Obstetrics and Gynecology Board Review Pearls of Wisdom

580 Obstetrics and Gynecology Board Review •••

❍ What is the daily dose of exogenous androgen intake (DHEA) that can cause signs of hyperandrogenism in female?
DHEA in daily dose of 50 to 100 mg taken chronically.

❍ What is premature adrenarche?
The appearance of pubic or axillary hair before age 8 years old in girls and 9 years old in boys, without other signs
of puberty or virilization and without an advance in bone age.

❍ What is the treatment of choice for adrenal tumors?
Surgery.

❍ What is the treatment of choice for adrenal carcinomas?
Surgical exploration followed by chemotherapy.

❍ True or False: Treatment of adrenal hyperandrogenism depends on the diagnosis.
True. Specifically adrenal tumors need surgery and adrenal carcinomas are highly malignant, with cure
uncommon; glucocorticoid resistance should be treated with dexamethasone (a glucocorticoid with no intrinsic
mineralocorticoid activity) and likely an androgen-blocking agent (spironolactone or flutamide); congenital adrenal
hyperplasia (CAH) is treated with a glucocorticoid and usually a mineralocorticoid.

❍ Adrenal sources of hyperandrogenism are best treated with?
Low-dose steroids including dexamethasone (0.25–0.5 mg/day) or prednisone (2.5–5 mg/day). However, used
alone, they are not very effective.

❍ Frequency of Cushing syndrome causes?

Diagnosis

Percentage of

Patients

Cushing disease 68

Ectopic ACTH 12

Ectopic CRH < 1

Adrenal adenoma 10

Adrenal carcinoma 8

Micronodular/macronodular hyperplasia 1

Major depression/alcoholism 1

❍ What are signs of Cushing syndrome?
Menstrual irregularities, progressive central obesity, skin atrophy, easy bruising, purple striae, hyperpigmentation
(due to increased ACTH-usually ectopic production), fungal infections of the skin and nail (tinea versicolor),
psychological changes (emotional lability, agitated depression, mild paranoia, insomnia), hypertension, decreased
glucose tolerance, ophthalmologic findings, and osteoporosis.