••• Chapter 58^ Hyperandrogenism^583
❍ Which chromosome is the gene for the androgen receptor located on?
The X chromosome. Defects may result in incomplete masculinization of males.
❍ According to the Rotterdam criteria, the diagnosis of PCOS requires the presence of?
Any 2 of the following three criteria: (1) Oligomenorrhea and/or anovulation, (2) clinical or biochemical signs of
hyperandrogenism (free testosterone is most sensitive), (3) polycystic ovaries by U/S [2 or more follicles in each
ovary, 2–9 mm in diameter; and/ or >10 mL ovarian volume per ovary (0.5 × length × width × thickness)]; note:
other etiologies must be excluded (CAH, androgen-secreting tumor, Cushing syndrome, etc).
❍ Measurement of what hormone could be used to replace ultrasound or other imaging that show polycystic
ovaries while still satisfying the third Rotterdam criteria?
Anti-Müllerian hormone (AMH) correlates with the number of antral follicles and has been shown to be elevated
in both adolescents and adults with PCOS as well as adolescents with oligomenorrhea without evidence of
hyperandrogenism.
❍ Which criteria are not needed in the NIH definition of PCOS?
Polycystic ovaries by US. Must have the first two criteria of the Rotterdam definition.
❍ What percentage of normal women meet ultrasonographic criteria for polycystic ovaries?
8% to 25%.
❍ What are the definitions of amenorrhea and oligomenorrhea?
Amenorrhea is no menstrual periods for 3 consecutive months or more.
Oligomenorrhea is <9 menstrual periods per year.
❍ Define hirsutism.
Excess terminal, thick pigmented, body hair in a male distribution; commonly on upper lip, chin, periareolar area,
and midsternum, along the linea alba of the lower abdomen.
❍ What is idiopathic hirsutism?
Hirsute women with regular menstrual cycles and normal serum androgen levels. The most logical explanation is
an increased sensitivity to androgens mediated by increased peripheral 5a-reductase activity.
❍ What percentage of women with PCOS have hirsutism?
Roughly 70% but its prevalence depends on race/ethnicity.
❍ Do Asian women with PCOS typically have hirsutism? Why or why not?
No. The concentration of hair follicles differs between races and ethnic groups. Asian and Native American women
generally have little body hair. This probably also reflects racial and ethnic differences in local levels of 5a-reductase
activity.
❍ What lipid abnormalities are typically found in patients with PCOS?
Decreased high-density lipoprotein (HDL) cholesterol and increased triglycerides.