PCOS

Question 1

most common clinical presentation of hyperandrogenism?

Answer 1

hirsutism or acne

Question 2

what are the adrenal causes of hyperandrogenism?

Answer 2

cushing
adrenal carcinoma
cong adrenal hyperplasia

Question 3

what are the ovarian causes of hyperandrogenism?

Answer 3

pcos
hypertrichosis(severe variant of pcos)
ovarian tumor(sertoli-leydig tumor)

Question 4

virilism can be seen more in which disease?

Answer 4

cushing

Question 5

**why is virilism dangerous sign?

Answer 5

risk for ovarian or adrenal cancer

Question 6

what is virilism?

Answer 6

condition in which women develop male** pattern hair and other physical activity growth such as deepening of voice, cliteromegaly, breast atrophy, amenorrhea
which is a result of adrenal or ovarian tumor

Question 7

what is the condition that is known as the severe form of andregonism and is characterized by excessive terminal hair growth in androgen dep areas of women’s**(not man like in virilism) body

Answer 7

hirsutism

Question 8

what condition is characterized by growth of non-pigmented hair and is not related to excessive androgen secretion?

Answer 8

hypertrichosis

Question 9

most common cause of hyperandrogenism?

Answer 9

PCOS

Question 10

etiology of hirsutism?

Answer 10

“CHHIICA with PCOS”
PCOS
Cong adrenal hyperplasia
Hyperprolactinemia
Hypo/Hyperthyroidism
Idiopathic hirsutism
Idiopathic hyperandrogenemia
Acromegaly

Question 11

which system of scoring is used for dx of hirsutism?

Answer 11

Ferriman-gallwey >or equal to 8

Question 12

***which criteria is used to dx PCOS?

Answer 12

Rotterdam criteria(must have at least 2/3)
1-hyperandrogenism
2-mestrual irregulations: olig-ovulation, anovulation…: <9cycles per year
3-polycystic ovaries on u/s

Question 13

pathophysiology of PCOS?

Answer 13

1-insulin resistance and hyperinsulinemia, which lead to inc in LH and slight dec in FSH
2-environmental and genetic factors

Question 14

**tx for pcos/hyperandrogenism?

Answer 14

-menstruation irregulation: OCS(supresses FSH and LH)

-Insulin res: metformin, diet, exercise

-hirsutism: OCS

+ antiandrogens(tx for hyperandrogenism)
OCS contraindications: pts with high INR/PTT , smokers, obese; instead give antiandrogens

Question 15

what is the most common adrenal cause of hyperandrogenism?

Answer 15

CAH cong adrenal hyperplasia

Question 16

**what are the most common enzymal deficiencies in CAH?

Answer 16

21 hydroxylase (90%)
11 hydroxylase (5%)

Question 17

pathophysiology of 21 hydroxylase deficiency?

Answer 17

-dec cortisol
-dec aldosterone (bcz 21 is used to catalyze the hydroxylation of 17 hydroxyprogesterone to 11 deoxycortisol in glucocorticoid path to form cortisol and aldosterone)
-inc 17 hydroxyprogesterone substrate
-high testosterone

Question 18

symptoms of 21 hydoxylase deficiency?

Answer 18

-hypotension->increased renin(compensation)
-hyperkalemia
-met acidosis
-female pseudohermaphroditism(accumulation of 17-hydroxyprog–>DHEA –>testosterone)

Question 19

how to diagnose CAH?

Answer 19

measuring early morning basal 17-hydroxyprogesterone levels, if >1000ng/dl–> diagnostic for 21-hydroxylase deficiency caused CAH

what if levels are between 200 and 1000?–> measure ACTH to check for aldosterone and cortisol are low