OnlineMedEd: Gynecology - "Virilization"

Question 1

Explain the difference between hirsutism and virilization.

Answer 1

• Hirsutism: overweight and hairy; caused by mild elevations in androgens
• Virilization: overweight, hairy, deepened voice, and clitoromegaly; caused by extreme elevations in androgens

Question 2

Which androgen comes from the ovary?

Answer 2

Testosterone

Question 3

Which androgen comes from the adrenal glands?

Answer 3

DHEAS

Question 4

Those with PCOS will have ________ DHEAS.

Answer 4

normal

PCOS occurs secondary to ovarian problems, not adrenal.

Question 5

A woman comes in with hirsutism. You can diagnose PCOS by _____________.

Answer 5

biochemical or radiological evidence: LH:FSH ratio > 3 or US showing cystic ovaries

Question 6

Treat PCOS with _______________.

Answer 6

• Exercise and weight loss
• Metformin
• OCPs (if she doesn’t want to get pregnant)
• Clomiphen (is she does)
• Spironolactone (for anti-androgen effects)

Question 7

Describe the presentation and workup of Sertoli-Leydig tumors.

Answer 7

• Virilization
• Extreme elevations in testosterone
• Normal DHEAS
• US showing tumor on one ovary
• Surgery is curative

Question 8

Extreme elevations in DHEAS are most often secondary to _______________.

Answer 8

adrenal tumors

CAH is more mild.

Question 9

How do you confirm CAH?

Answer 9

Urinary 17-OH progesterone

Question 10

Paradoxically, giving ______________ can treat the hyper-androgenism of CAH.

Answer 10

cortisol and fludrocortisone

The body wants these. When it can’t make them, it ramps up ACTH and thus ramps up DHEAS. Giving these tamps down ACTH and therefore reduces hirsutism.

Question 11

The “wildcard” of the hirsutism disorders is ____________.

Answer 11

familial hirsutism: a disorder in which all hormones are normal but the girl is hirsute