Physiology of androgens

Question 1

With regard to normal androgen physiology in women

Answer 1

• The adrenal medulla makes dehydroepiandrosterone sulfate
• Less than 10% of testosterone is bound to sex hormone binding globulin

Question 2

With regard to androgen action and metabolism

Answer 2

• Androgens are excreted unchanged in the urine

- Testosterone binds to a nuclear receptor

Question 3

With regard to the clinical presentation of hyperandrogenism

Answer 3

• The Ferriman-Gallwey score is useful in objectively assessing the severity of hirsutism
• Deepening voice and breast atrophy are features suggestive of an adrenal tumour

Question 4

Regarding the differential diagnoses of hyperandrogenism

Answer 4

• Ovarian hyperthecosis is a disease of the menopause
• Congenital adrenal hyperplasia is often diagnosed in infancy
• The most common virilising adrenal tumours are the Sertoli-Leydig cell type

Question 5

In cases of hyperandrogenism

Answer 5

• Ovarian hyperthecosis accounts for less than 50% of cases in postmenopausal women
• The non-classic 21-hydroxylase deficiency tends to typically present in childhood
• Luteomas of the ovary are one of the most common causes of gestational hyperandrogenism
• Unilateral solid ovarian lesions as a cause have an increased risk of malignancy when presenting in pregnancy.