578 Obstetrics and Gynecology Board Review •••
❍ Drugs associated with hirsutism include?
Cyclosporine, glucocorticoids, minoxidil, diazoxide, and phenytoin.
❍ True or False: Anabolic steroids used by female athletes may be a cause of hirsutism.
True.
❍ Typical endocrine profiles of athletes engaged in sports such as swimming or rowing differ from those
typical of dancers in what way?
Sports that emphasize strength over leanness such as swimming or rowing have athletes with mildly elevated LH
levels, elevated LH/FSH ratios and mild hyperandrogenism rather than hypoestrogenism from disruption of
GnRH pulsatility, and decrease in LH, causing decrease in ovarian stimulation.
❍ What is the effect of estradiol on hair growth?
Estradiol retards the rate and initiation of growth leading to finer, less pigmented and slower growing hair.
❍ In women with PCOS, most estrogen is derived from?
Extraglandular aromatization of androstenedione to estrone.
❍ Long-standing amenorrhea associated with PCOS may predispose to?
Endometrial hyperplasia and more rarely atypia and carcinoma.
❍ What are some theories driving the PCOS picture with increased ovarian androgen production?
Increased volume of theca cells, increased LH stimulation of theca cells, potentiation of the action of LH by
hyperinsulinemia, different biological activity of the beta-subunits of LH, increased LH receptor expression on
thecal cells of patients with PCOS, decreased FSH secretion resulting in decreased aromatase activity leading to
decreased potential estrogen production and increased androgen production as a result, and genetic predisposition.
❍ What is the relationship between hyperinsulinemia and hyperandrogenism?
Insulin amplifies androgen production and both insulin and IGF-1 can enhance the ovarian androgen response to
gonadotropin stimulation. Insulin also inhibits hepatic synthesis of SHBG and inhibits hepatic production of
IGF-binding protein 1 (IGF-BP-1).
❍ What are the three phases of hair growth?
Telogen (resting phase), anagen (active), and catagen (period of regression).
❍ What are the ovarian sources of hyperandrogenism?
PCOS, stromal hyperthecosis, and tumors.
❍ Virilizing tumors of the ovary include?
Sertoli-Leydig, lipoid cell, sex cord tumor with annular tubules (SCTAT), thecoma, and Gynandroblastoma (rare
tumor producing both ovarian and testicular cells or tissues).