Master the board step 3

Gynecology
Idiopathic Hirsutism
This is the diagnosis when there is no virilization and all laboratory tests are
normal. It is the most common cause of hirsutism.
Treatment
··
Spironolactone is the treatment of choice.
··
Eflornithine (Vaniqa) is the first-line topical drug for the treatment of
unwanted facial and chin hair.
Diagnosis Testosterone DHEAS LH/FSH 17-OHP
Next Step in
Management
Produced by
ovary &
adrenal gland
Produced
by
adrenal
glands
Produced
by the
anterior
pituitary
gland
Precursor in
cortisol
synthesis &
converted
peripherally to
androgens
Polycystic ovary
syndrome
↑ NL /↑ ↑LH
↓FSH
NL
Ultrasound to rule out
other disorders/tumors
Screen lipids and fasting
blood glucose
Congenital
adrenal
hyperplasia
NL/↑ NL /↑ NL/NL ↑↑ ACTH stimulation
confirms the diagnosis
Ovarian tumor ↑↑ NL NL/NL NL Ultrasound/CT to image
tumor
Adrenal tumor ↑ ↑↑ NL/NL NL Ultrasound/CT to image
tumor
Menopause Disorders
··
Menopause is defined as 12 months of amenorrhea with elevation of FSH
and LH. The mean age is 51 years. Smokers experience menopause up to 2
years earlier.
··
Diagnose with serial levels of elevated gonadotropins (FSH > 50 IU/mL).
··
If menopause occurs between ages 40 and 50, it is early menopause. It is
most often idiopathic but can also occur after radiation therapy or surgical
oophorectomy.
· · If menopause occurs before age 30, it is premature ovarian failure and may
be associated with autoimmune disease or Y chromosome mosaicism.
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