A 20 year average weight old female complains of Oligomenorrhea along with facial hair. Preliminary investigation reveal raised free testosterone levels. Which of the following could be likely etiology aEUR’
Correct Answer: Adrenal hyperplasia
Description: Adrenal hyperplasia [Ret Shaws text book of Gynae 14/e p. 102-103; Harrison 17/e p. 3011 Hirsutism is defined as presence of excessive terminal hair in androgen dependent areas of woman's body. - The disorder is a sign of increased androgen action on hair follicles. Polycystic ovarian disorder is the most common cause of hirsutism. - PCOS is characterized by chronic anovulation and hyperandro- genemia (increased testosterone). - Patients often repo menstrual irregularities, infeility obesity and symptoms associated with androgen excess. - Polycystic ovarian syndrome can be ruled out in this patient because of normal ultrasound. - Ultrasound examination in polycystic ovarian disease will reveal presence of 12 or more .follicles in each ovary measuring 2-9 mm in diameter. Androgen secreting tumours of ovary may also present with hirsutism -Androgen secreting tumours of the ovary are usually heralded by virilisation (i.e., development of male characteristics in women) and rapid progression of hirsutism and cessation of menses. - Signs of virilizations are : - Acne, clitoromegaly, deepening of voice, Hirsutism, increased libido. - Normal ultrasound rules out ovarian tumours is this case. Idiopathic hirsutism It is also called end organ hirsutism. Occurs in small propoion of women with hirsutism. Niether a familial form nor any detectable hormonal abnormality usually is diagnosed. These patients have normal menses, normal sized ovaries no evidence of adrenal or ovarian tumour dysfunction and normal plasma level of serum testosterone, 17 a OHP and DHEAS. It is thought to be related to disorders in peripheral androgen activity. Adrenal cause of Hirsutism Congenital adrenal hyperplasia in children may cause hirsutism along with classical features of CAH. Late onset congenital adrenal hyperplasia usually occurs as an incomplete version of congenital adrenal hyperplasia and affects approximately 1-5% of women who are hyperandrogenic. Late onset CAH is an inherited disorder of adrenal steroidogenensis with decreased coisol L production resulting in overproduction of androgenic steroids (testosterone). These patient present in adolescence or adult age with menstrual irregularities and Hirsutism.
Category:
Gynaecology & Obstetrics
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