OnlineMedEd: Gynecology - "Virilization" Flashcards

1
Q

Explain the difference between hirsutism and virilization.

A
  • Hirsutism: overweight and hairy; caused by mild elevations in androgens
  • Virilization: overweight, hairy, deepened voice, and clitoromegaly; caused by extreme elevations in androgens
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2
Q

Which androgen comes from the ovary?

A

Testosterone

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3
Q

Which androgen comes from the adrenal glands?

A

DHEAS

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4
Q

Those with PCOS will have ________ DHEAS.

A

normal

PCOS occurs secondary to ovarian problems, not adrenal.

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5
Q

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

A

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

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6
Q

Treat PCOS with _______________.

A
  • Exercise and weight loss
  • Metformin
  • OCPs (if she doesn’t want to get pregnant)
  • Clomiphen (is she does)
  • Spironolactone (for anti-androgen effects)
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7
Q

Describe the presentation and workup of Sertoli-Leydig tumors.

A
  • Virilization
  • Extreme elevations in testosterone
  • Normal DHEAS
  • US showing tumor on one ovary
  • Surgery is curative
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8
Q

Extreme elevations in DHEAS are most often secondary to _______________.

A

adrenal tumors

CAH is more mild.

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9
Q

How do you confirm CAH?

A

Urinary 17-OH progesterone

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10
Q

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

A

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.

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11
Q

The “wildcard” of the hirsutism disorders is ____________.

A

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

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