterone
Main form of androgen and their site of production:
adrenals
DHEAS
Main form of androgen and their site of production:
peripheral tissues
3a diol G
differentiate Bilogically inactive form vs biologically active form of testosterone
Bio inactive - bound to SHBG
Bio active - free/ bound to albumin
among the types of testosterone w/c one is used to assess hyperandrogenism
Bio active form
potent form of testosterone that causes effects to the target tissues
3 a diol G
occurs in women where there is increase in androgen lvls or excess
hyperandrogenism
manifestations of hyperandrogenism
hirsutism alopecia acne voice deepening amenorrhea
abnormalities in the sebaceous component would lead to
acne
abnormalities in the piliary component would lead to
hirsutism (excessive growth)
alopecia (excessive shedding)
3 phases of hair growth
anagen
catagen
telogen
treatment for hirsutism
oral contraceptives progestins GnRH agonist Ketoconazole spironolactone (anti-estrogen)
increased amt of body hair in its normal location
hypertrichosis
differentiate virilization from hirsutism in terms of testosterone lvls
hirustism - testosterone is mildly increased (<1.5)
viriliztion >2ng/ml
most common cause of hyperandrogenism
androgenic medications
examples of androgenic medications
testosterone
anabolic steroids
danazol
19-norprogestogens
abnormal gonadal development can be attributed to a defect in the
Y chromosome (whole or part)
solid ovarian tumor, usually unilateral that causes hyperandrogenism
luteoma
cystic tumor usually bilateral that causes hyperandrogenism
hyperreactio luteinalis
px 37 wk AOG undergo CS. solid ovarian luteoma was seen intraop. what will you do?
If unruptured, do not remove, it will usually regress to normal
the main problem in idiopathic hirsutism
increased 5 a reductase thereby increasing androgen production
histollogy of the ovary shows nest of luteinized theca cells scattered throughout the stroma
stromal hyperthecosis
mgt for stromal hyperthecosis
TAHBSO
ovarian tumor of reproductive age
sertoli-leydig cell tumors
ovarian neoplasm commonly on postmenopauseal
hilus cell tumors
most common adrenal neoplasm
adrenal carcinoma
forms of late onset 21 hydroxylase deficiency
CAH
LOHD
most common cause of sexual ambiguity
CAH
symptoms of LOHD
post pubertal oligomenorrhea/amenorrhea
prepubertal accelerated growth
familial tendency
diagnosis of LOHD
17-hydroxyprogesterone lvl >8ng/L
ACTH stimulation test above normal but <8ng/L
treatment for LOHD
corticosteroids
OCP
CAH is deficient with these enzymes
21-hydroxylase
11B hydroxylase
excessive cortisol production from adrenal neoplasm or excessive ACTH production from a pituitary tumor
Cushing’s disease
diagnosis for cushing’s
dexamethasone suppresion test Liddle's test plasma ACTH 24 hr urinary cortisol late night salivary cortisol
treatment for cushing’s
OCP ( cyproterone acetate)
anti-androgens (spironolactone, flutamide and finasteride)
most common endocinopathy in women
PCOS
triad of PCOS
oligo and/or anovulation/menstrual irregularty
clinical and/or biochem signs of hyperandrogenism
PCOS on UTZ
UTZ findings in PCOS
10 or more peripherally oriented cystic structures showing as black pearl necklace
increase in LH will increase androstenedione, more peripheral conversion into estrogen form (estrone) by
aromatase
type of CA that will put px with elevated LH at risk
endometrial cancer
how can decreased SHBG lead to anovulation and hirsutism
dec SHB means increase in free testosterone leading to atresia of follicles leading to anovulation and hirsutism
consequences of PCOS
infertility endomet CA ovarian CA DM HPN and CVD metabolic syndrome (high chol and trigly lvl)
best approach to improve peripheral insulin sensitivity
metformin (insulin sensitizing agent)
drugs for induction of ovulation
clomiphene citrate aromatase inhibitors (letrozole and anastrazole) injectable gonadotropin
px with pcos given Clomiphene citrate but ineffective. what is the 2nd line treatment?
aromatase inhibitors (letrozole and anastrazole)
what would u give to px with pcos who do not want to get pregnant but want to menstruate
medroxyprogesterone acetate
norethindorne
these drugs suppresses ovarian steroidogenesis and is usesd to improve signs of hirsutism and lipid profile
Estrogen-progestin OCP
last option for the treatment of metabolic and weight concerns in px with pcos
bariatric surgery
